Preconditioning with selective autoretroperfusion: In vivo and in silico evidence of washout hypothesis.

Introduction: Prompt reperfusion of coronary artery after acute myocardial infarction (AMI) is crucial for minimizing heart injury. The myocardium, however, may experience additional injury due to the flow restoration itself (reperfusion injury, RI). The purpose of this study was to demonstrate that short preconditioning (10 min) with selective autoretroperfusion (SARP) ameliorates RI, based on a washout hypothesis. Methods: AMI was induced in 23 pigs (3 groups) by occluding the left anterior descending (LAD) artery. In SARP-b (SARP balloon inflated) and SARP-nb (SARP balloon deflated) groups, arterial blood was retroperfused for 10 min via the great cardiac vein before releasing the arterial occlusion. A mathematical model of coronary circulation was used to simulate the SARP process and evaluate the potential washout effect. Results: SARP restored left ventricular function during LAD occlusion. Ejection fraction in the SARP-b group returned to baseline levels, compared to SARP-nb and control groups. Infarct area was significantly larger in the control group than in the SARP-b and SARP-nb groups. End-systolic wall thickness was preserved in the SARP-b compared to the SARP-nb and control groups. Analyte values (pH, lactate, glucose, and others), measured every 2 min during retroperfusion, suggest a "washout" effect as one important mechanism of action of SARP in reducing infarct size. With SARP, the values progressively approached baseline levels. The mathematical model also confirmed a possible washout effect of tracers. Discussion: RI can be ameliorated by delaying restoration of arterial flow for a brief period of time while pretreating the infarction with SARP to restore homeostasis via a washout mechanism.

Physical manifestations of stress in women. Correlations between temporomandibular and pelvic floor disorders.

INTRODUCTION: Stress is characterized as a challenging occurrence that triggers a physiological and/or behavioral allostatic response, alongside the demands typically encountered throughout the natural course of life. A sustained state of stress gives rise to secondary effects, including insomnia and neck pain. Also, the risk of musculoskeletal problems in the cervical and lumbar spine can be increased due to a sustained state of stress. The present study main objective is to study the association between orofacial and pelvic floor muscles in women in Spain. METHODOLOGY: An observational, cross-sectional, retrospective analytical study was designed and carried out in the laboratories of the European University of Madrid. Sixty-five participants were recruited with a mean age of 29.9 ± 7.69. Measurements were taken by myotonometry on natural oscillation frequency (Hz), dynamic stiffness (N/m), elasticity (N/m2), mechanical stress relaxation time (ms) and creep, for the following muscles: right and left masseter, right and left temporalis and central fibrous nucleus of the perineum (CFPF). On the other hand, the subjects completed the following questionnaires: perceived stress scale (PSS-14), anxiety scale (STAI), self-reported bruxism questionnaire (CBA), Fonseca Anamnestic Index and the Pittsburgh Sleep Quality Scale (PSQI). RESULTS: Significant correlations were found in several parameters between the right temporalis and CFPF (p<0.05). Highlighting the correlation between TMDs and lubrication r = -0.254 (p = 0.041) and bruxism with pain in sexual intercourse r = 0.261 (p = 0.036). CONCLUSION: The results support the proposed hypothesis. To the author's knowledge, this is the first study which relates both locations, and it is suggested to continue with the research and expand the knowledge of it.

Performance assessment of an electrostatic filter-diverter stent cerebrovascular protection device. Is it possible not to use anticoagulants in atrial fibrilation elderly patients?

Stroke is the second leading cause of death worldwide. Nearly two-thirds of strokes are produced by cardioembolisms, and half of cardioembolic strokes are triggered by Atrial Fibrillation (AF), the most common type of arrhythmia. A more recent cause of cardioembolisms is Transcatheter Aortic Valve Replacements (TAVRs), which may onset post-procedural adverse events such as stroke and Silent Brain Infarcts (SBIs), for which no definitive treatment exists, and which will only get worse as TAVRs are implanted in younger and lower risk patients. It is well known that some specific characteristics of elderly patients may lower the safety and efficacy of anticoagulation therapy, making it a real urgency to find alternative therapies. We propose a device consisting of a strut structure placed at the base of the treated artery to model the potential risk of cerebral embolisms caused by dislodged debris of varying sizes. This work analyzes a design based on a patented medical device, intended to block cardioembolisms from entering the cerebrovascular system, with a particular focus on AF, and potentially TAVR patients. The study has been carried out in two stages. Both of them based on computational fluid dynamics (CFD) coupled with Lagrangian particle tracking method. The first stage of the work evaluates a variety of strut thicknesses and inter-strut spacings, contrasting with the device-free baseline geometry. The analysis is carried out by imposing flowrate waveforms characteristic of both healthy and AF patients. Boundary conditions are calibrated to reproduce physiological flowrates and pressures in a patient's aortic arch. In the second stage, the optimal geometric design from the first stage was employed, with the addition of lateral struts to prevent the filtration of particles and electronegatively charged strut surfaces, studying the effect of electrical forces on the clots if they are considered charged. Flowrate boundary conditions were used to emulate both healthy and AF conditions. Results from numerical simulations coming form the first stage indicate that the device blocks particles of sizes larger than the inter-strut spacing. It was found that lateral strut space had the highest impact on efficacy. Based on the results of the second stage, deploying the electronegatively charged device in all three aortic arch arteries, the number of particles entering these arteries was reduced on average by 62.6% and 51.2%, for the healthy and diseased models respectively, matching or surpassing current oral anticoagulant efficacy. In conclusion, the device demonstrated a two-fold mechanism for filtering emboli: while the smallest particles are deflected by electrostatic repulsion, avoiding microembolisms, which could lead to cognitive impairment, the largest ones are mechanically filtered since they cannot fit in between the struts, effectively blocking the full range of particle sizes analyzed in this study. The device presented in this manuscript offers an anticoagulant-free method to prevent stroke and SBIs, imperative given the growing population of AF and elderly patients.

Pre-arterialization of coronary veins prior to retroperfusion of ischemic myocardium: percutaneous closure device.

Background: Chronic coronary retroperfusion to treat myocardial ischemia has previously failed due to edema and hemorrhage of coronary veins suddenly exposed to arterial pressures. The objective of this study was to selectively adapt the coronary veins to become arterialized prior to coronary venous retroperfusion to avoid vascular edema and hemorrhage. Methods and results: In 32 animals (Group I = 19 and Group II = 13), the left anterior descending (LAD) artery was occluded using an ameroid occlusion model. In Group I, the great cardiac vein was blocked with suture ligation (Group IA = 11) or with occlusion device (Group IB = 8) to arterialize the venous system within 2 weeks at intermediate pressure (between arterial and venous levels) before a coronary venous bypass graft (CVBG) was implemented through a left internal mammary artery (LIMA) anastomosis. Group II only received the LAD artery occlusion and served as control. Serial echocardiograms showed recovery of left ventricular (LV) function with this adaptation-arterialization approach, with an increase in ejection fraction (EF) in Group I from 38% ± 5% after coronary occlusion to 53% ± 7% eight weeks after CVBG, whereas in Group II the EF never recovered (41% ± 2%-33% ± 7%). The remodeling of the venous system not only allowed restoration of myocardial function when CVBG was implemented but possibly promoted a novel form of "collateralization" between the native arterioles and the newly arterialized venules, which revascularized the ischemic myocardium. Conclusions: These findings form a potential rationale for a venous arterialization-revascularization treatment for the refractory angina and the "no-option" patients using a hybrid percutaneous (closure device for arterialization)/surgical approach (CVBG) to revascularize the myocardium.

Association between RNAm-Based COVID-19 Vaccines and Permanency of Menstrual Cycle Alterations in Spanish Women: A Cross-Sectional Study.

Introduction: The purpose of this study was to delve more deeply into the medium and long-term relation between mRNA-based vaccines and changes in menstrual pain, cycle length, and amount of bleeding in Spanish women. Material and Methods: A total of 746 women (63% between 18−30 and 37% between 31−45 years old) participated in the study. A numerical rating scale was used for recording pain intensity, a pictorial chart for menstrual bleeding, and data from menstrual cycle duration, type of vaccine, number of doses and time from vaccination. Results: Sixty-five per cent of the women perceived changes in their menstrual cycle after receiving the vaccines, irrespective of type of vaccine or number of doses; all p values were >0.05. Most of them (n = 316 out of 484) reported more than one alteration in their menstrual cycle. Almost half of the participants had been vaccinated over 5 months (45%), 3−4 months (15%) 2−3 months (26%), and one month or less (13%) before. The percentage of women that reported alterations remained strongly constant across time, p > 0.05, ranging from 64 to 65%. Conclusions: Reported alterations in Spanish women after COVID vaccination remained more than 5 months after the last dose.

Anaerobic Variables As Specific Determinants of Functional Classification in Wheelchair Basketball.

Every parasport is currently encouraged to consider evidence-based classification to develop their respective classification system. Therefore, the aims of this study were to: (1) assess the relationship between trunk function and anaerobic power determining proficiency in wheelchair basketball, and (2) define "natural classes" in wheelchair basketball based on anaerobic power. Fifty-nine elite players (representing five national teams) were divided into four main functional classes: Group 1 (n=17), Group 2 (n=14), Group 3 (n=16), Group 4 (n=12). They performed the 6x10s Anaerobic Power Test using an arm crank ergometer. Average values of mean power, peak power, relative mean power, relative peak power, and power decrement were calculated for the 6x10s and 3x10s tests. The Spearman's correlation matrix revealed significant correlations between classes and values recorded in the 6x10s test. This confirmation between anaerobic power and players' classification endorses the division of players into different classes. Furthermore, cluster analysis (with fair quality) divided players into two "natural classes". The first resulting class was mainly formed of participants from Group 1 (71%). An important complement to this research could be to consider wheelchair acceleration and the volume of trunk action in wheelchair basketball classification.

The spatiotemporal control of expert tennis players when returning first serves: A perception-action perspective.

The aim of the current experiment was to examine the spatiotemporal control of expert tennis players while executing first service returns within a representative experimental setting. We recruited and tested 12 male expert tennis players in hard courts. A comprehensive analysis of the timing (eleven temporal variables analysed at 300 Hz) and performance success of the return actions were carried out, while simultaneously considering task constraints such as the accuracy and the speed of the serves. Temporal organisation of return actions were scaled relative to the server's racket-ball contact (5 ms), an adaptation of fly-time of the split-step, which resulted in consistent landings (133 ms), and initiation of lateral movements towards the ball - with no response errors - after the server's stroke (around 177 ms). Poorer returns occurred when responding to accurate serves accompanied by late trunk movements towards the ball. Returners scaled the timing of the response to the unfolding action of the serve in order to support both spatial and temporal accuracy. These novel findings highlight the significance of the study of fast-ball sports in representative settings and offer further detail on the spatiotemporal control of skilful perception-action.

A temporal analysis of the swimmers' coordination in the relay start.

The main aims of the present research were 1) to characterise the inter-subject and intra-subject timing of the preparatory movements of competitive swimmers during relay starts and 2) to relate the preparatory movements with the relay start outcome. Nine international youth swimmers performed 10 relay freestyle starts (one-step technique) filmed at 120 Hz from a lateral viewpoint. Results obtained (0.14 ± 0.10 s changeover time, 0.31 ± 0.07 s entry time, 2.59 ± 0.09 m entry distance and 0.96 ± 0.06 s time to 5 m) indicated that the longer the preparation time (from the initial position to the swimmer's take-off), the better the changeover time, entry distance, and 5 m time. Specifically, a mixed linear model identified preparation time (p < 0.001, F (1,80.01) = 56.36), and entry distance (p = 0.008, F (1,80.01) = 7.36) as predicting variables for 5 m time. Also, faster swimmers on times to 5 m were found to be more consistent - lower levels of intra-subject variability - in 5 m (r = 0.76, p = 0.018) and changeover (r = 0.72, p = 0.029) times. In summary, the timing of the preparatory movements seems to be a key aspect to optimise relay start performances.

How Enaction and Ecological Approaches Can Contribute to Sports and Skill Learning.

The purpose of this paper is to explain learning in sports and physical education (PE) from the perspective of enactive and ecological psychology. The learning process is first presented from the enactive perspective, and some relevant notions such as sense-making and sensorimotor schemes are developed. Then, natural learning environments are described, and their importance in the human development process is explained. This is followed by a section devoted to the learner's experience in which some research methods are explained, such as neurophenomenology, in addition to self-confrontation, interviews aimed at bringing out the meaning, sensations, and emotions that performers experience when they are immersed in their sport or a PE class. The sections on the ecological approach deal with the attunement, calibration, the education of intention, and the importance of representative experimental designs. The last section addresses the main similarities and differences between the two approaches. Finally, we state our theoretical position in favor of a common project that brings together the main elements of both post-cognitive approaches.

Selective Autoretroperfusion Provides Substantial Cardioprotection in Swine: Incremental Improvements With Mild Hypothermia.

Mild hypothermia (MH) and retroperfusion are 2 techniques proposed to reduce infarct size due to myocardial infarction. The authors evaluated the effects of focal MH combined with selective coronary venous autoretroperfusion (SARP) as an acute cardioprotective modality before percutaneous coronary intervention (PCI) in a swine model of left ventricular myocardial infarction. Significant reduction in infarct size with preservation of cardiac function and cardiomyocyte viability were achieved. The authors propose that SARP alone or in combination with MH may provide a clinically relevant percutaneous short-term option of cardiac support to high-risk patients undergoing PCI.

Self-Control in Aiming Supports Coping With Psychological Pressure in Soccer Penalty Kicks.

This study addressed the question whether coaches better allow athletes to self-control their decisions when under pressure or whether to impose a decision upon them. To this end, an experiment was conducted that manipulated the soccer kickers' degree of control in decision-making. Two groups of elite under-19 soccer players (n = 18) took penalty kicks in a self-controlled (i.e., kickers themselves decided to which side to direct the ball) and an externally controlled condition (i.e., the decision to which side to direct the ball was imposed upon the kickers). One group performed the penalty kick under psychological pressure (i.e., the present coaching staff assessed their performance), while the second group performed without pressure. Just before and after performing the kicks, CSAI-2 was used to measure cognitive and somatic anxiety and self-confidence. Further, the number of goals scored, ball placement and speed, and the duration of preparatory and performatory behaviors were determined. The results verified increased levels of cognitive and somatic anxiety after performing the kicks in the pressured group compared to the no-pressure group. In addition, degree of self-control affected the participants' performance, particularly in the pressured group. They scored more goals and placed the kicks higher in the self-controlled than in the externally-controlled condition. Participants also took more time preparing and performing the run-up in the self-controlled condition. Findings indicate that increased self-control helps coping with the debilitating effects of pressure and can counter performance deteriorations. The findings are discussed within the framework of self-control theories, and recommendations for practitioners and athletes are made.

Role of Aortic Geometry on Stroke Propensity based on Simulations of Patient-Specific Models.

Stroke is a life threatening event that is expected to more than double over the next 40 years. Atrial fibrillation (AF) has been reported as a strong independent risk factor for stroke. We have previously shown that a hemodynamic perturbation by AF or reduced cardiac output and cycle length may have a significant impact on clot trajectory and thus embolic stroke propensity through the left common carotid artery using an idealized aortic arch model. Here, we show the dependence of flow patterns and hence stroke propensity on geometry of patient-specific aortas. We performed computational fluid dynamics (CFD) simulations to determine the variations of AF-induced stroke propensity over various image-based patient-dependent aorta models. The results demonstrated that curvature pattern of aorta can play a determinant role in AF-induced stroke propensity alteration. Specifically, it was shown that the hemodynamic perturbation by AF considered led to substantial increase in stroke propensity (i.e., 2.5~3.8 fold elevation) for lower curvature angle <90° while the changes in stroke propensity by AF are negligible for higher curvature angle >90°. The present simulations suggest that aortic arch curvature is an important risk factor for embolic stroke which should be tested in future clinical trials.

Gaze control during interceptive actions with different spatiotemporal demands.

It is widely accepted that the sources of information used to guide interceptive actions depend on conflicting spatiotemporal task demands. However, there is a paucity of evidence that shows how information pick-up during interceptive actions is adapted to such conflicting constraints. The present study therefore examined the effects of systematic manipulations of spatiotemporal constraints on performance, timing and gaze in an in situ interceptive action. To this end, expert futsal goalkeepers faced penalty kicks taken from 10 m and 6 m. With the more lenient spatiotemporal constraints (i.e., kicks from 10 m), the goalkeepers saved more kicks, initiated their actions later, and looked longer toward ball relative to the penalty takers' body. Furthermore, analysis of gaze patterns showed that interindividual variations in information pick-up were related to the unfolding of the penalty taker's action, revealing a less variable, funnel-like gaze pattern toward the end of the action. These findings are interpreted to reflect that changes in spatiotemporal demands induce the differential use of information for the accurate control of interceptive actions. (PsycINFO Database Record

Suction catheter for enhanced control and accuracy of transseptal access.

AIMS: Percutaneous structural heart therapies, such as mitral value repair, require site-specific transseptal access (TSA). This can be challenging for interventional cardiologists. We describe a TSA catheter (TSAC) that utilises suction for enhanced control and puncture accuracy. Here, we aim to evaluate the safety and efficacy of the device. METHODS AND RESULTS: Ex vivo interatrial septum preparations were dissected from swine (n=8) and diseased human hearts (n=6) to quantify TSAC suction and needle puncture force. TSAC suction was 6.5-fold greater than the opposing needle puncture force, and thus provides sufficient stabilisation for punctures. The safety and efficacy of TSAC was evaluated in a chronic mitral regurgitation swine model (n=10) and compared to a conventional TSA device. MR was induced by disrupting one to three mitral chordae tendineae, and the progression of heart disease was followed for three weeks. During device testing, procedure time and fluoroscopy exposure were not statistically different between devices. TSAC reduced septal displacement from 8.7±0.30 mm to 3.60±0.19 mm (p<0.05) and improved puncture accuracy 1.75-fold. CONCLUSIONS: TSAC provides controlled TSA and improves puncture accuracy, while maintaining procedure time and workflow. These findings provide a strong rationale for a first-in-man study to demonstrate the clinical utility of the device.

Thrombus deflector stent for stroke prevention: A simulation study.

Atrial fibrillation (AF) is a dysfunction of heart rhythm and represents an increased predisposition to ischemic stroke in AF patients. It has been shown that the AF-induced hemodynamic conditions may contribute to the increased embolic propensity through the carotid arteries. We simulated a stroke-prevention device with a unique strut structure to deflect the trajectory of a blood clot to the carotid artery. We identified the important determinants of functionality in a device design using computational fluid dynamics simulations. Quantitative assessment of deflection efficacy over various clot dimensions was carried out for the device with different strut configurations under AF flow conditions. The simulations demonstrate that the trajectory of a clot destined to the left common carotid artery (LCCA) can be deflected by a strut-structured device at the LCCA inlet with virtually no change in flow resistance. The deflection efficacy of the device is dependent on the clot properties and strut designs of the device. A configuration of 0.75 mm thick and 0.75 mm distant struts with 50% of surface convexity were found to provide maximum deflection efficacy (e.g., 36% greater deflection efficacy than a flat filter) among the strut structures considered. The results suggest that a deflector stent implanted in the aortic branch may be an effective stroke-prevention device. The present simulations motivate pre-clinical animal studies as well as further studies on patient-specific design of the device that maximize the deflection efficacy while minimizing device safety issues.

La pericia perceptivo-motriz y la cognición en el deporte: Del enfoque ecológico y dinámico a la enacción / Perceptual-motor expertise and cognition in sport: From ecological and dynamic approach to enaction

En el presente artículo se discuten tres corrientes teóricas alter-nativas al cognitivismo, para explicar el desarrollo hacia la pericia en el ámbito del aprendizaje y del control motor en deporte, haciendo especial énfasis en el enactivismo. En la primera parte se tratan las principales nociones de la psicología ecológica, como la regulación del movimiento, la percepción directa o la reciprocidad entre percepción y acción. A continuación se explican las principales aportaciones de la teoría de los sistemas dinámicos a la comprensión de la coordinación del movimiento, de la emergencia de la motricidad y de la interacción de las diferentes variables o restricciones. En el siguiente apartado, se expone el enfoque enactivo como una extensión conceptual proveniente de las ciencias cognitivas y que trasciende a los otros paradigmas. Desde esta orientación, se aboga por una fusión entre el cuerpo y la mente del deportista que es indisociable al medio ambiente y que se opone al dualismo y reduccionismo imperante. Por último, se presentan algunas directrices y aplicaciones de investigaciones enactivas que en la actualidad están en pleno desarrollo

In this paper three alternative theoretical streams to cognitivism, with particular emphasis on enactivism are discussed in order to explain the sport skill acquisition process and human control of movement. In the first part, main concepts of ecological psychology are outlined, like movement regulation, direct perception or mutual interdependence between perception and action. Afterwards, using dynamical model as background, some concepts of motor skill coordination are explained (i.e., constraints or movement emergency). The next section will be focused on enactive approach as a conceptual extension from cognitive science that transcends the other paradigms. From this orientation, it calls for a mind-body fusion of the athlete, which is inseparable to the environment and opposing the prevailing dualism and reductionism. Finally, some guidelines and applications enactive research that are currently being developed are presented

Efficacy of a laparoscopic gastric restrictive device in an obese canine model.

BACKGROUND: Bariatric surgery using laparoscopic techniques is the most effective treatment for morbid obesity. The objective of the study is to assess the safety and efficacy of a novel laparoscopic reversible gastric restrictive (RGR) device in a group of obese dogs. An implant was also performed in a cadaver to assess implant feasibility in a human. METHODS: Four obese mongrel dogs were subjected to RGR implantation for 3 months followed by recovery for an additional 6 weeks after device removal. Food intake, body weight, radiographic barium imaging, and gastric endoscopy were used to monitor RGR performance before implant, after implant, and implant removal. An additional RGR laparoscopic implantation procedure was performed in a human cadaver. RESULTS: The implanted obese dogs exhibited a significant decrease in food intake and body weight over 3 months with the RGR device. The reduction of food intake was sustained at an average of 46 % after implant and the excess weight loss reached an average of 75 % at the end of 12 weeks with recovery to approximately 78 % of baseline after 6 weeks of implant removal. Barium imaging and gastric endoscopy both confirmed passage for food through the restrictive device channel in the stomach. The RGR device was successfully implanted laparoscopically on the cadaver stomach in less than an hour. CONCLUSIONS: The RGR device is laparoscopically deliverable and removable with effective and sustainable weight loss over a 12-week period in an obese dog model. The implant is also technically feasible in man.

Stroke propensity is increased under atrial fibrillation hemodynamics: a simulation study.

Atrial fibrillation (AF) is the most common sustained dysfunction in heart rhythm clinically and has been identified as an independent risk factor for stroke through formation and embolization of thrombi. AF is associated with reduced cardiac output and short and irregular cardiac cycle length. Although the effect of AF on cardiac hemodynamic parameters has been reported, it remains unclear how the hemodynamic perturbations affect the potential embolization of blood clots to the brain that can cause stroke. To understand stroke propensity in AF, we performed computer simulations to describe trajectories of blood clots subject to the aortic flow conditions that represent normal heart rhythm and AF. Quantitative assessment of stroke propensity by blood clot embolism was carried out for a range of clot properties (e.g., 2-6 mm in diameter and 0-0.8 m/s ejection speed) under normal and AF flow conditions. The simulations demonstrate that the trajectory of clot is significantly affected by clot properties as well as hemodynamic waveforms which lead to significant variations in stroke propensity. The predicted maximum difference in stroke propensity in the left common carotid artery was shown to be about 60% between the normal and AF flow conditions examined. The results suggest that the reduced cardiac output and cycle length induced by AF can significantly increase the incidence of carotid embolism. The present simulations motivate further studies on patient-specific risk assessment of stroke in AF.

Mild anastomotic stenosis in patient-specific CABG model may enhance graft patency: a new hypothesis.

It is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40-60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes · cm(-2)) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes · cm(-2)). These findings have significant implications for graft adaptation and long-term patency.

Growth and remodeling of the left ventricle: A case study of myocardial infarction and surgical ventricular restoration.

Cardiac growth and remodeling in the form of chamber dilation and wall thinning are typical hallmarks of infarct-induced heart failure. Over time, the infarct region stiffens, the remaining muscle takes over function, and the chamber weakens and dilates. Current therapies seek to attenuate these effects by removing the infarct region or by providing structural support to the ventricular wall. However, the underlying mechanisms of these therapies are unclear, and the results remain suboptimal. Here we show that myocardial infarction induces pronounced regional and transmural variations in cardiac form. We introduce a mechanistic growth model capable of predicting structural alterations in response to mechanical overload. Under a uniform loading, this model predicts non-uniform growth. Using this model, we simulate growth in a patient-specific left ventricle. We compare two cases, growth in an infarcted heart, pre-operative, and growth in the same heart, after the infarct was surgically excluded, post-operative. Our results suggest that removing the infarct and creating a left ventricle with homogeneous mechanical properties does not necessarily reduce the driving forces for growth and remodeling. These preliminary findings agree conceptually with clinical observations.