Peristaltic hemodynamics of a new pediatric circulatory assist system for Fontan circulation using shape memory alloy fibers.

Fontan procedure is one of the common surgical treatments of congenital heart diseases. Patients with Fontan circulation have single ventricle in the systemic circulation with the total cavopulmonary connection. We have been developing a pulmonary circulatory assist device using shape memory alloy fibers for Fontan circulation with total cavopulmonary connection. It consisted of the shape memory alloy fibers, the diameter of which are 100 µm. The fibers could wrap the ePTFE conduit for Fontan TCPC connection from the outside. We designed the sequential motion control system for sophisticated pulmonary hemodynamics by the pulsatile flow generation. In order to achieve pulsatile flow assistance in pulmonary arterial system, we fabricated a mechanical structure by sequential contraction of shape memory alloy fibers. Then, we developed a sequential contraction controller for the assist system, which could reproduce the wall contractile velocity at 6.0 to 20.0 cm/sec. We examined hemodynamic characteristic of its function using a mock circulatory system, which consisted of two overflow tanks representing venous and pulmonary arterial pressures in Fontan circulation. As a result, the pulmonary circulation assist device with sequential contraction could achieve effective promotion of the pulsatility in pulmonary arterial flow.

Controlling methods of a newly developed extra aortic counter-pulsation device using shape memory alloy fibers.

Diastolic counter-pulsation has been used to provide circulatory augmentation for short term cardiac support. The success of intra-aortic balloon pump (IABP) therapy has generated interest in long term counter-pulsation strategies to treat heart failure patients. The authors have been developing a totally implantable extra aortic pulsation device for the circulatory support of heart failure patients, using 150 µm Ni-Ti anisotropic shape memory alloy (SMA) fibers. These fibers contract by Joule heating with an electric current supply. The special features of our design are as follow: non blood contacting, extra aortic pulsation function synchronizing with the native heart, a wrapping mechanical structure for the aorta in order to achieve its assistance as the aortomyoplsty and the extra aortic balloon pump. The device consisted of rubber silicone wall plates, serially connected for radial contraction. We examined the contractile function of the device, as well as it controlling methods; the phase delay parameter and the pulse width modulation, in a systemic mock circulatory system, with a pneumatically driven silicone left ventricle model, arterial rubber tubing, a peripheral resistance unit, and a venous reservoir. The device was secured around the aortic tubing with a counter-pulsation mode of 1:4 against the heartbeat. Pressure and flow waveforms were measured at the aortic outflow, as well as its driving condition of the contraction phase width and the phase delay. The device achieved its variable phase control for co-pulsation or counter-pulsation modes by changing the phase delay of the SMA fibers. Peak diastolic pressure significantly augmented, mean flow increased (p<0.05) according to the pulse width modulation. Therefore the newly developed extra aortic counter-pulsation device using SMA fibers, through it controlling methods indicated its promising alternative extra aortic approach for non-blood contacting cardiovascular circulatory support.

[Changes in the fractal component of spectral analysis of heart rate variability and systolic blood pressure variability during the head-up tilt test].

Blood pressure and heart rate change are related to the level of physical activity, and are correlated with each other. Heart rate and blood pressure signals were investigated by coarse graining spectral analysis and changes in the harmonic and non-harmonic (fractal) power were examined during the head-up tilt test. Fourteen healthy subjects, 9 men and 5 women (mean age 30.4 +/- 1.0 years) completed the test protocol of 15 min supine rest followed by the head-up tilt (80 degrees) test. Heart rate was measured continuously with standard bipolar leads and electrocardiography. A finger cuff was placed on the left index finger for beat-by-beat recording of systolic blood pressure based on the continuous noninvasive method, and the impulse train was stored on a personal computer for spectral analysis. The harmonic component, the integrated powers in the low-frequency and high-frequency regions, and the fractal component were then calculated. The fractal component was plotted on a log power versus log frequency plane with spectral index beta estimated as the slope of the linear regression of this 1/f beta plot. RR-interval was significantly shorter during the head-up tilt position than in the supine rest position with a marked reduction in the high-frequency power. The ratio of fractal component for total power was increased and the slope beta of the 1/f beta relationship was significantly greater in the head-up tilt (1.61 +/- 0.05) than in the supine rest (0.92 +/- 0.07) position. Systolic blood pressure showed a significant increase during head-up tilt, and marked increases in high-frequency power and fractal power. However, both the ratio of fractal component for total power and the slope beta remained unchanged. Further studies are needed to clarify whether the slope beta is essentially stable or variable in some conditions.