An in vivo investigation on the effects of stent implantation on hematological and hemorheological parameters.

BACKGROUND: Even though cardiovascular stenting is widely used for the treatment of coronary artery disease, information on how it can affect the hematological and hemorheological profile is scarce in the literature. Most of the work on this issue is based on theoretical or computational fluid dynamics models, lacking in-depth in vitro and in vivo experimental verification. OBJECTIVE: This work investigates, in an in vivo setting, the effects of stenting and the implantation time-course on hematological and hemorheological parameters that could potentially compromise the device's functionality and longevity. METHODS: Custom-made self-expanding nitinol stents were implanted in the common carotid artery of male CD1 mice. Whole blood samples were collected from control (non-stented) and stented animals at 5 and 10 weeks post-implantation. Hematological measurements and blood viscosity, red blood cell aggregation, and deformability were performed using standard techniques. RESULTS: Implant-induced changes were observed in some of the hematological and hemorheological indices. Blood viscosity seems to have been negatively affected by an increased hematocrit and reduced RBC deformability, at 10 weeks post-implantation, despite a slight decrease in RBC aggregation. CONCLUSIONS: Although the alterations observed may be the result of the peri-implant inflammatory response, the physiological consequences due to hemorheological changes need to be further investigated.

The effects of stenting on hemorheological parameters: An in vitro investigation under various blood flow conditions.

 Despite their wide clinical usage, stent functionality may be compromised by complications at the site of implantation, including early/late stent thrombosis and occlusion. Although several studies have described the effect of fluid-structure interaction on local haemodynamics, there is yet limited information on the effect of the stent presence on specific hemorheological parameters. The current work investigates the red blood cell (RBC) mechanical behavior and physiological changes as a result of flow through stented vessels. Blood samples from healthy volunteers were prepared as RBC suspensions in plasma and in phosphate buffer saline at 45% haematocrit. Self-expanding nitinol stents were inserted in clear perfluoroalkoxy alkane tubing which was connected to a syringe, and integrated in a syringe pump. The samples were tested at flow rates of 17.5, 35 and 70 ml/min, and control tests were performed in non-stented vessels. For each flow rate, the sample viscosity, RBC aggregation and deformability, and RBC lysis were estimated. The results indicate that the presence of a stent in a vessel has an influence on the hemorheological characteristics of blood. The viscosity of all samples increases slightly with the increase of the flow rate and exposure. RBC aggregation and elongation index (EI) decrease as the flow rate and exposure increases. RBC lysis for the extreme cases is evident. The results indicate that the stresses developed in the stent area for the extreme conditions could be sufficiently high to influence the integrity of the RBC membrane.

Preventing maritime transport of pathogens: the remarkable antimicrobial properties of silver-supported catalysts for ship ballast water disinfection.

Ship ballast water (SBW) antimicrobial treatment is considered as a priority issue for the shipping industry. The present work investigates the possibility of utilizing antimicrobial catalysis as an effective method for the treatment of SBW. Taking into account the well-known antimicrobial properties of ionic silver (Ag+), five silver-supported catalysts (Ag/γ-Al2O3) with various loadings (0.05, 0.1, 0.2, 0.5, and 1 wt%) were prepared and examined for the antimicrobial treatment of SBW. The bactericidal activity of the aforementioned catalysts was investigated towards the inhibition of Escherichia coli (Gram-negative) and Escherichia faecalis (Gram-positive) bacteria. Catalytic experiments were conducted in a three-phase continuous flow stirred tank reactor, used in a semi-batch mode. It was found that using the catalyst with the lowest metal loading, the inhibition of E. coli reached 95.8% after 30 minutes of treatment of an E. coli bacterial solution, while the inhibition obtained for E. faecalis was 76.2% after 60 minutes of treatment of an E. faecalis bacterial solution. Even better results (100% inhibition after 5 min of reaction) were obtained using the catalysts with higher Ag loadings. The results of the present work indicate that the prepared monometallic catalysts exert their antimicrobial activity within a short period of time, revealing, for the first time ever, that the field of antimicrobial heterogeneous catalysis using deposited ionic silver on a solid support may prove decisive for the disinfection of SBW.

Validation of rapid velocity encoded cine imaging of a dynamically complex flow field using turbo block regional interpolation scheme for k space.

Block regional interpolation scheme for k space (BRISK) is a sparse sampling approach to allow rapid magnetic resonance imaging of dynamic events. Rapid velocity encoded cine (VEC) imaging with Turbo BRISK is potentially an important clinical diagnostic technique for cardiovascular diseases. Previously we applied BRISK and Turbo BRISK to imaging pulsatile flow in a straight tube. To evaluate the capabilities of Turbo BRISK imaging in more complex dynamic flow fields such as might exist in the human vasculature, an in vitro curved tube model, similar in geometry to the aortic arch, was fabricated and imaged under pulsatile flow conditions. Velocity maps were obtained using conventional VEC and Turbo BRISK (turbo factors 1 through 5). Comparison of the flow fields obtained with each higher order turbo factor showed excellent agreement with conventional VEC with minimal loss of information. Similarly, flow maps showed good agreement with the profiles from a laser Doppler velocimetry model. Turbo-5 BRISK, for example, allowed a 94% savings in imaging time, reducing the conventional imaging time from over 8 min to a near breath-hold imaging period of 31 s. Turbo BRISK shows excellent promise toward the development of a clinical tool to evaluate complex dynamic intravascular flow fields.

Hemodynamic evaluation with TURBO BRISK--a rapid phase contrast angiography technique.

Hemodynamic imaging by phase contrast angiography was significantly accelerated by selective interpolation and segmentation in k-space using TURBO BRISK. The method was tested in vitro on three independent flowfields, representative of human blood rheology: a straight tube simulating the descending aorta, a curved tube simulating the aortic arch and a two-chamber orifice flow model simulating valvular regurgitation. The results were compared to data obtained by Laser Doppler Velocimetry (LDV) and showed good agreement. For the straight tube, the flow velocity obtained by five TURBO BRISK methods with increasing segmentation factors and corresponding time savings showed good agreement with LDV. For the curved tube, the velocity showed good general agreement with some differences in the decelerating part of the cycle, and in the low-velocity secondary flow structures. The orifice flow evaluation, the most time consuming case, was performed by the control volume method. It showed good agreement with actual flows through the orifice. Data acquisitions for TURBO-4 BRISK could be performed in 20s for each velocity component. The method shows promise for breath-hold acquisitions in clinical applications, including calculation of blood flow volumes through diseased arteries, measurement of blood backflow volumes through dysfunctional heart valves to time valve replacement operations, and evaluation of arterial wall shear stress, an important factor in the genesis of atherosclerosis.

Color Doppler velocity accuracy proximal to regurgitant orifices: influence of orifice aspect ratio.

Many noninvasive methodologies used for the accurate evaluation of valvular regurgitation require precise velocity measurements from ultrasound instruments. Previous studies have indicated that velocity measurements from color Doppler (CD) instruments are susceptible to errors due to the interaction of the ultrasound beam and the proximal orifice flow field. This study examined the influence of high aspect ratio (AR) orifices on the CD velocity error. Center line velocity error distributions for orifices ranging from 7.07 to 78.5 mm2, varying in shape from circular to an AR = 8 ellipse, were evaluated using a numerical model of the ultrasound beam and the simulated regurgitant flow field. An in vitro study was also performed and confirmed the findings of the numerical model. The study showed that increasing AR does not significantly change the error characteristics. The study confirmed that orifice size is the dominant factor in the error distribution, and that corrections speculated for circular orifices can be extended to elliptical orifices without significant errors.

Morphological evaluation of a regurgitant orifice by 3-D echocardiography: applications in the quantification of valvular regurgitation.

The clinical evaluation of blood flow regurgitation through a heart valve or stenotic lesion is an unresolved problem. The proximal flowfield region has been the study focus in the last few years; however, investigators have failed to identify an accurate and reliable calculation scheme due to lack of geometric information about the shape and size of the regurgitating or stenotic orifice. Presented here is a superior method of calculation, by using three-dimensional (3-D) echocardiography combined with Doppler velocimetry. The geometric structure of the orifice in a regurgitating porcine prosthetic valve in vitro was formulated by 3-D image construction of sequentially obtained 2-D images. The velocity flowfield was accessed by color Doppler flow mapping (CD) and continuous-wave Doppler (CW). Two accurate methods of calculation of regurgitant variables were developed. The first method calculated peak regurgitant flow rate from CD and the second method calculated regurgitant flow volume from CW. Both methods showed excellent correlation with the corresponding true values from an electromagnetic flowmeter. The promising preliminary results in such a realistic porcine model indicate the possibility of establishing a routine procedure to be tested in the clinical setting.

Rapid velocity-encoded cine imaging with turbo-BRISK.

Velocity-encoded cine (VEC) imaging is potentially an important clinical diagnostic technique for cardiovascular diseases. Advances in gradient technology combined with segmentation approaches have made possible breathhold VEC imaging, allowing data to be obtained free of respiratory artifacts. However, when using conventional segmentation approaches, spatial and temporal resolutions are typically compromised to accommodate short breathhold times. Here we apply a sparse sampling technique, turbo-BRISK (i.e., segmented block regional interpolation scheme for k-space) to VEC imaging, allowing increased spatial and temporal resolution to be obtained in a short breathhold period. BRISK is a sparse sampling technique with interpolation used to generate unsampled data. BRISK was implemented to reduce the scan time by 70% compared with a conventional scan. Further, turbo-BRISK scans, using segmentation factors up to 5, reduce the scan time by up to 94%. Phantom and in vivo results are presented that demonstrate the accuracy of turbo-BRISK VEC imaging. In vitro validation is performed using conventional magnetic resonance VEC. Pulsatile centerline flow velocity measurements obtained with turbo-BRISK acquisitions were correlated with conventional magnetic resonance imaging measurements and achieved r values of 0.99 +/- 0.004 (mean +/- SD) with stroke volumes agreeing to within 4%. A potential limitation of BRISK is reduced accuracy for rapidly varying velocity profiles. We present low- and high-resolution data sets to illustrate the resolution dependence of this phenomenon and demonstrate that at conventional resolutions, turbo-BRISK can accurately represent rapid velocity changes. In vivo results indicate that centerline velocity waveforms in the descending aorta correlate well with conventional measurements with an average r value of 0.98 +/- 0.01.

Evaluation of the proximal flow field to circular and noncircular orifices of different aspect ratios.

Investigations of valvular regurgitation attempt to specify flow field characteristics and apply them to the proximal isovelocity surface area (PISA) method for quantifying regurgitant flow. Most investigators assume a hemispherical shape to these equivelocity shells proximal to an axisymmetric (circular) orifice. However, in vivo flow fields are viscous and regurgitant openings vary in shape and size. By using centerline profiles and isovelocity surfaces, this investigation describes the flow field proximal to circular and elliptical orifices. Steady, proximal flow fields are obtained with two- and three-dimensional computational fluid dynamic (CFD) simulations. These simulations are verified by in vitro, laser-Doppler velocimetry (LDV) experiments. The data show that a unique, normalized proximal flow field results for each orifice shape independent of orifice flow or size. The distinct differences in flow field characteristics with orifice shape may provide a mechanism for evaluating orifice characteristics and regurgitant flows. Instead of the hemispherical approximation technique, this study attempts to show the potential to define a universal flow evaluation method based on the details of the flowfield according to orifice shape. Preliminary results indicate that Magnetic Resonance (MR) and Color Doppler (CD) may reproduce these flow details and allow such a procedure in vivo.

An improved flow evaluation scheme in orifices of different aspect ratios.

An accurate and reliable method of regurgitant flow calculation is currently unavailable. The goal of this study was to define a new general method of flow calculation for orifices of different aspect ratios. The success of the method relies on matching the imaged flow field distribution obtained by color flow mapping (CFM) to a three-dimensional (3D) numerical flow field distribution of known geometry. The flow field in three orifices of identical cross-sectional area with aspect ratios of 1 (circular), 2 and 4 (elliptical) was evaluated by: (a) CFM, (b) 3D echocardiographic imaging, and (c) 3D finite element modeling (FEM). The orifice shape and size were accurately estimated by 3D echocardiographic imaging. FEM showed that the normalized centerline velocity profile of the flow field depends on the orifice aspect ratio. CFM provided a good description of the centerline profile for each case. For a given distance from the orifice center, the equivelocity contour surface area increases with increasing aspect ratio. A simple flow calculation scheme was developed to calculate regurgitant flow independent of orifice shape. This improved method showed better results than previous studies and may prove to be advantageous when analyzing in vivo flow fields with complex geometries.

Accuracy of color doppler velocity in the flow field proximal to a regurgitant orifice: implications for color doppler quantitation of valvular incompetence.

Color Doppler is routinely used in estimates of valvular regurgitation. Velocity and subsequently flow measurements are made at about 7-10 cm from the ultrasonic transducer. Error in velocity measurement may occur due to spatial broadening of the color Doppler beam in the axial, azimuthal and lateral directions. Error in velocity may also occur due to wall filters since the filtering process is not uniform throughout the velocity range indicated by the color bar. An attempt to estimate this error was made using an in vitro orifice model, a numerical finite element model (FEM), and information from the manufacturer. We found that the acoustic beam spatial expansion, wall filter sensitivity and Nyquist limit (NYL) have to be considered simultaneously to account for errors. The combined spatial expansion and wall filter effect on velocity was estimated as a weighted average over the sample volume. The error distributions are not universal but depend on orifice size and flow. For a 3-mm orifice and 100 cm s NYL the overall effect was overestimation of low velocities and significant underestimation of high velocities due to the high velocity gradients inside the sample volume. For the 5- and the 10-mm orifice the effect was less accentuated. Based on this overall error distribution, a correction was incorporated on color Doppler obtained data. The incorporated correction yielded better agreement with numerical velocity data. This correction is important in the application of the proximal isovelocity surface area (PISA) technique and the evaluation of regurgitant flowrates.

A numerical and experimental investigation of the flow acceleration region proximal to an orifice.

Attempts to quantify valvular regurgitation have recently been focused on the proximal orifice flow field. A complete description of the proximal orifice flow field is provided in this investigation. A steady state in vitro model accessible by both color Doppler ultrasound (CDU) and laser Doppler velocimetry (LDV) was utilized. Velocities for varying flow rates and orifices were calculated by finite element modeling (FEM), by LDV and by CDU. The steady flow model was composed of circular orifices of 3, 5 and 10 mm diameters at flow rates from 0.7 to 10 L/min. Regurgitant flow rates were calculated from the proximal CDU data by two separate methods. The first approach utilized angle corrected velocities while the second approach utilized only velocities which did not require angle correction (centerline velocities). Both methods correlated well with known flow rates (y = 0.97x -0.09, r = 0.98, SEE = 0.45, p < 0.0001; and y = 1.0x + 0.07, r = 0.99, SEE = 0.27, p < 0.0001, respectively) and were superior to results obtained by assuming a hemispherical geometry as is done in the aliasing technique. The methodology provides a complete analysis of the proximal flow field and involves fewer geometric assumptions than the aliasing approach. This may prove to be an advantage when analyzing in vivo flow fields with complex, uncertain geometry.

Intramachine and intermachine variability in transesophageal color Doppler images of pulsatile jets. In vitro studies.

BACKGROUND: Color Doppler flow mapping is widely used as a marker of severity of valvular regurgitation, and the transesophageal approach has provided high-quality images in patients with poor acoustic windows. However, different instruments produce significantly variable images. Techniques that use jet spatial information to determine the severity of the lesion may need to be derived specifically for the instrument used. Given a lack of standardization of the many commonly used instruments, the goal of this study was to quantify variability between instruments by imaging well-defined jet flow fields created in vitro. METHODS AND RESULTS: Pulsatile jets were created in vitro using a blood analogue fluid through physiological orifice diameters and imaged from a distal window using six commonly used color Doppler instruments. Transesophageal transducers (5.0 MHz) were used with all instruments studied. Peak jet areas were planimetered and averaged with systematic variations in Nyquist limit, color filter, and sector angle (which produced variations in frame rate). Changes in instrument settings produced significant variation in jet size for all instruments studied. Comparisons within instruments and among instruments were difficult because of preset and ambiguous setting levels. When comparisons were possible between similar settings, variability was dramatic (eg, 57% variability between instruments with very similar Nyquist limits). CONCLUSIONS: A lack of standardized color Doppler instrument settings prohibits translation of jet area techniques from one instrument to another. This should be taken into consideration when using different machines for clinical study.

Shear stress at a compliant model of the human carotid bifurcation.

To investigate the role of a compliant wall to the near wall hemodynamic flowfield, two models of the carotid bifurcation were constructed. Both were of identical internal geometries, however, one was made of compliant material which produced approximately the same degree of wall motion as that occurring in vivo while the other one was rigid. The inner geometries were formed from the same mold so that the configurations are directly comparable. Each model was placed in a pulsatile flow system that produced a physiologic flow waveform. Velocity was measured with a single component Laser system and wall shear rate was estimated from near wall data. Wall motion in the compliant model was measured by a wall motion transducer and the maximum diameter change varied between 4-7 percent in the model with the greatest change at the axis intersection. The mean shear stress in the compliant model was observed to be smaller by about 30 percent at most locations. The variation in peak shear stress was greater and occasionally reached as much as 100 percent with the compliant model consistently having smaller positive and negative peaks. The separation point was seen to move further upstream in the compliant cast. The modified flowfield in the presence of a compliant wall can then be important in the hemodynamic theory of atherogenesis.