Epicardial coronary blood flow including the presence of stenoses and aorto-coronary bypasses--II: Experimental comparison and parametric investigations.

This article is the second in a series which presents a computer model of the left coronary arteries. The first article discussed the geometry, the governing equations, and the numerical method employed. This paper details an acute canine experiment used to validate the approach as well as the systematic investigation of several important parameters governing the left coronary circulation. These parameters include peripheral resistance, wall properties, and altered geometric properties through various stenosis/bypass configurations. With appropriate selection of parameters, the model reproduces an in vivo waveform very closely. The model also predicts many clinical phenomena, such as the "critical" value of stenosis, the dramatic reduction in flow through a stenosis when bypassed, and the restorative effect of the bypass upon flow to the distal bed. The model also is used to show that the autonomic state of the animal profoundly affects the influence of various factors, e.g., the critical value of a stenosis is much higher under resting conditions than under hyperemic conditions.

Epicardial coronary blood flow including the presence of stenoses and aorto-coronary bypasses--I: Model and numerical method.

A computer model and numerical method for calculating left epicardial coronary blood flow has been developed. This model employs a finite-branching geometry of the coronary vasculature and the one-dimensional, unsteady equations for flow with friction. The epicardial coronary geometry includes the left main and its bifurcation, the left anterior descending and left circumflex coronary arteries, and a selected number of small branches. Each of the latter terminate in an impedance, whose resistive component is related to intramyocardial compression through a linear dependence on left ventricular pressure. The elastic properties of the epicardial arteries are taken to be non-linear and are prescribed by specifying the local small-disturbance wave speed. The model allows for the incorporation of multiple stenoses as well as aorto-coronary bypasses. Calculations using this model predict pressure and flow waveform development and allow for the systematic investigation of the dependence of coronary flow on various parameters, e.g., peripheral resistance, wall properties, and branching pattern, as well as the presence of stenoses and bypass grafts. Reasonable comparison between calculations and earlier experiments in horses has been obtained.

A finite-element simulation of pulsatile flow in flexible obstructed tubes.

A finite-element model for pulsatile flow in a straight flexible partially obstructed tube is developed. In the unobstructed sections of the tube the model considers the continuity equation, the one-dimensional momentum equation, and an equation of state relating tube cross-sectional area to pressure. For the obstructed region, a nonlinear relationship between the flow and the pressure drop across the stenosis is considered. The applicability of a model is checked by comparing predicted flow and pressure waveforms with corresponding in-vitro experimental measurements obtained on a mechanical system. These comparisons indicated that the model satisfactorily predicts pressures and flows under variety of frequencies of oscillation and stenosis severities.