Browsing by Author "Bouwmeester, J. C."

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    A new teaching model of the systemic circulation that incorporates reservoir characteristics
    (2015-02-24) Tyberg, John V.; Bouwmeester, J. C.; Burrowes, Lindsay M.; Parker, Kim H.; Shrive, Nigel G.; Wang, Jiun-Jr.
    Abstract A hydraulic teaching model of the human systemic circulation is proposed, based on the principles of the reservoir-wave approach. Reservoir characteristics are portrayed by the arterial tall-and-narrow and venous short-and-wide columns, the relative compliances of which are signified by their diameters. Wave characteristics are represented by proximal arterial and venous resistances; rapid left ventricular ejection and rapid right atrial filling cause flow-dependent pressure drops across the respective resistances. (The value of the proximal arterial resistance is numerically equal to the characteristic impedance.) The pressure drop across the proximal arterial resistance, excess pressure, is understood to be fundamentally wave-related and has been shown to be a measure of the efficiency of cardiac-vascular coupling. Excess pressure also predicts an incremental risk of cardiovascular morbidity and largely accounts for the hysteresis evidenced by an open aortic pressure-volume loop.
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    P1.4 Hemodynamics of Pulmonary Hypertension: Application of the Reservoir-Wave Approach
    (2015-11-23) Ghimire, Anukul; Andersen, Mads; Burrowes, Lindsay; Bouwmeester, J. C.; Grant, Andrew; Belenkie, Israel; Fine, Nowell; Borlaug, Barry; Tyberg, John
    Abstract Using the reservoir-wave approach, previously we characterized pulmonary vasculature mechanics with multiple interventions in a canine model. In the present study, we measured high-fidelity pulmonary arterial (PA) pressure, Doppler flow velocity, and pulmonary capillary wedge pressure in 11 patients referred for evaluation of exertional dyspnea. The analysis was performed using the reservoir-wave approach; wave intensity analysis was subsequently utilized to characterize the PA wave pattern. Our objective was to identify specific abnormalities associated with pulmonary hypertension. Seven patients with varying PA pressures had reduced pulmonary vascular conductance (i.e., the amount of flow that the lungs can accept per pressure gradient), suggesting that these patients might benefit from pulmonary vasodilator therapy, some even in the absence of markedly elevated PA pressures. Right ventricular (RV) performance was assessed by examining the work done by the wave component of systolic PA pressure. Wave work, the non-recoverable energy expended by the RV to eject blood, varied directly with mean PA pressure. Wave pressure was partitioned into two components: forward-travelling and reflected backward-travelling waves. Among patients with lower PA pressures, we found pressure-decreasing backward waves that aided the RV during ejection, as previously reported in normal experimental animals. Among patients with higher PA pressures, we detected pressure-increasing backward waves that impede RV ejection. We conclude that it is important to measure pulmonary vascular conductance to properly assess the pulmonary vasculature. The reservoir-wave approach and wave intensity analysis may prove to be valuable tools to evaluate RV performance and may facilitate development of therapeutic strategies.
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    P3.02 Describing Waves in the Pulmonary Veins: Application of a Reservoir-Wave Model
    (2012-11-17) Bouwmeester, J. C.; Shrive, N. G.; Tyberg, J. V.
    Abstract Background The pulmonary venous pressure waveform is typically described by the downstream events in the left atrium and ventricle. These downstream events create waves that contribute to the overall waveform. Methods In anesthetised open-chest dogs, measurements of pressure and flow were made in the pulmonary artery and vein. Experiments involved increases to blood volume and the application of 10 cm H2O positive end-expiratory pressure (PEEP). The reservoir-wave model describes the reservoir pressure, which is subtracted from measured pressure, to result in the excess pressure (Pexcess). Excess velocity (Uexcess) is similarly formulated. Pexcess and Uexcess are used in wave intensity analysis to calculate wave speed and separate the contributions of waves originating upstream (forward waves) and downstream (backward waves). Results Separated waves are shown in the bottom panel of Figure 1. The effect of PEEP resulted in larger decreases to Pbackward (p < 0.001) after the mitral valve opened. As a result, y was lower than x by ~2.0 mmHg. With PEEP, the delay between arterial and venous forward waves increased from 155 ± 4 ms to 183 ± 4 ms (mean ± SE, p < 0.001). Conclusion The majority of pulmonary venous pressure landmarks can be attributed to the actions of the left atrium and ventricle but the v wave has substantial contributions from waves originating in the pulmonary artery. Diastolic suction has a larger effect with PEEP, presumably from some external constraint applied to the heart and consequently lowered end-systolic left ventricular volume. Figure 1 Common venous markers related to measured pressures (top panel) and the separation of Pexcess into forward and backward components (bottom panel) at control conditions.