The Influence of Acoustic Impedance Mismatch on Post-Stenotic Pulsed-Doppler Ultrasound Measurements in a Coronary Artery Model

Acoustic impedance mismatch at the fluid-wall interface was shown to affect the spectra from an intravascular Doppler device in an in vitro model with a diameter typical of human coronary arteries. Measurements were obtained first under Poiseuille flow conditions with impedance mismatches of 0%, 7% and 12%, and then under stenosed conditions for the 0% and 7% mismatch cases. For the zero mismatch case, the Doppler spectra could be readily interpreted in terms of fluid mechanical phenomena. When mismatch was present, the spectra from Poiseuille flow exhibited multiple peaks which could not be directly related to the velocity profile. Also, the spectra from stenosed flow with a mismatch of 7% were similar to those from the zero mismatch case but did not exhibit the specific flow-related features as clearly. These results indicate that the impedance mismatch alters the acoustic environment inside the model and that this causes artifact in the Doppler spectra

Patients After the Fontan Insights From Computational Fluid Dynamics

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Chordal force distribution determines systolic mitral leaflet configuration and severity of functional mitral regurgitation

AbstractOBJECTIVESThe purpose of this study was to investigate the impact of the chordae tendineae force distribution on systolic mitral leaflet geometry and mitral valve competence invitro.BACKGROUNDFunctional mitral regurgitation is caused by changes in several elements of the valve apparatus. Interaction among these have to comply with the chordal forcedistribution defined by the chordal coapting forces (FC) created by the transmitral pressure difference, which close the leaflets and the chordal tethering forces(FT) pulling the leaflets apart.METHODSPorcine mitral valves (n = 5) were mounted in a left ventricular model where leading edge chordal forces measured by dedicated miniature force transducers werecontrolled by changing left ventricular pressure and papillary muscle position. Chordae geometry and occlusional leaflet area (OLA) needed to cover the leaflet orifice for a givenleaflet configuration were determined by two-dimensional echo and reconstructed three-dimensionally. Occlusional leaflet area was used as expression for incomplete leafletcoaptation. Regurgitant fraction (RF) was measured with an electromagnetic flowmeter.RESULTSMixed procedure statistics revealed a linear correlation between the sum of the chordal net forces, ∑[FC−FT]s, and OLA with regression coefficient (minimum − maximum) beta = −115 to −65 [mm2/N]; p< 0.001 and RF (beta = −0.06 to −0.01 [%/N]; p < 0.001). Increasing FTby papillary muscle malalignment restrictedleaflet mobility, resulting in a tented leaflet configuration due to an apical and posterior shift of the coaptation line. Anterior leaflet coapting forces increased due to mitralleaflet remodeling, which generated a nonuniform regurgitant orifice area.CONCLUSIONSAltered chordal force distribution caused functional mitral regurgitation based on tented leaflet configuration as observed clinically

Synthetic Cannabinoid-Related Deaths in England, 2012-2019.

Aim: To identify drug-related death trends associated with synthetic cannabinoid receptor agonists (SCRAs) reported to the National Programme on Substance Abuse Deaths (NPSAD) from England. Design: Case reports from NPSAD (England) where a SCRA was detected in post-mortem tissue(s) and/or implicated in the death were extracted, analyzed, and compared against non-SCRA-related deaths that occurred over the same time period (2012-2019). Findings: One hundred sixty-five death SCRA-related reports were extracted, with 18 different SCRAs detected. Following the first death in 2012, a subsequent sharp increase in reporting is evident. Acute SCRA use was the underlying cause of death in the majority of cases (75.8%) with cardiorespiratory complications the most frequently cited underlying physiological cause (13.4%). SCRA users were predominantly found dead (68.6%), with a large proportion of those witnessed becoming unresponsive described as suddenly collapsing (81.6%). Psychoactive polydrug use was detected in 90.3% of cases, with alcohol the most commonly co-detected (50.3%), followed by opioids (42.2%), benzodiazepines/Z-drugs (32.1%), stimulants (32.1%, [28.5% cocaine]), and cannabis (24.8%). Compared to all non-SCRA-related NPSAD deaths occurring over the same time period, SCRA-related decedents were more predominantly male (90.3% vs. 72.0%; p<0.01), and lived in more deprived areas (p<0.01). While a comparatively significant proportion of decedents were homeless (19.4% vs. 4.1%), living in a hostel (13.3% vs. 2.3%) or in prison (4.9% vs. 0.2%) at time of death (all p<0.01), the greatest majority of SCRA-related decedents were living in private residential accommodations (57.6%). Conclusions: This is the largest dataset regarding SCRA-related mortalities reported to date. Reporting of SCRA-related deaths in England have increased considerably, with polydrug use a specific concern. Lack of effective deterrents to SCRA use under current UK legislation, compounded by limited knowledge regarding the physiological impacts of SCRA consumption and their interaction with other co-administered substances are contributory factors to the occurrence of SCRA-related mortalities in an increasingly deprived demographic

Correction of Pulmonary Arteriovenous Malformation Using Image-Based Surgical Planning

The objectives of this study were to develop an image-based surgical planning framework that 1) allows for in-depth analysis of pre-operative hemodynamics by the use of cardiac magnetic resonance and 2) enables surgeons to determine the optimum surgical scenarios before the operation. This framework is tailored for applications in which post-operative hemodynamics are important. In particular, it is exemplified here for a Fontan patient with severe left pulmonary arteriovenous malformations due to abnormal hepatic flow distribution to the lungs. Patients first undergo cardiac magnetic resonance for 3-dimensional anatomy and flow reconstruction. After analysis of the pre-operative flow fields, the 3-dimensional anatomy is imported into an interactive surgical planning interface for the surgeon to virtually perform multiple surgical scenarios. Associated hemodynamics are predicted by the use of a fully validated computational fluid dynamic solver. Finally, efficiency metrics (e.g., pressure decrease and hepatic flow distribution) are weighted against surgical feasibility to determine the optimal surgical option