Adaptation of Conduit Artery Vascular Smooth Muscle Tone to Induced Hypertension

We studied the changes in vascular smooth muscle (VSM) cell tone during the adaptation of rat common carotids to induced hypertension. Hypertension was induced in 8 week old male Wistar rats by total ligation of the aorta between the two kidneys. Mean blood pressure increased abruptly from 92±2 mm Hg (mean±SE) to 145±4 mm Hg and remained constant thereafter. Rats were sacrificed 2, 4, 8, and 56 days after surgery and the left common carotid artery was excised for analysis. Pressure-diameter curves were measured in vitro under normal, maximally contracted, and totally relaxed VSM. The VSM tone was analyzed in terms of its basal tone (active stress at low strains) and its myogenic tone (increase in active stress at high strains). Our results show that the capacity of the VSM to develop maximal active stress is not altered in hypertension. Basal tone, however, increases rapidly in the acute hypertension phase (2-8 days postsurgery) and drops to nearly control values at 56 days postsurgery. Also, the onset of myogenic response decreases to lower strains following the step change in pressure, to be restored back to control levels at 56 days postsurgery. We conclude that VSM adaptation is most significant in the acute hypertension phase and acts as a first, rapid defense mechanism for the arterial wall. The VSM tone returns back to normal levels once the slower geometrical and structural remodeling is developed sufficiently to restore the biomechanical environment and function of the arterial wall to control levels. © 2002 Biomedical Engineering Society. PAC2002: 8719Rr, 8719Ff, 8719U

The non-circular shape of FloWatch-PAB prevents the need for pulmonary artery reconstruction after banding. Computational fluid dynamics and clinical correlations

OBJECTIVE: To evaluate the differences between non-circular shape of FloWatch-PAB and conventional pulmonary artery (PA) banding. METHODS: Geometrical analysis. Conventional banding and FloWatch-PAB perimeters were plotted against cross-sections. Computational fluid dynamics (CFD) model. CFD compared non-circular FloWatch-PAB cross-sections with conventional banding regarding pressure gradients. Clinical data. Seven children, median age 2 months (7 days to 3 years), median weight 4.2 kg (3.2-9.8 kg), with complex congenital heart defects underwent PA banding with FloWatch-PAB implantation. RESULTS: Geometrical analysis. Conventional banding: progressive reduction of cross-sections was accompanied by progressive reduction of PA perimeters. FloWatch-PAB: with equal reduction of cross-sections the PA perimeter remained constant. CFD model. Non-circular and circular banding provided same trans-banding pressure gradients for same cross-sections at any given flow. Clinical data. Mean PA internal diameter at banding was 13.3+/-4.5 mm. After a mean interval of 5.9+/-3.7 months, all children underwent intra-cardiac repair and simple FloWatch-PAB removal without PA reconstruction. Mean PA internal diameter with FloWatch-PAB removal increased from 3.0+/-0.8 to 12.4+/-4.5 mm (normal mean internal diameter for the age=9.9+/-1.6). No residual pressure gradient was recorded in correspondence of the site of the previous FloWatch-PAB implantation in 6/7 patients, 10 mmHg peak and 5 mmHg mean gradient in 1/7. CONCLUSIONS: The non-circular shape of FloWatch-PAB can replace conventional circular banding with the following advantages: (a) the pressure gradient will remain essentially the same as for conventional circular banding for any given cross-section, but with significantly smaller reduction of PA perimeter; and (b) PA reconstruction at the time of de-banding for intra-cardiac repair can be avoided

Adaptation of conduit artery vascular smooth muscle tone to induced hypertension

We studied the changes in vascular smooth muscle (VSM) cell tone during the adaptation of rat common carotids to induced hypertension. Hypertension was induced in 8 week old male Wistar rats by total ligation of the aorta between the two kidneys. Mean blood pressure increased abruptly from 92 +/- 2mm Hg (mean +/- SE) to 145 +/- 4 mm Hg and remained constant thereafter. Rats were sacrificed 2, 4, 8, and 56 days after surgery and the left common carotid artery was excised for analysis. Pressure-diameter curves were measured in vitro under normal, maximally contracted, and totally relaxed VSM. The VSM tone was analyzed in terms of its basal tone (active stress at low strains) and its myogenic tone (increase in active stress at high strains). Our results show that the capacity of the VSM to develop maximal active stress is not altered in hypertension. Basal tone, however, increases rapidly in the acute hypertension phase (2-8 days postsurgery) and drops to nearly control values at 56 days postsurgery. Also, the onset of myogenic response decreases to lower strains following the step change in pressure, to be restored back to control levels at 56 days postsurgery. We conclude that VSM adaptation is most significant in the acute hypertension phase and acts as a first, rapid defense mechanism for the arterial wall. The VSM tone returns back to normal levels once the slower geometrical and structural remodeling is developed sufficiently to restore the biomechanical environment and function of the arterial wall to control levels

A new implantable device for telemetric control of pulmonary blood flow.

The main problem encountered in pulmonary artery banding is the difficulty in determining the optimal perimeter of the band, and sometime repeated surgical operations are required to adjust the band perimeter in order to control the pulmonary blood flow. To overcome these difficulties EndoArt S.A. (Lausanne, Switzerland) developed an externally adjustable, telemetrically controlled device for pulmonary artery banding (FloWatch), which is wireless, battery free, easy to implant and use, and we here report on the technical characteristics of the device. The preliminary acute experimental studies demonstrated the feasibility of the implant and the good functioning of the device

Model of geometrical and smooth muscle tone adaptation of carotid artery subject to step change in pressure

Recent experimental studies have shown significant alterations of the vascular smooth muscle (VSM) tone when an artery is subjected to an elevation in pressure. Therefore, the VSM participates in the adaptation process not only by means of its synthetic activity (fibronectins and collagen) or proliferative activity (hypertrophy and hyperplasia) but also by adjusting its contractile properties and its tone level. In previous theoretical models describing the time evolution of the arterial wall adaptation in response to induced hypertension, the contribution of VSM tone has been neglected. In this study, we propose a new biomechanical model for the wall adaptation to induced hypertension, including changes in VSM tone. On the basis of Hill's model, total circumferential stress is separated into its passive and active components, the active part being the stress developed by the VSM. Adaptation rate equations describe the geometrical adaptation (wall thickening) and the adaptation of active stress (VSM tone). The evolution curves that are derived from the theoretical model fit well the experimental data describing the adaptation of the rat common carotid subjected to a step increase in pressure. This leads to the identification of the model parameters and time constants by characterizing the rapidity of the adaptation processes. The agreement between the results of this simple theoretical model and the experimental data suggests that the theoretical approach used here may appropriately account for the biomechanics underlying the arterial wall adaptation

Doppler-guided regulation of a telemetrically operated adjustable pulmonary banding system

OBJECTIVES: We report on the Doppler-assessed regulation of an adjustable pulmonary artery band (PAB) in an animal model and in our first group of patients. BACKGROUND: Indications for pulmonary artery banding have expanded to include patients requiring a late arterial switch. A telemetry-operated, fully implantable, adjustable PAB system (FloWatch- PAB, Endoart SA, Lausanne, Switzerland) has been developed to facilitate these operations. METHODS: The device was implanted in 13 minipigs (age one to five months, weights 3.2 to 12.0 kg). The main study was performed on nine minipigs with adjustments of the PAB at implantation and at 1, 3, 5, 8, and 12 weeks after, assessed by Doppler pressure gradients. Explanation was performed 12 weeks after surgery. A long-term histology study (6 months and 14 months after surgery) was done on the other four minipigs. After approval by the ethics committee, the device was implanted in eight patients with weights between 2.8 and 9 kg to decrease pulmonary blood flow and pressure and to retrain the left ventricle before arterial switch. The device was progressively tightened, with increasing transband Doppler gradients. Follow-up was one to three months. RESULTS: An excellent correlation between transbanding systolic pressure gradient and degree of PAB constriction was encountered in the minipig study as well as in the human setting. No early or late deaths or reoperations occurred. Malfunction of the device was noted in three of 21 implanted devices. Two were related to surgically inflicted damage at implantation and one to an electronic problem that was fixed by resetting the control device. CONCLUSIONS: The device offers a Doppler-controllable adjustment of pulmonary blood flow. It permits controlled tightening and release of the band, which improves perioperative and postoperative courses and decreases surgical interventions to adjust tightness of the band. It allows a protracted occlusion protocol, which may provide the best effect on retraining the left ventricle

Geometrical, functional, and histomorphometric adaptation of rat carotid artery in induced hypertension

Acute and long-term (up to 56 days) evolution of geometry, structural properties, vascular smooth muscle (VSM) tone and histomorphometric properties of the rat common carotid arteries under induced hypertension were investigated. Hypertension was induced in 8-week old male Wistar rats by total ligation of the aorta between the two kidneys. Rats were sacrificed 2, 4, 8 and 56 days postsurgery. The arterial wall layers thicken non-uniformly during the adaptation process, the inner layers thicken more in the acute phase of hypertension, whereas the outer layers of the wall are thicker than the inner layers at the end of the adaptation phase. Collagen content in the wall media exhibits a non-linear evolution, with a rapid increase in the acute hypertension phase followed by a slower increase at long-term. The elastin content increase is slight and steady, whereas VSM shows a steady but considerable increase which outdoes the collagen increase in long-term phase. VSM tone increases rapidly in the acute phase of remodelling (0-8 days) and this increase in tone contributes to a considerable increase in arterial compliance in the operating pressure range. At long-term (56 days) VSM tone returns to near control level, but compliance is even further increased, which suggests that at long-term the compliance increase is attributed primarily to structural remodelling