A Modified Elastance Model to Control Mock Ventricles in Real-Time: Numerical and Experimental Validation

This article describes an elastance-based mock ventricle able to reproduce the correct ventricular pressure-volume relationship and its correct interaction with the hydraulic circuit connected to it. A real-time control of the mock ventricle was obtained by a new left ventricular mathematical model including resistive and inductive terms added to the classical Suga-Sagawa elastance model throughout the whole cardiac cycle. A valved piston pump was used to mimic the left ventricle. The pressure measured into the pump chamber was fed back into the mathematical model and the calculated reference left ventricular volume was used to drive the piston. Results show that the classical model is very sensitive to pressure disturbances, especially during the filling phase, while the modified model is able to filter out the oscillations thus eliminating their detrimental effects. The presented model is thus suitable to control mock ventricles in real-time, where sudden pressure disturbances represent a key issue and are not negligible. This real-time controlled mock ventricle is able to reproduce the elastance mechanism of a natural ventricle by mimicking its preload (mean atrial pressure) and afterload (mean aortic pressure) sensitivity, i.e., the Starling law. Therefore, it can be used for designing and testing cardiovascular prostheses due to its capability to reproduce the correct ventricle-vascular system interaction.

[1]  W J KOLFF,et al.  Mock circulation to test pumps designed for permanent replacement of damaged hearts. , 1959, Cleveland Clinic quarterly.

[2]  K. Sagawa,et al.  End‐Systolic Pressure Determines Stroke Volume from Fixed End‐Diastolic Volume in the Isolated Canine Left Ventricle under a Constant Contractile State , 1979, Circulation research.

[3]  George M Pantalos,et al.  Characterization of an Adult Mock Circulation for Testing Cardiac Support Devices , 2004, ASAIO journal.

[4]  H. Suga,et al.  Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. , 2005, American journal of physiology. Heart and circulatory physiology.

[5]  James B. Young,et al.  Healing the heart with ventricular assist device therapy: mechanisms of cardiac recovery. , 2001, The Annals of thoracic surgery.

[6]  Abraham Noordergraaf,et al.  Reduced Models of Arterial Systems , 1985, IEEE Transactions on Biomedical Engineering.

[7]  Brad E. Paden,et al.  Fluidic operational amplifier for mock circulatory systems , 2006, 2004 43rd IEEE Conference on Decision and Control (CDC) (IEEE Cat. No.04CH37601).

[8]  George M Pantalos,et al.  Left Ventricular and Myocardial Perfusion Responses to Volume Unloading and Afterload Reduction in a Computer Simulation , 2004, ASAIO journal.

[9]  D. Kass,et al.  Marked discordance between dynamic and passive diastolic pressure-volume relations in idiopathic hypertrophic cardiomyopathy. , 1996, Circulation.

[10]  F M Donovan,et al.  Design of a hydraulic analog of the circulatory system for evaluating artificial hearts. , 1975, Biomaterials, medical devices, and artificial organs.

[11]  N. Westerhof,et al.  An artificial arterial system for pumping hearts. , 1971, Journal of applied physiology.

[12]  J D Thomas,et al.  Numeric modeling of the cardiovascular system with a left ventricular assist device. , 1999, ASAIO journal.

[13]  G. Ferrari,et al.  Development of a Hybrid (numerical-hydraulic) Circulatory Model: Prototype Testing and Its Response to IABP Assistance , 2005, The International journal of artificial organs.

[14]  M. Arabia,et al.  A new test circulatory system for research in cardiovascular engineering , 2006, Annals of Biomedical Engineering.

[15]  T. Nozawa,et al.  Modulation of left ventricular diastolic distensibility by collateral flow recruitment during balloon coronary occlusion. , 1999, Journal of the American College of Cardiology.

[16]  W. E. Craig,et al.  Nonobstructive left ventricular ejection pressure gradients in man. , 1987, Circulation research.

[17]  M Arabia,et al.  Modeling, analysis, and validation of a pneumatically driven left ventricle for use in mock circulatory systems. , 2007, Medical engineering & physics.

[18]  As Arris Tijsseling,et al.  FLUID-STRUCTURE INTERACTION IN LIQUID- FILLED PIPE SYSTEMS : A REVIEW , 1996 .

[19]  Internal capacitance and resistance allow prediction of right ventricle outflow. , 1982, The American journal of physiology.

[20]  S. Nakatani,et al.  Diastolic suction in the human ventricle: observation during balloon mitral valvuloplasty with a single balloon. , 1994, American heart journal.

[21]  W L Maughan,et al.  Effect of Arterial Impedance Changes on the End‐Systolic Pressure, Volume Relation , 1984, Circulation research.

[22]  H Reul,et al.  Compact Mock Loops of the Systemic and Pulmonary Circulation for Blood Pump Testing , 1992, The International journal of artificial organs.

[23]  A. Y. Wong,et al.  Mechanics of cardiac muscle, based on Huxley's model: mathematical stimulation of isometric contraction. , 1971, Journal of biomechanics.

[24]  M Arabia,et al.  Hybrid test bench for evaluation of any device related to mechanical cardiac assistance. , 2005, The International journal of artificial organs.

[25]  A. Shoukas,et al.  Load Independence of the Instantaneous Pressure‐Volume Ratio of the Canine Left Ventricle and Effects of Epinephrine and Heart Rate on the Ratio , 1973, Circulation research.

[26]  W L Maughan,et al.  Factors affecting the end-systolic pressure-volume relationship. , 1984, Federation proceedings.

[27]  K Sagawa,et al.  Models of ventricular contraction based on time-varying elastance. , 1982, Critical reviews in biomedical engineering.

[28]  J. F. Antaki,et al.  Elastance-Based Control of a Mock Circulatory System , 2001, Annals of Biomedical Engineering.

[29]  F. Colacino,et al.  Left Ventricle Load Impedance Control by Apical VAD Can Help Heart Recovery and Patient Perfusion: A Numerical Study , 2007, ASAIO journal.

[30]  A. Selzer Circulatory Physiology—Cardiac Output and Its Regulation ed 2. , 1974 .

[31]  R Hetzer,et al.  Cardiac recovery in dilated cardiomyopathy by unloading with a left ventricular assist device. , 1999, The Annals of thoracic surgery.

[32]  A. Redaelli,et al.  Intraventricular pressure drop and aortic blood acceleration as indices of cardiac inotropy: a comparison with the first derivative of aortic pressure based on computer fluid dynamics. , 1998, Medical engineering & physics.

[33]  P. Ask,et al.  Mathematical model that characterizes transmitral and pulmonary venous flow velocity patterns. , 1995, The American journal of physiology.

[34]  A. Pasipoularides,et al.  Clinical assessment of ventricular ejection dynamics with and without outflow obstruction. , 1990, Journal of the American College of Cardiology.

[35]  H Suga,et al.  Determinants of Instantaneous Pressure in Canine Left Ventricle: Time and Volume Specification , 1980, Circulation research.

[36]  Analysis of LVADs in a controlled mock systemic circulation , 2006 .

[37]  Georg Wieselthaler,et al.  Interaction of the cardiovascular system with an implanted rotary assist device: simulation study with a refined computer model. , 2002, Artificial organs.

[38]  F Piedimonte Banco prova per la valutazione di dispositivi di assistenza ventricolare (VAD): progettazione e prove sperimentali , 2007 .

[39]  R. Applegate,et al.  Cardiac Contraction and the Pressure-Volume Relationship , 1990 .

[40]  W L Maughan,et al.  Contribution of External Forces to Left Ventricular Diastolic Pressure: Implications for the Clinical Use of the Starling Law , 1995, Annals of Internal Medicine.