Document Detail

Effect of adjustable passive constraint on the failing left ventricle: a finite-element model study.
MedLine Citation:
PMID:  20103222     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Passive constraint is used to prevent left ventricular dilation and subsequent remodeling. However, there has been concern about the effect of passive constraint on diastolic left ventricular chamber stiffness and pump function. This study determined the relationship between constraint, diastolic wall stress, chamber stiffness, and pump function. We tested the hypothesis that passive constraint at 3 mm Hg reduces wall stress with minimal change in pump function.
METHODS: A three-dimensional finite-element model of the globally dilated left ventricle based on left ventricular dimensions obtained in dogs that had undergone serial intracoronary microsphere injection was created. The model was adjusted to match experimentally observed end-diastolic left ventricular volume and midventricular wall thickness. The experimental results used to create the model were previously reported. A pressure of 3, 5, 7, and 9 mm Hg was applied to the epicardium. Fiber stress, end-diastolic pressure-volume relationship, end-systolic pressure-volume relationship, and the stroke volume-end-diastolic pressure (Starling) relationship were calculated.
RESULTS: As epicardial constraint pressure increased, fiber stress decreased, the end-diastolic pressure-volume relationship shifted to the left, and the Starling relationship shifted down and to the right. The end-systolic pressure-volume relationship did not change. A constraining pressure of 2.3 mm Hg was associated with a 10% reduction in stroke volume, and mean end-diastolic fiber stress was reduced by 18.3% (inner wall), 15.3% (mid wall), and 14.2% (outer wall).
CONCLUSIONS: Both stress and cardiac output decrease in a linear fashion as the amount of passive constraint is increased. If the reduction in cardiac output is to be less than 10%, passive constraint should not exceed 2.3 mm Hg. On the other hand, this amount of constraint may be sufficient to reverse eccentric hypertrophy after myocardial infarction.
Choon-Sik Jhun; Jonathan F Wenk; Zhihong Zhang; Samuel T Wall; Kay Sun; Hani N Sabbah; Mark B Ratcliffe; Julius M Guccione
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-03-04     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  132-7     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cardiomyopathy, Dilated / complications,  physiopathology,  therapy*
Computer Simulation*
Disease Models, Animal
Equipment Design
Finite Element Analysis*
Heart Failure / etiology,  physiopathology,  prevention & control*
Heart-Assist Devices*
Imaging, Three-Dimensional
Models, Cardiovascular*
Ventricular Pressure / physiology
Grant Support
5R01 HL063348/HL/NHLBI NIH HHS; 5R01 HL077921/HL/NHLBI NIH HHS; P41 RR008605/RR/NCRR NIH HHS; P41 RR008605-050006/RR/NCRR NIH HHS; P41 RR08605/RR/NCRR NIH HHS; R01 HL063348/HL/NHLBI NIH HHS; R01 HL063348-10A1/HL/NHLBI NIH HHS; R01 HL077921/HL/NHLBI NIH HHS; R01 HL077921-04/HL/NHLBI NIH HHS
Comment In:
Ann Thorac Surg. 2010 Jan;89(1):137-8   [PMID:  20103223 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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