Browsing by Department "Division of Cardiothoracic Surgery"

Now showing 1 - 10 of 10
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    A theoretical study of left ventricular and heart muscle dynamics
    (1973) Hadingham, Paul Trahair; Milner, Morris
    The characteristics of the left ventricle of the human heart considered as a pump have been extensively analysed. Using a new approach relying heavily on the Tensor Calculus, a theoretical model describing the mechanical and dynamical operation of the left ventricle has been developed. This has considerably greater versatility than previously proposed models. In particular the physiological shape, both under normal as well as many abnormal situations, is realistically simulated. Further, the mechanical behaviour of the ventricular wall is synthesised from anatomical data concerning the cardiac muscle fibre structure of the wall. Its mechanical and dynamical properties are then, as in the physiological situation, dependent on those of the muscle fibre. These fibre properties have also been fully investigated and a simple new model for cardiac muscle dynamics, incorporating active state, proposed. This description of the ventricular behaviour in terms of muscle properties represents the first logically structured link between cardiac muscle fibre characteristics and ventricular performance.
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    Dilatation in the femoral vascular bed does not cause retrograde relaxation of the iliac artery in the anaesthetized pig
    (2008) Markos, F; Ruane‐O’Hora, T; Snow, H M; Kelly, R; Wainwright, C; Skene, K; Drake-Holland, A J; Noble, M I M
    Aim:  We tested the hypothesis that dilatation of a feeding artery may be elicited by transmission of a signal through the tissue of the arterial wall from a vasodilated peripheral vascular bed. Methods:  In eight pentobarbital anaesthetized pigs, acetylcholine (ACh, an endothelium-dependent vasodilator) was injected intra-arterially above (upstream) and below (downstream) a test segment of the left iliac artery, the diameter of which was measured continuously by sonomicrometry. Results:  Under control conditions, ACh injections upstream and downstream of the test segment caused dilatation. Downstream injection dilated the peripheral arterioles, resulting in increased blood flow and proximal dilatation. This is a shear stress, nitric oxide (NO)-dependent response. The experiment was then repeated after applying a stenosis to prevent the increased flow caused by downstream injection of ACh; the stenosis was placed either above the site of diameter measurement to allow retrograde conduction, or below that site to prevent distally injected ACh reaching the measurement site. Under these conditions, downstream injection of ACh had a minimal effect on the shear stress of the test segment with no increase in test segment diameter. This was not due to endothelial damage or dysfunction as injection of ACh upstream still caused a large increase in test segment diameter. Conclusions:  Our results indicate that dilatation of the feeding artery of a vasodilated bed is caused by increased shear stress within the feeding artery and not via a signal transmitted through the arterial wall from below.
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    Long-Term Left Ventricular Remodelling in Rat Model of Nonreperfused Myocardial Infarction: Sequential MR Imaging Using a 3T Clinical Scanner
    (2012) Saleh, Muhammad G; Sharp, Sarah-Kate; Alhamud, Alkathafi; Spottiswoode, Bruce S; van der Kouwe, André J W; Davies, Neil H; Franz, Thomas; Meintjes, Ernesta M
    Purpose. To evaluate whether 3T clinical MRI with a small-animal coil and gradient-echo (GE) sequence could be used to characterize long-term left ventricular remodelling (LVR) following nonreperfused myocardial infarction (MI) using semi-automatic segmentation software (SASS) in a rat model. Materials and Methods. 5 healthy rats were used to validate left ventricular mass (LVM) measured by MRI with postmortem values. 5 sham and 7 infarcted rats were scanned at 2 and 4 weeks after surgery to allow for functional and structural analysis of the heart. Measurements included ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and LVM. Changes in different regions of the heart were quantified using wall thickness analyses. Results. LVM validation in healthy rats demonstrated high correlation between MR and postmortem values. Functional assessment at 4 weeks after MI revealed considerable reduction in EF, increases in ESV, EDV, and LVM, and contractile dysfunction in infarcted and noninfarcted regions. Conclusion. Clinical 3T MRI with a small animal coil and GE sequence generated images in a rat heart with adequate signal-to-noise ratio (SNR) for successful semiautomatic segmentation to accurately and rapidly evaluate long-term LVR after MI.
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    Paravalvular sealing pf percutaneous heart valves
    (2019) Conradie, David Gideon; Bezuidenhout, Deon; De Villiers, Jandre
    Paravalvular regurgitation (PVR), which frequently occurs after transcatheter aortic valve replacements (TAVR) can lead to adverse clinical consequences and has been shown to correlate to an increased late mortality and morbidity. Quantification, graduation and testing for PVR has proven challenging and a standardized method for pre-clinical testing is still sought. Commercial transcatheter heart valves (THV's) rely on sealing skirts made from treated pericardium or polyethylene terephthalate (PET) fabrics. The current study was aimed at developing novel electrospun skirts for the minimization of PVR in THV's. Thermoplastic polyurethane (TPU) was electrospun onto mandrels and several techniques (CO2 - laser, ultra-sonic, solvent and conductive heat bonding) used to attach the scaffolds to pre-coated TAVR stents. Attachment strength was modelled by finite element analysis (FEA) of stents in the crimped and expanded conditions and empirically determined by physical pull-off tests. PVR was evaluated for four different skirt designs (1× single layer “FLAT” and 3× double layers: Forward Flow Filling “FFF”, No Filling “NF” and Back Flow Filling “BFF”) using a pulse duplicator fitted with perforated mounting rings. Optimization of solution, process and environmental parameters yielded scaffolds with average fibre diameters of 3.17 ± 0.64 μm and average pore sizes 9.52 ± 6.90 μm. Tensile strength was found to be similar in the direction perpendicular to collector rotation [Abstract incomplete due to DSpace NOT being able to accommodate some formulas and equations in the abstract, BS]
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    PROSE: Prospective Randomized Trial of the On-X Mechanical Prosthesis and the St Jude Medical Mechanical Prosthesis Evaluation
    (2021-11-03) Jamieson, W R E; Ely, John L; Brink, Johan; Pennel, Timothy; Bannon, Paul; Patel, Jashvant; Kumar Gupta, Rajiv; Mohan Rao, Prasanna S; Agrawal, Damyanti; Wiklund, Lars; Kappetein, A P; Haaverstad, Rune; Geisner, Thomas; Doenst, Torsten; Schlensak, Christian; Nair, Salgunan; Brown, Craig; Siepe, Matthias; Damiano, Ralph J; Langlois, Yves; Cherian, K M; Azar, Hormoz; Chen, John C; Bavaria, Joseph E; Fedoruk, Lynn M; Munfakh, Nabil A; Sridhar, V; Scholz, Peter M; Pfeffer, Thomas A; Ye, Jian
    Objectives The PROSE trial purpose is to investigate whether the incidence of thromboembolic—related complications is reduced with a current generation mechanical prosthesis (On-X Life Technologies/CryoLife Inc.—On-X) compared with a previous generation mechanical prosthesis (St Jude Medical—SJM). The primary purpose of the initial report is to document the preoperative demographics, and the preoperative and operative risk factors by individual prosthesis and by Western and Developing populations. Methods The PROSE study was conducted in 28 worldwide centres and incorporated 855 subjects randomized between 2003 and 2016. The study enrollment was discontinued on August 31, 2016. The preoperative demographics incorporated age, gender, functional class, etiology, prosthetic degeneration, primary rhythm, primary valve lesion, weight, height, BSA and BMI. The preoperative and operative evaluation incorporated 24 risk factors. Results The total patient population (855) incorporated On-X population (462) and the St Jude Medical population (393). There was no significant difference of any of the preoperative demographics between the On-X and SJM groups. The preoperative and operative risk factors evaluation showed there was no significant difference between the On-X and St Jude Medical populations. The preoperative and operative risk factors by valve position (aortic and mitral) also documented no differentiation. The dominant preoperative demographics of the Western world population were older age, male gender, sinus rhythm, aortic stenosis, congenital aortic lesion, and mitral regurgitation. The dominant demographics of the Developing world population were rheumatic etiology, atrial fibrillation, aortic regurgitation, mixed aortic lesions, mitral stenosis and mixed mitral lesions. The Developing world group had only one significant risk factor, congestive heart failure. The majority of the preoperative and operative risk factors were significant in the Western world population. Conclusions The preoperative demographics do not differentiate the prostheses but do differentiate the Western and Developing world populations. The preoperative and operative risk factors do not differentiate the prostheses BUT do differentiate the Western and Developing world populations.
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    Thoracic amoebiasis : a clinical study.
    (1964) Macleod, Ian Nevis
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    Ultrasonography Evaluation of Patency of Implanted Infra-Renal Vascular Grafts in the Rat Model.
    (2020) Da Silva, Natercia; Pennel, Timothy; Bezuidenhout, Deon; Hadebe, Nkanyiso; Zilla, Peter
    Introduction: Intensive research over the last six decades has resulted in minimal improvement in vascular graft development. Small animal models are the first line of species exposed to vascular graft implantation and invasive monitoring of experimental graft patency may contribute to pain, suffering, higher cost and earlier sacrifice. Non-invasive ultrasonographic evaluation of vascular implants during the conduction of animal studies allows for chronic follow-up with multiple assessments. This study aims to apply and endorse the utilization of ultrasound as a less invasive diagnostic method in determining patency of vascular grafts in units where imaging modalities like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are not readily available. Methods: Pre-operative control ultrasound evaluation of the ejection fraction, aortic diameter and aortic velocity were conducted on Wistar rats (250-350g). Infra-renal aortic vascular graft implantation was then performed, with 8 rats receiving straight (1.8mm ID, 18mm length) expanded polytetrafluoroethylene (ePTFE) grafts, while 12 rats received a long (1.8mm ID, 100mm length) looped ePTFE conduit with a sealed mid-graft (10mm length) section. Ultrasonography was conducted on days 1, 3, 7 and weeks 4, 8 and 12 post operatively. Grafts were explanted if there was any ultrasonographic evidence of occlusion or at twelveweek termination of the study. Explant was preceded by angiography and followed by histological assessment of the grafts for patency. Results: Three of the looped and all 8 of the straight grafts were patent at the 12 week explant time point, as correctly assessed by ultrasound and confirmed by angiography and histology. Three of the nine occluded looped grafts were explanted at eight weeks due to early ultrasonographic detection of occlusion; the remaining 6 were explanted at twelve weeks. There were two false positive results, which were incorrectly assessed as patent at twelve weeks of implantation on ultrasonographic evaluation, but confirmed to be occluded on angiography at explant. The results of ultrasonography evaluation of implanted infra-renal vascular grafts had a high specificity of 100% with a sensitivity of 78%. The outcome of the results between ultrasound and angiography corresponded in 18 out of 20 vascular grafts, with a calculated positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 85%. 4 Conclusion: Ultrasound is easily available and a non-invasive diagnostic modality allowing for safe and reliable results, which may be repeated at different time frames following vascular implants in small animal models. Ultrasonographic limitations exist, emphasizing the need for an experienced operator with adequate knowledge and training. Its use may be complicated by tortuous geometries of vessels, which is technically more challenging to evaluate with ultrasound than with imaging techniques like CT and MRI. It does, however, add information without additional loss of life or increased use of animal numbers. Ultrasound is an essential additive diagnostic tool for chronic follow-up and evaluation of vascular graft implants.