Thesis--Wisconsin. / Includes bibliographical references (leaves 75-80).

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Thesis (M. Sc.)--York University, 1998. Graduate Programme in Exercise and Health Science. / Typescript. Includes bibliographical references (leaves 187-215). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ27389.

The aim of this work was to investigate the physiological adaptations that occur in the maternal cardiovascular system during singleton and twin pregnancy. The cardiovascular system has been shown to undergo major adaptations during human pregnancy. Most investigators agreed that cardiac output increased during pregnancy however there was no unanimity regarding the extent and timing of this increase nor about the physiological mechanisms underlying it. Even less was known about the haemodynamic readjustments following delivery and about the alterations in multiple pregnancy. Further study has been limited by the lack of an accurate noninvasive technique which is applicable and reproducible during pregnancy. Cross-sectional echocardiography combined with Doppler ultrasound measurement of blood velocity provides a noninvasive method for measuring cardiac output at a number of locations within the heart and great vessels. Preliminary investigations revealed that cardiac outputs determined by this method correlated closely with those measured by the direct Fick technique in non-pregnant subjects. In addition the method was highly reproducible in both pregnant and nonpregnant subjects. M-mode echocardiography allows accurate and noninvasive measurements of cardiac chamber size and ventricular function. These measurements were also found to be highly reproducible in pregnant and non-pregnant subjects. Using these techniques the aims of this thesis were to investigate the extent, timing and mechanisms of the changes in cardiac output during singleton and twin pregnancy. Echocardiographic investigations were performed prior to and during singleton pregnancy, during the first 6 months after singleton pregnancy, and during and 6 months after twin pregnancy. All subjects were studied in the left semi-lateral position. The results suggested that; (1) During singleton pregnancy cardiac output was increased early in the first trimester and continued to rise until 24 weeks gestation when values were 43-49% above pre-pregnant control values. Thereafter there was no further change. Heart rate and left ventricular function increased during the first trimester. Left atrial and left ventricular end-diastolic dimensions increased during the second trimester suggesting an increase in venous return. Cardiac valve cross-sectional areas and left ventricular wall thickness also increased during pregnancy. After delivery cardiac output had fallen to non-pregnant values by 2 weeks. This was associated with reductions in left ventricular performance and left atrial and left ventricular end-diastolic dimensions. The decrease in valve cross-sectional areas and left ventricular wall thickness was not evident until later in the puerperium. (2) During twin pregnancy cardiac output was increased by 20 weeks gestation and thereafter showed no further change. Maximum cardiac output was 59-62% above postnatal control values. This increase was greater than that recorded during singleton pregnancy due to a relatively greater increase in heart rate. Twin pregnancy was also associated with a greater increase in left atrial dimension. The results of these studies shed light on some of the the unanswered questions in the field of maternal haemodynamics. The noninvasive Doppler techniques used allowed accurate and reproducible measurements of cardiac output in pregnant subjects. This work has important implications for the future investigation of cardiac and hypertensive disorders during pregnancy.

Thesis (M.S.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains viii, 91 p. : ill. (some col.) Includes abstract. Includes bibliographical references (p. 67-69).

Based on data from my in-vitro investigation in the non-pulsatile flow test rig, my best estimate for the random (inter-reading) error was +/-10.0% (95% c.i.) for single and +/-5.8% for triplicate readings and the systematic (between catheters) error was +/-11.6%. Thus, the overall error was +/-15.3% for a single, and +/-13.0% for triplicate readings. / For the in-vitro model, a test rig through which water circulated at different rates with ports to insert catheters into a flow chamber was assembled. Flow rate was measured by an externally placed transonic flow probe and meter. The meter was calibrated by timed filling of a cylinder. Arrow and Edwards 7Fr thermodilution catheters, connected to a Siemens SC9000 cardiac output monitor, were tested. Thermodilution readings were made by injecting 5 mL of ice-cold water. Measurement error was divided into random and systematic components, which were determined separately. Between-readings (random) variability was determined for each catheter by taking sets of 10 readings at different flow rates. Coefficient of variation (CV) was calculated for each set and averaged. Between-catheters systems (systematic) variability was derived by plotting calibration lines for sets of catheters. Slopes were used to estimate the systematic component. Performances of three cardiac output monitors were compared: Siemens SC9000, Siemens Sirecust 1261, and Philips MP50. After the constant rate model, I also developed a pulsatile model and did a similar evaluation. / For the in-vivo model, ten domestic pigs, weight 27--32kg, were anaesthetized with propofol and ketamine infusion. The aortic flow probe was surgically placed via a left thoracotomy. A pulmonary artery catheter sheath was inserted in the right internal jugular vein. Both Arrow and Edwards catheters were used. A 10 ml, room temperature, saline injectate was used and cardiac output was calculated using the Seimens SC9000 monitor. Sets of cardiac output readings were taken over 5 minute intervals of stable haemodynamics. Catheters were frequently changed and cardiac output increased (e.g. Dopamine and Adrenaline) and decreased (e.g. Trinitrate and Beta-Blocker) using drug infusions. Baseline (e.g. no drug intervention) and drug treatment data were analyzed separately. / For the pulsatile model, the best estimate for the random (inter-reading) error (95% c.i.) was +/-16.7% for single and +/-9.7% for triplicate readings and the systematic (between catheters) error was +/-21.1 %. Thus, the overall error was +/-26.9% for a single, and +/-23.2% for triplicate readings. / I set out to evaluate in the pig model two types of measurement errors, random and systematic errors, which I defined using the test rig in-vitro, the coefficient of variation (CV) was +2.8% (95% c.i.), with random error (95% c.i.) of + 5.5%. But if the ranges of cardiac output was widened, the error was increased to + 19.3% . The systematic component ofthe error (95% c.i.) was +20.0%. / There was a good linear regression relationship between the two methods (e.g. thermodilution and flow probe). The mean correlation coefficient was 0.95 (0.9--0.99, 95% c.i.) based on data from 8 pigs'. However, there were significant systematic errors due to calibration of the measurement systems between pig experiment and catheter testings. By eliminating the systematic errors based on the calibration line corrections, I was able to draw modified Bland and Altman plots for the 8 pigs. The bias was eliminated and become 0 L/min. The limits of agreement or percentage errors of this analysis, were within the +/-30% limits. / Thermodilution cardiac output, measured using a pulmonary artery catheter and cardiac output monitor, is the reference standard against which all new methods of cardiac output measurement are judged. There has been a recent decline in the use of pulmonary artery thermodilution cardiac output in favour of less invasive methods. When validating these new methods comparisons are made using Bland and Altman analysis with single bolus thermodilution as the accepted reference method. 95% confidence intervals and percentage errors are generated that rely on a precision of +/-20% (Stetz et al (1982)) for thermodilution measurements. However, this precision is now being questioned as it is based on data collected over 30-years ago. Lack of precision of this reference standard, and uncertainty about its true values, causes difficulty when validating new cardiac output technology. Thus, the aim of this thesis was to reappraise the error of thermodilution by testing currently available catheters in both in-vitro and in-vivo settings. / When testing in haemodynamically unstable conditions (e.g. high and low flow states), the percentage error was increased by about +/-15% in the treatment groups comparing with baseline group data. This finding was in agreement with the growing world opinion that thermodilution may not be as accurate as originally thought, in extreme haemodynamic conditions, such as hypovolaemia or high cardiac output states. / Yang, Xiaoxing. / Adviser: Lester August Hall Critchley. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Thesis (M.S.)--University of Michigan, 1979.

Thesis (M.S.)--University of Michigan, 1979.

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