by Cheuk Man Yu. / Thesis (M.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 211-237). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

This thesis examined the effect of heat stress, dehydration and exercise on global left ventricular (LV) function and LV twist, untwisting and strain (LV mechanics) in healthy individuals. The primary aim was to identify whether the different haemodynamics induced by heat stress, dehydration and exercise would be associated with alterations in systolic and diastolic LV mechanics as assessed by two-dimensional speckle tracking echocardiography. Study one showed that enhanced systolic and diastolic LV mechanics during progressively increasing heat stress at rest likely compensate in part for a lower venous return, resulting in a maintained stroke volume (SV). In contrast, heat stress during knee-extensor exercise did not significantly increase LV twist, suggesting that exercise attenuates the increase in LV mechanics seen during passive heat stress. Study two revealed that dehydration enhances systolic LV mechanics whilst diastolic mechanics remain unaltered at rest, despite pronounced reductions in preload. The maintenance of systolic and diastolic LV mechanics with dehydration during knee-extensor exercise further suggests that the large decline in SV with dehydration and hyperthermia is caused by peripheral cardiovascular factors and not impaired LV mechanics. During both, heat stress and dehydration, enhanced systolic mechanics were achieved solely by increases in basal rotation. In contrast, the third study demonstrated that when individuals are normothermic and euhydrated, systolic and diastolic basal and apical mechanics increase significantly during incremental exercise to approximately 50% peak power. The subsequent plateau suggests that LV mechanics reach their peak at sub-maximal exercise intensities. Together, the present findings emphasise the importance of acute adjustments in both, basal and apical LV mechanics, during periods of increased cardiovascular demand.

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<p> A stress analysis of porcine aortic valve leaflets in diastole at 80 mm. Hg. in-vitro is presented. Incorporations of local surface geometry, leaflet material inhomogeneity, anisotropy and non-linearity are applied. The stress theory used is a modified form of the thin membrane stress theory for a homogeneous, linearly elastic and orthotropic lamina. Modifications are made so that the linear Hooke's Law equations of stress may be applied to the inhomogeneous, non-linearly elastic and orthotropic thin membrane aortic valve leaflets. </p> <p> Stress calculations are made on the premise that the diastolic valve leaflets at 80 mm. Hg. are in pre-transition (that is, characterized by a small elastic modulus) for the circumferential direction, and in post-transition (that is, characterized by a large elastic modulus) for the radial direction. Circumferential stresses are calculated to be relatively negligible; they are estimated to be less than 1 gm/mm². Radial stresses for the non coronary leaflet lie primarily in the 0 to 20 gm/mm² range. The regions of the largest stress concentrations are in the areas of mutual leaflet coaptation, especially near the Nodes of Aranti. A progressive increase of the radial stresses from the sinus annulus edges toward the coaptation edges of the leaflets is also observed. Based on the one valve reported , it appears that the left coronary leaflet is the highest stressed and the right coronary leaflet is the least stressed. Central leaflet radial stresses for the right coronary leaflet are in the 0 to 10 gm/mm² range, as compared to 0 to 20 gm/mm² for the non coronary and left coronary leaflets. </p> <p> The question as to whether the diastolic strains of the valve leaflets are in pre-transition, transition or post-transition is raised. The resolution of the question is seen to be critical to the validity of the stress analysis. It is also realized that further improvements in the analysis are possible through improvements and refinements to the experimental methods used in obtaining the necessary inputs for the analysis. </p> / Thesis / Master of Engineering (ME)

Left ventricular diastole (filling) is a complex process with many features and coupled compensatory mechanisms which coordinate to maintain optimal filling and ejection of the left ventricle. Diastolic filling is controlled by the left ventricular recoil, relaxation, and compliance as well as atrial and ventricular pressures making left ventricular diastolic dysfunction very difficult to understand and diagnose. An improved understanding of these unique flows is important to both the fundamental mechanics of the cardiac diastolic filling as well as the development of novel and accurate diagnostic techniques. This work includes studies of in-vivo and in-vitro vortex rings. Vortex rings created in the left ventricle past the mitral valve during diastole are produced in a confined domain and are influenced by the left ventricular walls. Therefore, an in-vitro analysis of the formation and decay of vortex rings within confined cylindrical domains using particle image velocimetry was conducted. Varying mechanisms of vortex ring breakdown were observed over a wide range of Reynolds numbers, and an analytical model for vortex ring circulation decay of laminar vortex rings was developed. Also, in this work a novel method for analyzing color M-mode echocardiography data using a newly developed automated algorithm is introduced which examines the pressure gradients and velocities within the left ventricle. From this analysis, a new diagnostic filling parameter is introduced which displays a greater probability of detection of diastolic dysfunction over the conventionally used diagnostic parameter. / Ph. D.

Background: Myocardial failure and dysfunction is not uncommon during critical illness and following cardiac surgery. For optimal treatment, a better understanding of the effects of inotropic drugs is needed. In this thesis, two non-adrenergic mediated inotropes, milrinone and levosimendan were studied in different models of myocardial dysfunction. The study aims were to assess the following: the effects of milrinone on blood flow in coronary artery bypass grafts during CABG surgery; the effects of milrinone on left ventricular diastolic function during post-ischaemic myocardial dysfunction; whether milrinone or levosimendan are protective or injurious during acute myocardial ischaemia, and if levosimendan potentiates myocardial function when added to milrinone in an experimental model of post-ischaemic (stunned) myocardium. Material and Methods: In Study I, 44 patients undergoing coronary artery bypass surgery(CABG) were included as subjects. Milrinone or saline was administrated in a single dose during cardio-pulmonary bypass (CPB) and coronary graft flow measurements were recorded after 10 and 30 min following CPB. In Study II; 24 patients undergoing CABG had estimations of peak ventricular filling rates made before and after CPB with administration of milrinone or saline as a single dose during CPB, performed by assessment of the rate of change in diastolic cross-sectional left ventricular area. In Study III, energy-metabolic effects of milrinone and levosimendan were measured in an anaesthetized porcine model during 45 minutes of regional myocardial ischemia. Microdialysis sampling of metabolites of local ischemic metabolism allowed assessment of glycolytic activity and the degree of myocardial calcium overload. In Study IV, in a porcine model of postischaemic myocardial stunning, ventricular pressure-volume relationships were analyzed when milrinone or a combination of milrinone and levosimendan were given together. Results: In Study I, there was a clear increase in non-sequential saphenous vein graft blood flow with milrinone at 10 minutes (64.5 ± 37.4 compared to placebo 43.6 ± 25.7 ml/min (mean ± SD).). A decreasing but still measureable flow increase was seen for milrinone at 30 minutes. In Study II, an increase in early left ventricular filling rate (ventricular cross-sectional area rate of change,dA/dt) was seen in the milrinone treated group. Pre-bypass milrinone group dA/dt 22.0 ± 9.5 changed to post-bypass values dA/dt 27.8 ± 11.5 cm2/sec). Placebo group pre-bypass dA/dt was 21.0 ± 8.7 and post-bypass 17.1 ± 7.1 cm2/sec. A milrinone effect was demonstrated in an adjusted regression model (p = 0.001). In Study III, neither milrinone nor levosimendan led to a change in energy-metabolic activity during ischemia as reflected by interstitial glucose, pyruvate, lactate orglycerol. Neither drug exacerbated the relative myocardial calcium overload during ischemia. In Study IV, milrinone improved active relaxation (tau) in post-ischemic stunned myocardium, but did not markedly improve systolic function by preload recruitable stroke work. Levosimendan added to milrinone showed minimal effect on active relaxation but a positive effect on systolic function in combination with milrinone. Conclusions: We conclude that milrinone treatment leads to an increase in blood flow in newly implanted coronary saphenous vein grafts, and improves ventricular relaxation post-cardiopulmonary bypass. Neither milrinone nor levosimendan, in this porcine model, negatively influence myocardial energy metabolism or calcium overload during acute ischaemia. Addition of levosimendan to milrinone treatment during post-ischaemic ventricular dysfunction may provide additive inotropic effects on systolic function but probably not for active relaxation.

Reproduction de : Thèse doctorat : Sciences des activités physiques et sportives : Reims : 2007. / Titre provenant de l'écran titre. Bibliogr. p. 112-124.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2008. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Western Australia, 2006.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.