Fabrizio Clemente

A hybrid mock circulatory system: Testing a prototype under physiologic and pathological conditions

Hydraulic models of circulation are used to test mechanical heart assist devices and for research and training purposes. However, when compared with numerical models, they are rather expensive and often not sufficiently flexible or accurate. Flexibility and accuracy can be improved by merging numerical models with physical models, thus obtaining a hybrid model where numerical and physical sections are connected by an electrohydraulic interface.This concept is applied here to represent left ventricular function. The resulting hybrid model is inserted into the existing closed loop model of circulation. The hybrid model reproduces ventricular function by a variable elastance numerical model. Its interaction with the hydraulic sections is governed by measuring left atrial and systemic arterial pressures and computing the left ventricular output flow by the resolution of the corresponding equations. This signal is used to control a flow generator reproduced by a gear pump driven by a DC motor.Results obtained under different circulatory conditions demonstrate the behavior of the ventricular model on the pressure-volume plane and report the trend of the main hemodynamic variables.

Computer simulation of haemodynamic parameters changes with left ventricle assist device and mechanical ventilation.

Left Ventricular Assist Device is used for recovery in patients with heart failure and is supposed to increase total cardiac output, systemic arterial pressure and to decrease left atrial pressure. Aim of our computer simulation was to assess the influence of Left Ventricular Assist Device (LVAD) on chosen haemodynamic parameters in the presence of ventilatory support. The software package used for this simulation reproduces, in stationary conditions, the heart and the circulatory system in terms of pressure and volume relationships. Different circulatory sections (left and right heart, systemic and pulmonary arterial circulation, systemic and pulmonary venous circulation) are described by lumped parameter models. Mechanical properties of each section are modelled by RLC elements. The model chosen for the representation of the Starlings law of the heart for each ventricle is based on the variable elastance model. The LVAD model is inserted between the left atrium and the aorta. The contractility of the heart and systemic arterial resistance were adjusted to model pathological states. Our simulation showed that positive thoracic pressure generated by mechanical ventilation of the lungs dramatically changes left atrial and pulmonary arterial pressures and should be considered when assessing LVAD effectiveness. Pathological changes of systemic arterial resistance may have a considerable effect on these parameters, especially when LVAD is applied simultaneously with mechanical ventilation. Cardiac output, systemic arterial and right atrial pressures are less affected by changes of thoracic pressure in cases of heart pathology.

Low-Invasive Diagnosis of Metallic Prosthesis Osseointegration by Electrical Impedance Spectroscopy

In this paper, a digital-measurement method for low-invasive clinical diagnosis of metallic prosthesis osseointegration is proposed. Electrical impedance spectroscopy is exploited to characterize the quality of the tissue at the interface between the bone and the prosthesis. The method overcomes current resolution limits of biological electrical-impedance analysis by means of several polarization levels. Electrical modeling through an equivalent circuit is used to define a quantitative index of osseointegration. In vitro experimental results of the proposed method validation show its sensitivity and its effectiveness in low-depth prostheses, such as in dentistry applications

A piezo-film-based measurement system for global haemodynamic assessment

A non-invasive piezo-film-based measurement method for haemodynamic assessment is proposed. The design of a system, able to reconstruct the blood pressure waveform online by dealing with problems arising from the piezo-film capacitive nature in the targeted frequency range (from quasi-dc up to 12 Hz), is illustrated. The system is based on a commercial piezo-film placed easily on the radial artery with a special brace without any discomfort for the patient. The analogical conditioning circuit and digital signal processing are continuously tuned with the signal from the sensor to reconstruct the blood pressure signal online. Diagnostic schema, based on physio-pathological models, have been implemented in order to compute online trends of max[dP(t)/d(t)] and volemic status highly useful for the intensivist and anaesthesiologist. The system was characterized by numerical simulation and experimental in vivo comparison to the traditional reference system.

A flexible FFT algorithm for processing biomedical signals using a personal computer.

The aim was to demonstrate the possibility of using personal computer PC-DOS (or generally MS-DOS) for real-time (or quasi real-time) biomedical signal processing by adding a simple A/D conversion card and the mathematical coprocessor XXX87. We have realized an assembly written fast Fourier transform (FFT) routine derived from a radix-4 algorithm, which is autogenerated, i.e. an algorithm modified by another algorithm running off-line according to the number of FFT points. The program is implemented as a subroutine to be called upon by high-level language in different procedures. This approach reduces the computational time, which is particularly useful when many Fourier transforms on different data arrays are required. Reported here are two different applications of the routine as applied to the spectral analysis of Doppler ultrasound velocimetry and surface electromyography.

The influence of left ventricle assist device and ventilatory support on energy-related cardiovascular variables

One of the main purposes in using Left Ventricle Assist Devices (LVAD) to assist recovery in patients with heart failure, is to reduce the external work (EW) of the left natural ventricle. The simultaneous presence of mechanical ventilatory support can affect the value of this variable. The aim of our computer simulation was to trace the influence of LVAD on EW, cardiac mechanical efficiency (CME) and pressure volume area (PVA) in the presence of ventilatory support. Pathological conditions of the heart were reproduced. Peripheral systemic arterial resistance (Ras) was also changed to model physiological and pathological states. The influence of mechanical ventilation was introduced by changing levels of mean thoracic pressure. In this way we were able to predict changes of EW, CME and PVA in both ventricles, during ventilatory (mechanical) and cardiovascular (LVAD) support. Our simulation showed that positive thoracic pressure seems to affect the energy-related cardiovascular variables and should be taken into account during the assessment of LVAD effectiveness. Pathological changes of systemic peripheral resistance have a considerable effect on EW, CME and PVA of left ventricle. On the other hand energy-related parameters of the right ventricle are not especially affected by changes in systemic peripheral resistance.

Monitoring of Fixture Osteointegration after BAHA® Implantation

The osteointegration phase of BAHA® fixture was assessed via electrical impedance spectroscopy in BAHA® implantees. Measurements were carried out by using a prototype device and were correlated with previously published histological data obtained at certain times after surgery, i.e. 1–2 days, 1 week, 1 and 3 months. Module variations of impedance spectra were found to be in agreement with the different pathophysiological conditions of bone ingrowth. The proposed methodology has shown to be promisingly reliable to properly monitor BAHA fixture osteointegration.

Study of systolic pressure variation (SPV) in presence of mechanical ventilation.

Systolic pressure variation (SPV) and its components (dUp and dDown) have been demonstrated to be of interest in assessing preload in mechanically ventilated patients. The aim of this paper is to analyse the sensitivity of these variables to preload and volemic changes during mechanical ventilation in different conditions of the cardiovascular system. Computer simulation experiments have been done using a modular lumped parameter model of the cardiovascular system. The effect of mechanical ventilation has been reproduced operating on intrathoracic pressure. Experiments have been performed varying preload through filling pressure. Sensitivity of SVP, dUp and dDown is described varying separately left ventricular elastance (Ev), systemic arterial resistance (Ras) and systemic arterial compliance (Cas). The sensitivity of SPV and dDown to preload and filling pressure is appreciable for high values of Ev and for a wide variation of Ras. Preliminary clinical data concerning the three parameters show good correlation with simulation results.

Ventricular energetics during mechanical ventilation and intraaortic balloon pumping?computer simulation

Computer simulation of a cardiovascular system enabled us to predict the effects of simultaneous application of mechanical ventilation (MV) and intraaortic ballon pumping (IABP) on ventricular energetics. External work (EW), pressure-volume area (PVA), potential energy (PE) and cardiac mechanical efficiency (CME) were calculated. Numerical simulation showed that changes of positive intrathoracic pressure have a considerable effect on left and right ventricular EW, PE, PVA and CME, whether IABP is used or not. The right ventricular energetics was much less influenced by systemic resistance (Ras) changes than the left ventricular one. Simultaneous application of IABP and MV showed a remarkable effect on left ventricular EW. The net result was reversed sensitivity to pulmonary resistance (Rap) and reduced sensitivity to Ras. PVA was generally reduced, while CME is increased by simultaneous presence of IABP and MV. The sensitivity of CME to Rap and Ras variation was diminished in this situation.

Electrical impedance spectral measurements of muscular tissue in different physiological condition

Electrical Impedance Spectroscopy (EIS) has been applied for tissue evaluation in different clinical fields. The aim of this study is to characterize the electrical properties of muscular tissues and its variation due to a prolonged contraction and successive relaxation. The layout of measurement has been studied. Preliminary results show significant differences in the characterization of impedance data in the different examined situations.