The calculation of the intramyocardial stress.

A mathematical approach is given by which the intramyocardial stress sigma induced in the passive medium of the myocardium is expressed as the sum of the stress (sigma)p induced in the passive medium by the left ventricular pressure P and the external pressure Po, and the stress(sigma)d induced in the passive medium by the active force generated by the muscular fibers of the myocardium. Relations between sigma = (sigma)p + (sigma)d, the left ventricular elastance E and the residual volume Vd are also derived. Applications to experimental data are given and clinical implications of the results are discussed.     

Coronary perfusion pressure and inflow resistance have different influence on intramyocardial flows during coronary sinus interventions

A mathematical model is used to represent the vascular bed of the left coronary circulation by an arterial, a capillary and a venous compartment. The model is first adjusted so as to reproduce arterial hemodynamics known from measurements during normal perfusion. Additionally, measurements under coronary sinus occlusion are used to assess the venous section of the model. While the calculated phasic shapes of epicardial flows are seen to agree with measurements, intramyocardial flows, which are inaccessable to measurement, are predicted from the model. The model is run under stepwise changes of coronary perfusion pressure and coronary artery resistance for both the normal state and coronary sinus occlusion. Intramyocardial flow between capillaries and veins, being the main determinant for a possible therapeutic effect of coronary sinus interventions, is estimated.     

Septal collateralization: Demonstration of canine intramyocardial collaterals

The anatomical distribution of intra-myocardial collateral arteries that develop from the septal to the other major coronary arteries was studied in dogs following gradual Ameroid occlusion of tftt circumflex artery. The septal artery was cannulated and injected with Batson's plastic compound resulting in a cast of the coronary circulation. Collateral vessels radiated from the septal vascular bed to both the circumflex and anterior descending arteries. The collaterals developed from the entire base-to-apex extent of the septal artery and were found on both the right and left sides of the septum. Collateral growth appeared to be more concentrated at the apex of the heart. The anatomical details of septal collateral circulation illustrate the importance of intramyocardial collateralization in the dog, which was thought to exhibit primarily epicar-dial collaterals.     

Parametric analysis of flow in the intramyocardial circulation

A simple mathematical model of the intramyocardial circulation has been utilized to provide a better understanding of coronary blood flow. The model includes three myocardial layers, each characterized by a three-parameter windkessel with one capacitance and two resistances. The effects of the beating heart are taken into account by means of an intramyocardial pump and the possible collapse of the vessels by an elevated backpressure. The three basic parameters that govern the flow are a normalized time constant, , the total resistance, R_t, and a parameter, α, which specifies the resistance distribution in the intramyocardial circulation. Both the normal beating heart and prolonged diastole have been investigated analytically as well as numerically. It is shown that each of these parameters has its own special significance. Calculated pressure-flow relationships and zero-flow pressures for the case of prolonged diastole show a high sensitivity to and α.     

Diabetic cardiomyopathy. A morphological study of intramyocardial arteries

The mechanism of heart failure in patients with diabetic cardiomyopathy is not clear. Previous studies suggested that vascular lesions specific for diabetes mellitus were present and that the lesions could be the basis for impaired cardiac function. We have investigated the histologic and histochemical characteristics of intramyocardial vessels (20 to 500 microns) in a group of diabetics using comparable groups of patients with hypertension, patients with hypertension and diabetes mellitus, and, as controls, patients with neither hypertension nor diabetes mellitus. Analysis of multiple blocks taken from the 42 study patients disclosed no lesions specific for diabetes mellitus or hypertension. The discrepancy between our findings and earlier reports is probably due to a lack of controls and the use of non-perfusion-fixed material in the earlier studies.     

Detection of intramyocardial scroll waves using absorptive transillumination imaging

Optical imaging using voltage-sensitive dyes has become an important tool for studying vortex-like electrical waves in the heart. Such waves, known as spiral or scroll waves, can spontaneously form in pathological ventricular myocardium, causing ventricular fibrillation and sudden death. Until recently, observations of scroll waves were limited to their surface manifestations, thus providing little information about the shape and location of their organizing center, the filament. We use computer modeling to assess the feasibility of visualizing filaments using dynamic transillumination imaging in conjunction with near-IR voltage-sensitive absorptive dyes (absorptive transillumination). We simulate transillumination signals produced by the intramural scroll waves in a realistic slab of ventricular tissue with trabeculated endocardial surface. The computations use a detailed ionic model of electrical excitation (LRd) coupled to a photon transport model for cardiac tissue. Our simulations show that dynamic absorptive transillumination data, with subsequent processing involving either amplitude maps, time-space plots, or power-of-the-dominant-frequency maps, can be used to reliably detect intramural scroll waves through the whole thickness (approximately 10 mm) of the ventricular wall. Neither variations in the thickness of the myocardial wall nor noise impeded the detection of intramural filaments.     

The subependymal plate and the genesis of gliomas.

A case of experimentally induced glioma in the rat is described, whose origin is clearly linked with hyperplasia of the subependymal plate.     

Quantitative study of intramyocardial compression in the fibrillating heart.

Extravascular compression inhibits coronary blood flow in fibrillating hearts. Pressure-flow curves from spontaneously fibrillating hearts whose coronary arteries were maximally dilated were examined to see whether this inhibition involves a vascular waterfall mechanism as has been found in the beating heart. Waterfall behavior is indicated when pressure-flow curves are linear and experience a zero-flow intercept at pressures greater than venous pressure. Regional pressure-flow curves revealed a zero flow intercept of 28.4 mmHg for the inner quarter of the left ventricle, indicating that compression is quite high in that region. A zero-pressure intercept of only 15.1 was found at the outer quarter, which was not significantly different from venous pressure. We conclude that the spontaneously fibrillating heart experiences a gradient of compression falling from 28 mmHg at the subendocardium to near zero at the subepicardium.     

The role of neurotransmitters in the genesis of uremic encephalopathy

To classify the influence of neurotransmitters in the genesis of uremic encephalopathy we studied cerebrospinal fluid (CSF) and plasma (P) amino acid (AA) concentration, in patients undergoing various dialytic treatments (hemodialysis = HD, intermittent and continuous peritoneal dialysis = IPD and CAPD). HD causes a significant decrease in CSF/P ratios of branched chain AA (BCAA) and a significant increase in CSF Glycine/Valine ratio, suggesting an augmented brain uptake of Glycine at detriment of Valine. In IPD the general trend of Aromatic AA/BCAA ratio suggests a preferential transport of Aromatic AA through the blood brain barrier. The differences between IPD and HD are confirmed by data concerning metabolites of Serotonin and Dopamine: CSF concentrations of 5- Hydroxyindoleacetic acid and Homovanillic acid are low in HD but high in IPD. So, a reduced (in HD) and an increased (in IPD) activity of monoamine systems could be at the basis of some neurological disturbances appearing in uremia.