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(BQ) Part 2 book Advances in hemodynamic research presents the following contents: Congenital heart disease and circulatory physiology, hemodynamics in coronary arterial disease and myocardial perfusion, application to cardiovascular surgery, reperfusion hemodynamics as an early predictor of cardiac function in a DCDD setting,...
PART II: CLINICAL APPLICATION OF HEMODYNAMIC RESEARCH In: Advances in Hemodynamics Research Editor: Keiichi Itatani ISBN: 978-1-63483-187-1 © 2015 Nova Science Publishers, Inc Chapter CONGENITAL HEART DISEASE AND CIRCULATORY PHYSIOLOGY Takashi Honda1, Kagami Miyaji2 and Masahiro Ishii1 Department of Pediatrics, Kitasato University School of Medicine, Japan Department of Cardiovascular Surgery, Kitasato University School of Medicine, Japan ABSTRACT The physiological basis of congenital heart diseases in most cases is an abnormality in hemodynamics Therefore, a timely diagnosis based on echocardiography has contributed to the medical practice for patients with congenital heart diseases Echocardiography has clarified not only the hemodynamics of children, but also that of fetuses, and fetal therapies based on the fetal echocardiography findings are now being developed The technical innovations in echocardiography are remarkable Vector flow mapping echocardiography made it possible to visualize the blood flow and to analyze the energy dynamics Cardiac magnetic resonance imaging is also a promising imaging modality, because a three-dimensional evaluation and an assessment of the myocardial characteristics are possible without limitations such as poor echo window, which often affects the hemodynamic evaluation on echocardiography Owing to recent innovations in diagnosis, medical treatment and surgical techniques, long- term survival can be expected even in patients with complex congenital heart diseases At present, we are consequently facing new problems regarding the medical practice for adult patients after surgeries for Tetralogy of Fallot and single ventricular anomalies The accumulation of knowledge on the hemodynamics in these adult patients will show us the direction that should be taken to overcome long-term life-threatening complications In this chapter, we discuss the characteristics of the hemodynamics in patients with CHD from fetus to adult, and propose ways to improve the life expectancy and activities of daily living in patients with CHD Keywords: congenital heart disease, right ventricle, single ventricle Corresponding Author address E-mail: thonda@med.kitasato-u.ac.jp 166 Takashi Honda, Kagami Miyaji and Masahiro Ishii HEMODYNAMICS AND VENTRICULAR FUNCTION IN FETAL AND NEONATAL PERIOD 1.1 Fetal Circulation In order to preferentially supply oxygen to the brain and heart, fetal circulation has distinct physiological mechanisms The placenta serves as a site for gas exchange, and oxygenated blood returns to the ductus venosus thorough the umbilical vein, and welloxygenated blood from the ductus venosus, as well as blood from left hepatic vein, streams into the left atrium and ventricle through the foramen ovale (Figure 6.1) In contrast, the blood flow from the superior and inferior vena cava streams into the right ventricle without passing through the foramen ovale (Rudolph AM 1985) Several studies using radionuclidelabeled microspheres have clarified the distribution of these streams (Edelstone et al 1979, Reuss et al 1980) In addition, a sharp ridge at the entrance of the ductus venosus into the inferior vena cava (Bristow et al 1981) and the difference in velocity between the inferior vena cava and the ductus venosus blood flow are considered to contribute to this blood distribution (Schmidt et al 1996) In addition, although the pressures in the ascending aorta and descending aorta are almost identical, the aortic isthmus serves as a site of functional separation Rudolph AM 1985 reported that inflation of a balloon lead a dramatic fall in the right ventricular function, and this study clarified the role of the aortic isthmus as a site of functional separation As a consequence of these complicated but desirable mechanisms, the blood from the placenta streams into the right atrium through the inferior vena cava, and the majority of the blood passes through the foramen ovale into the left atrium and ventricle And the left ventricle ejects this oxygenated blood flow towards the brain, heart and upper extremities Therefore, the brain can be supplied with a high amount of oxygen And the blood flow from the superior vena cava subsequently returns to the right atrium, and the majority of the blood flows into the right ventricle, and then provides oxygen for internal organs and lower extremities In order to maintain the fetal circulation, patency of foramen ovale and ductus arteriosus, as well as high pulmonary vascular resistance, are essential Approximately 1-20% of the combined ventricular output is reported to be distributed to the lungs (Rasanen et al 1998) Therefore, the fetal circulation would be inhibited if these elements were impaired For example, premature closure of the foramen ovale is associated with mitral and/or aortic atresia/stenosis and endocardial fibroelastosis, and has also been postulated to be a cause of hypoplastic left heart syndrome (HLHS) (Nowlen et al 2000) On the other hand, premature closure of the ductus arteriosus causes all of the right ventricular output to be ejected into the left and right pulmonary arteries, leading to pulmonary hypertension In addition, right ventricular dysfunction and tricuspid regurgitation occur as consequences of the increased right ventricular afterload (Gewillig et al 2009) As nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins, the use of NSAIDs for pregnant women would cause of premature closure of the fetal ductus arteriosus (Shastri et al 2013) Congenital Heart Disease and Circulatory Physiology 167 Figure 6.1 The fetal circulation The blood flow from the placenta returns to the right atrium through the umbilical vein, and subsequently streams into the left atrium and ventricle through the foramen ovale As the aortic isthmus works as a site of functional blood flow separation, this well-oxygenated blood flow from the left ventricle mainly supplies oxygen to the brain and upper extremities In contrast, the blood flow from the superior and inferior vena cava streams into the right ventricle, subsequently providing oxygen to the internal organs and lower extremities AAo = ascending aorta, DA = ductus arteriosus, Dao = descending aorta, IVC = inferior vena cava, LA = left atrium, LHV = left hepatic vein, LPA = left pulmonary artery, LV = left ventricle, PA = pulmonary artery, PV = pulmonary vein, RA = right ventricle, RHV = right hepatic vein, RPA = right pulmonary artery, RV = right ventricle, SVC = superior vena cava, and UV = umbilical vein There are other unique characteristics associated with the fetal circulation First, the right ventricle is dominant during the fetal period The right ventricle ejects 60-65%, and the left only 35-40% of combined ventricular output (Rudolph AM 1985) Therefore, severe tricuspid regurgitation, which can be seen in fetuses with Ebstein‘s anomaly, often leads to fetal heart failure or death (Roberson et al 1989, Oberhoffer et al 1992) Second, decreasing heart rate by vagal stimulation resulted in a marked decrease in ventricular function In addition, electrical pacing above the resting rate of 160-180/min caused the ventricular output to reach a maximum of about 15% above the resting level (Rudolph et al 1976), indicating that the fetal heart is functioning near its maximum performance Third, Thornburg et al 1983 168 Takashi Honda, Kagami Miyaji and Masahiro Ishii reported that reducing the ventricular pressure below its resting level caused a dramatic decrease in cardiac output, and that increasing the ventricular pressure produced only a small increase in the cardiac output in fetal lambs Meanwhile, inflation of a balloon also caused a dramatic decrease in the right ventricular cardiac output (Gilbert et al 1982) Therefore, it is considered that the fetal ventricle functions are near the top of their performance, and there is little functional reserve that can be used in response to increased volume and pressure workload Figure 6.2 Twin-to-twin transfusion syndrome (TTTS) In twins with TTTS, placental anastomosis vessels allow the blood to pass from one fetus (donor twin) to the other (recipient twin) The subsequent circulatory disequilibrium causes the donor twin to have a decreased blood volume, impairing its development and growth; whereas, the recipient twin has an increased blood volume, leading to fetal heart failure Fetoscopic laser photocoagulation (FLP) corrects this circulatory disequilibrium by intercepting the placental anastomosis vessels, leading to improvement of the twins‘ conditions Recently, several centers for highly advanced medical treatment have started fetal cardiac intervention in order to interrupt the progression of diseases based on the prenatal diagnosis, and to subsequently improve the perinatal and lifelong outcomes Fetoscopic laser photocoaglation (FLP) is a novel treatment for fetuses with twin-to-twin transfusion syndrome (TTTS) (Senate et al 2004, Sago et al 2010) TTTS is a severe disease that can occur in monochorionic twin pregnancy, and results from circulatory disequilibrium caused by vascular anastomosis between the circulation of the donor and the recipient (Figure 6.2) Some recipient twins have been reported to suffer from pulmonary stenosis or lethal cardiomyopathy, in addition to cardiomegaly and hydrops fetalis (Zosmer et al 1994); whereas, there are a donor twin report with coarctation of the aorta and hypoplastic arch (van den Boom et al 2010) FLP procedure improves the fetal hemodynamics, and is expected to prevent these cardiac complications Although rapid changes in fetal hemodynamics may possibly lead to right ventricular load on donor twins (Mineo et al 2014), this procedure has already become an established treatment Severe aortic stenosis is known to impede the left Congenital Heart Disease and Circulatory Physiology 169 ventricular development and subsequently lead to HLHS Recently, fetal aortic valvuloplasty has been performed in advance research facilities to prevent progression to HLHS (Freud et al 2014) Fetal cardiac interventions are also attempted for other structural heart diseases, such as an intact or highly restrictive atrial septum, which also leads to HLHS, and pulmonary atresia with an intact ventricular septum, which leads to right ventricular hypoplasia (Schidlow et al 2014) 1.2 Hemodynamics in Neonates A shift from fetal to neonatal circulation can also be considered as a shift from placental circulation to pulmonary circulation When the placental circulation is interrupted at birth, the amount of pulmonary blood flow increases approximately 10 times that during the fetal period with spreading pulmonary alveolus and decreased pulmonary arterial resistance (Morin et al 1985) During the first hours after birth, the pulmonary arterial blood pressure may be half that of the systemic pressure (Kramer et al 1995) As the consequence of these changes, oxygenation becomes possible in the lungs The ductus arteriosus subsequently closes in the first 15 hours due to the elevated arterial oxygen partial pressure and decreased production of prostaglandin In contrast, the foramen ovale closes due to an increase in the left atrial pressure and extension of the ostium primum atrial septum The knowledge on these perinatal hemodynamic changes is of great importance when managing neonates with congenital heart diseases For example, persistent pulmonary hypertension of the newborn (PPHN) is the condition that the pulmonary vascular resistance does not sufficiently decrease In neonates with PPHN, the systemic blood pressure cannot be maintained, and the neonates develop insufficient oxygenation without appropriate therapeutic intervention Adequate lung recruitment and alveolar ventilation with 100% oxygen, deep sedation and inhaled nitric oxide are effective to lower the pulmonary vascular resistance Maladaptation of the pulmonary circulation at birth due to neonatal cardiopulmonary diseases, including birth asphyxia, sepsis, meconium aspiration and respiratory distress, are all considered to be the causes of PPHN (Storme et al 2013) Even in normal neonates, it takes to weeks before the pulmonary vascular resistance decreases to the adult level Of note, the left-to-right shunting continues to increase during the first months in infants with ventricular septal defect (VSD) In most patients with genetic anomalies including 21 trisomy, the pulmonary vascular resistance is high by nature Preserving ductus arteriosus or foramen ovale is sometimes required in the management of complex congenital heart diseases In order to maintain the systemic blood flow in neonates with HLHS and coarctation of the aorta (CoA), prostaglandin E1 is administered to preserve the ductus arteriosus In cases with pulmonary atresia (PA), prostaglandin E1 is also administered to maintain the pulmonary blood flow (Kramer et al 1995) Adequate intraatrial mixing is required in some cases with HLHS, PA and transposition of the great arteries (TGA) In such cases without adequate intraatrial mixing, balloon atrial septostomy (BAS) is performed (Rashkind et al 1966) Therefore, rapid therapeutic intervention based on the precise understanding of the hemodynamics is essential to improve the prognoses of neonates with congenital heart diseases 170 Takashi Honda, Kagami Miyaji and Masahiro Ishii THE IMPACT OF VENTRICULAR OVERLOAD 2.1 Ventricle with Pressure Overload The pressure load on the ventricle is generally caused by ventricular outflow tract stenosis Aortic stenosis (AS) and CoA are typical congenital heart diseases associated with pressure overload on the left ventricle These diseased lesions are often accompanied by HLHS In contrast, pulmonary stenosis is a representative heart disease associated with pressure overload on the right ventricle, and is one of the diagnostic requirements of tetralogy of Fallot (TOF) Patients with several genetic disorders often have these stenotic lesions William‘s syndrome is often accompanied by supra-aortic stenosis and pulmonary stenosis, while Allagile syndrome is accompanied by peripheral pulmonary stenosis The first pathophysiological change in the myocardium caused by pressure overload on the ventricles is dilatation with wall thinning and wall stress elevation Subsequent hypertrophy induces the recovery of systolic function and normalizes the wall stress This compensatory process helps the left ventricle to eject sufficient systemic blood flow (Takaoka et al 2002, Cingolani et al 2003) On the pressure volume (P-V) loop, in response to left-shifting of the end diastolic P-V relationship (EDPVR) due to increased pressure load, the end systolic P-V relationship (ESPVR) also shifts to the left due to increase in the left ventricular mass (Figure 6.3A) (Sugawa et al 1988) Stroke volume is consequently maintained in spite of the increase in pressure load on the ventricle However, hypertrophy is also considered to be an inducer of apoptosis of myocytes as a result of hypoxia and mechanical loading (Hirota et al 1999, Wernig et al 2002) In the ventricles with a severely high pressure load, replacement of degenerated myocytes by collagen fibers is one of the contributors to diastolic dysfunction In addition, the wall thickness of the ventricle itself increases the stiffness (Schwartz et al 1996) Consequently, EDPVR further shifts to the left and stroke volume eventually decreases in severe cases (Figure 6.3B) (Harris et al 2002) The current guidelines recommend that various parameters should be assessed to determine the severity of stenotic lesions, including peak jet velocity, mean pressure gradient, valve area and valve area indexed for the body surface area (Bonow et al 2008) Several recent studies have focused on the importance of taking into account the pressure recovery phenomenon which occurs downstream from the valves (Baumgartner et al 1990, Voelker et al 1992) Based on the pressure recovery phenomenon, Garcia et al proposed a new index based on the energy loss (EL) concept According to their theory, a part of static pressure is converted to dynamic pressure, leading to overestimation of the pressure gradient on echocardiography (Figure 6.4) Pressure recovery may be relevant in patients with severe stenotic lesions The authors of that study therefore proposed that an evaluation of energy loss would provide a novel index to assess the severity of stenotic lesions Based on Garcia‘s theory, Bahlmann et al 2013 demonstrated that EL index provides independent and additional prognostic information in patients with AS In addition, vector flow mapping (VFM) echocardiography has recently made it possible to measure EL based on energy dispersion We previously measured energy loss before and after the commisurotomy of stenotic pulmonary valve in an infant with double outlet right ventricle (DORV) and VSD, and demonstrated that energy loss significantly decreased (Honda et al 2014) This dynamic Congenital Heart Disease and Circulatory Physiology 171 change was caused by the improved profile of the main pulmonary arterial blood flow, likely due to conversion from turbulent flow to linear flow Therefore, EL is a parameter that can be used to directly reflect the afterload on the ventricle, and future studies will indicate the clinical utility of this novel parameter Figure 6.3 (A) An illustration of the pressure-volume (P-V) loop in a patient with moderately increased afterload In response to the increased afterload, not only end diastolic pressure-volume relationship (EDPVR) but also end systolic pressure-volume relationship (ESPVR) increases Consequently, stroke volume is preserved in spite of an increased afterload (B) An illustration of the P-V loop in a patient with severely increased afterload As EDPVR shifts further to the left in cases with severe afterload, the stroke volume eventually decreases Stiffened aorta is 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Soc Echocardiogr 2003;16(7):777–802 INDEX # 3D Cine PC MRI, 263, 268 3D images, 270 4D Flow, 24, 25, 79, 87, 88, 91, 93, 95 A Abraham, 75, 160, 161, 162 access, 79 acquisitions, 81, 84, 85, 87, 238 adaptation, 180 adenosine, 252 adenosine triphosphate, 252 adhesion, 47 adolescents, 211 adulthood, 209 adults, 38, 138, 171, 181, 183, 184, 187, 189, 190, 204, 205, 211, 250 advancement(s), 62, 130 adventitia, 216 adverse effects, 150, 161, 209 adverse event, 56 aerobic capacity, 49, 202, 210 aerobic exercise, 187 aerospace, 114 age, 38, 46, 58, 154, 155, 204, 210, 255 albumin, 238 algorithm, 54, 123, 197, 198, 247, 284 alters, 178, 252, 264 alveolus, 169 American Heart Association, 160, 161, 162, 184, 190, 243 ammonia, 238 amplitude, 83 anastomosis, 37, 43, 96, 168, 178, 179, 182, 183, 245, 277, 279 anatomic site, 227 anatomy, 7, 218, 267, 272, 275, 277, 278, 282, 289 aneurysm, 23, 89, 91, 96, 135, 278, 280, 281, 286, 287, 289, 290 angina, 213, 226, 236 angiogram, 232 angiography, 83, 96, 97, 141, 160, 184, 190, 214, 217, 219, 232, 241, 242, 245, 253, 267, 272, 276 angioplasty, 48, 93, 245 anisotropy, 253 anticancer drug, 56 anticoagulation, 186 anti-inflammatory drugs, 166 antioxidant, 260 aorta, 25, 47, 49, 89, 91, 95, 100, 108, 128, 134, 142, 166, 167, 168, 169, 171, 173, 177, 179, 180, 181, 184, 189, 264, 268, 270, 278, 279, 280, 281, 282, 283, 287, 288, 289 Aortic Dissection, 263 aortic regurgitation, 33, 38, 49 aortic stenosis, 37, 44, 145, 168, 170, 187, 189, 283, 286 aortic valve, 8, 15, 24, 31, 37, 46, 47, 49, 59, 138, 141, 142, 149, 150, 185, 196, 263, 283, 284, 288 APC, 178, 273 apex, 8, 24, 27, 59, 68, 69, 71, 138, 141, 142, 151, 155, 176, 191, 192, 193, 195, 198, 199, 200, 203, 204, 206, 207, 214, 230 apoptosis, 91, 170, 190 arrest, 250, 251, 252 arrhythmia(s), 177, 179, 185, 273 arteries, 15, 21, 76, 89, 92, 97, 100, 104, 108, 134, 135, 136, 166, 169, 178, 179, 180, 183, 188, 214, 215, 216, 217, 219, 221, 228, 230, 235, 237, 241, 246, 268, 273, 276, 277, 278, 287, 288 arterioles, 129, 214, 216 arteriosclerosis, 91 arteriovenous malformation, 274 asphyxia, 169 aspiration, 169 292 Index assessment, vii, 4, 37, 45, 46, 51, 54, 55, 56, 57, 58, 60, 61, 64, 65, 69, 74, 76, 79, 85, 96, 141, 146, 150, 160, 162, 165, 183, 185, 205, 207, 213, 222, 226, 237, 238, 246, 247, 253, 257, 276, 286, 287 asymptomatic, 44, 56, 74, 278, 286, 290 atherogenesis, 244 atherosclerosis, 15, 96, 213, 214, 217, 219, 226, 227, 228, 230, 232, 235, 243, 245, 246, 287, 288 atherosclerotic plaque, 45, 226, 228, 246, 290 athletes, 55, 72, 76, 209 ATP, 225, 250, 251, 252 atrial fibrillation, 60 atrial septal defect, 173, 178, 186, 188 atrioventricular node, 215 atrium, 12, 25, 57, 95, 138, 145, 150, 155, 166, 167, 179, 191, 192, 193, 199, 201, 204, 214, 266 B backscattering, 238 base, 24, 51, 68, 69, 71, 128, 135, 192, 193, 195, 199, 200, 207, 211, 222 basic research, 144 behaviors, 99, 101, 128, 129 bending, 215, 229, 275, 284 beneficial effect, 70 benefits, 87, 199, 258, 260 bicuspid, 47, 284 bilateral, 26, 89, 92, 178, 183 bile, 81 biological systems, 134 biomarkers, 249, 251 biomechanics, 99, 209 blood pressure, 4, 7, 18, 44, 58, 156, 169, 217, 228, 235 blood stream, 51, 62, 69, 91, 231 blood vessels, 43, 100, 108, 124, 126, 130, 235, 267 body size, 274 body weight, 99 boundary surface, 19 brain, 166, 167, 178, 185, 186, 242, 249, 250, 251 branching, 214 breathing, 4, 25 bronchitis, 179, 185 bypass graft, 21, 245, 264, 271, 276, 288 C Ca2+, 252 CAD, 237, 242, 270, 271, 277, 278 calcification(s), 220, 221, 278, 280 calcium, 96, 194, 204, 252 calibration, 141, 247 caloric restriction, 58, 74 cancer, 55, 76, 200, 201 candidates, 254, 260 capillary, 5, 10, 11, 15, 57, 73, 145, 148, 216, 235, 238, 239 carcinoma, 46 cardiac catheterization, 51, 73, 193, 196, 198, 267 cardiac muscle, 186, 214, 217, 228, 231 cardiac output, 4, 5, 7, 21, 38, 137, 147, 148, 152, 154, 157, 168, 173, 202, 203, 255, 257, 274 cardiac structure, 51 cardiac surgery, 189, 289 cardiomyopathy, 34, 38, 45, 48, 55, 56, 57, 60, 65, 69, 70, 71, 72, 73, 75, 76, 162, 168, 199, 203, 204, 208, 210, 212, 283, 289 cardioplegia, 251, 254 cardiovascular disease(s), vii, 3, 4, 5, 17, 38, 54, 56, 96, 185, 189, 204, 209, 264, 275, 276, 280, 285 cardiovascular system, 4, 5, 37, 62, 87, 96, 99, 133, 152, 190, 192, 202 carotid arteries, 76, 228, 287 case study, 48 catecholamines, 210 catheter, 4, 6, 8, 37, 57, 131, 137, 139, 140, 141, 142, 162, 183, 213, 221, 222, 225, 253, 264, 267, 269, 276, 286, 290 causal relationship, 232 cell culture, 34 cell death, 249, 252 cerebral aneurysm, 135 cerebral arteries, 135 cerebral blood flow, 242 cerebrospinal fluid, 97 CFR, 222, 225, 226, 276 challenges, 58 chemotherapy, 55, 76, 200, 201 CHF, 158 childhood, 175, 259 children, 46, 93, 165, 173, 177, 178, 181, 185, 189, 204, 211, 268, 275 cholesterol, 228, 230 chopping, 130 chronic heart failure, 74, 76, 153, 162, 209, 210, 211 CIA, 89 cigarette smoking, 91 circulation, 11, 12, 19, 30, 46, 96, 102, 106, 108, 113, 127, 132, 134, 146, 147, 166, 167, 168, 169, 178, 180, 182, 186, 188, 223, 224, 226, 234, 238, 244, 268, 273, 274, 275 Circulatory Physiology, v, vii, 4, 165 circulatory system, vii, 3, 4, 5, 10, 11, 13, 19, 35, 42, 192, 268, 270 Index classical methods, 268 classification, 61, 218 clinical application, vii, 15, 26, 183, 268 clinical assessment, 146, 205 clinical problems, vii, 8, 99 clinical trials, 257 closure, 24, 47, 138, 149, 150, 166, 175, 176, 178, 185, 187, 189, 196, 197, 270 coarctation, 168, 169, 179, 189 coherence, 81 collaboration, 64, 160, 161, 190 collagen, 128, 170, 173, 174, 195 collateral, 173, 221, 224, 225 collisions, 100, 176 color, 25, 26, 28, 29, 33, 46, 48, 62, 63, 64, 66, 67, 68, 71, 73, 76, 89, 90, 92, 151, 152, 191, 193, 196, 197, 198, 199, 204, 207, 210, 242, 244, 267, 289 combined effect, 157 commercial, 26, 113, 114, 130, 221, 276 compatibility, 129 competition, 277 complexity, 117 compliance, 10, 11, 48, 72, 152, 176, 194, 202, 206, 234, 244, 268 complications, 165, 168, 178, 179, 183, 264, 273, 275, 287 compressibility, 101, 102 compression, 14, 15, 16, 217, 219, 232, 243, 246 computation, 19, 123, 132, 135, 136, 270, 275, 276 computational fluid dynamics, 19, 20, 45, 47, 49, 99, 136, 183, 184, 263, 265, 266, 270, 287, 289, 290 computational modeling, 19, 37, 213 computed tomography, 20, 135, 219, 221, 237, 241, 243, 244, 245, 246, 268, 276 computer, vii, 3, 11, 19, 21, 68, 73, 99, 135, 136, 263, 264, 266, 268, 269, 270, 271, 272, 277, 281, 284, 286 computer simulations, 281 computer technology, vii computer-aided design (CAD), 271, 277 computing, 132, 270, 275, 284 conditioning, 258 conductance, 141, 142, 162 configuration, 3, 7, 8, 137, 148, 213, 253, 263 congenital heart disease, v, vii, 25, 37, 72, 74, 134, 165, 169, 170, 173, 174, 184, 187, 190, 202, 207, 263, 267, 268, 272 congestive heart failure, 7, 72, 192, 209 connective tissue, 216 connectivity, 123 conservation, 53, 64, 114 constant rate, 102 293 constrictive pericarditis, 57, 73 construction, 11 consumption, 152, 154, 157, 160, 184, 209, 235, 236, 243, 257 contour, 132, 264 controversial, 128, 194 convention, 108, 138 convergence, 21, 123, 131, 132, 133 convergence criteria, 21, 131 cooling, 251 cooperation, 175 coordination, 195 coronary arteries, 15, 214, 216, 217, 219, 221, 235, 241, 246, 268, 276, 278, 288 coronary artery bypass graft, 245, 264 coronary artery disease, 75, 214, 230, 237, 243, 244, 246, 267, 276, 290 coronary heart disease, 263, 271, 276, 277 correlation(s), 46, 57, 59, 68, 73, 75, 178, 198, 202, 222, 246, 254, 255, 257, 259 cost, 19, 21, 123, 128, 129, 132, 240, 270, 276, 277 Council of Europe, 250, 259 covering, 41, 230 CPU, 132, 269 critical value, 194, 222 cross-sectional study, 46, 186 CSF, 81, 85 CTA, 278 culture, 34 cure, 91, 96 cyanosis, 177, 264 cycles, 127, 146, 234 cycling, 142, 194 cytoplasm, 194 D daily living, 165, 264 damages, 55 damping, 140, 189 data analysis, 21 data set, 73, 87 DBD, 249, 250, 251, 253, 255 DCDD, v, vii, 249, 250, 251, 252, 253, 254, 255, 257, 258 decay, 56, 137, 149, 195, 211 decomposition, 64 defects, 45, 46, 53, 173, 186, 237, 267 deformation, 33, 55, 74, 77, 129, 194, 195, 211, 217, 270, 271, 272, 274, 275, 284 depolarization, 195 depression, 147, 150 depth, 29, 63 294 Index derivatives, 79 destruction, 238, 247 detachment, 37, 194, 228, 230 detectable, 196 detection, 15, 19, 26, 55, 75, 76, 96, 221, 237, 240, 241, 242, 244 developed countries, 226 developmental process, 228 deviation, 229, 277, 285 diabetes, 91, 222, 228 diabetic patients, 56, 74 diagnostic criteria, 57 diastole, vii, 8, 27, 28, 33, 34, 38, 56, 57, 58, 61, 64, 67, 68, 69, 70, 85, 95, 104, 137, 138, 140, 143, 144, 150, 151, 155, 157, 160, 182, 189, 191, 192, 193, 194, 195, 196, 198, 204, 207, 208, 209, 213, 217, 221, 234 Diastolic Heart Failure, 160, 192, 203 diastolic pressure, 58, 61, 139, 143, 144, 145, 146, 149, 150, 152, 153, 154, 155, 156, 158, 159, 171, 174, 178, 194, 202, 203, 204, 210, 217, 232, 253, 255, 256, 257 diet, 73 differential equations, 19, 108, 124 diffusion, 111, 112, 259 diffusivity, 80, 81 dilated cardiomyopathy, 34, 38, 45, 48, 65, 69, 72, 162, 199, 204, 208, 210, 212, 283, 289 dilation, 173, 187 dimensionless numbers, 99, 104, 108 direct measure, 37, 51, 57, 58, 217, 267 disability, 157 discretization, 99, 109, 110, 111, 112, 113, 118, 131 disease model, 210 disease progression, 232, 281, 284 diseases, vii, 4, 23, 38, 54, 55, 56, 58, 64, 71, 75, 95, 96, 133, 146, 165, 168, 169, 170, 173, 189, 191, 192, 201, 204, 218, 230, 232, 235, 242, 264, 267, 268, 275, 276, 280, 285 disequilibrium, 168 disorder, 112 dispersion, 82, 85, 170, 175, 206, 211 displacement, 54, 68, 114, 217, 219 distress, 169 distribution, 3, 4, 7, 17, 19, 20, 23, 29, 38, 46, 47, 48, 64, 67, 75, 90, 93, 126, 132, 166, 183, 193, 199, 213, 227, 234, 235, 244, 246, 264, 265, 268, 277, 282, 283, 284, 285, 286 divergence, 43, 215 dogs, 211, 236 DOI, 134 donors, 249, 259, 260 Donors after Brain Death, 250 Donors after Circulatory Determination of Death, 250 doppler, 76, 183, 186, 188 drawing, 101, 113 drugs, 56, 166 ductus arteriosus, 166, 167, 169, 173, 189 dynamic viscosity, 104, 106, 130, 131 dyslipidemia, 229 dyspnea, 156, 157, 158, 202 E ECG, 85, 87, 178, 236, 243 echocardiogram, 206 Echocardiography, v, vii, 25, 28, 46, 48, 51, 52, 54, 62, 75, 165, 180, 196, 238, 246, 263, 267, 285, 290 elastin, 128 elderly population, 58, 204 election, 207 electrocardiogram, 221, 236 emboli, 195 embolization, 195 emission, 237, 241, 244, 246 employment, 131 encoding, 83, 84, 87 endothelial cells, 34, 91, 96, 228, 232, 276 endothelial dysfunction, 268 endothelium, 79, 91 end-stage renal disease, 60 endurance, 160, 161 energy, 4, 9, 14, 26, 27, 30, 31, 33, 35, 36, 37, 38, 39, 42, 43, 44, 46, 47, 48, 49, 53, 64, 68, 69, 70, 71, 75, 127, 147, 155, 165, 170, 172, 173, 175, 176, 179, 181, 182, 183, 185, 186, 193, 194, 195, 264, 265, 267, 274, 275, 285, 286, 289 energy conservation, 53 energy efficiency, 71, 181, 182, 183, 274, 275 energy transfer, 69 engineering, 3, 96, 187 England, 188, 259, 261 enlargement, 227 entropy, 42 environment(s), 128, 129, 189, 228 enzyme, 91, 208 epithelium, 91 equilibrium, 80, 129, 194, 204 equipment, 3, 6, 21, 198, 249, 253, 258, 268 erythrocytes, 134 ethanol, 210 ethical issues, 258 Europe, 250, 259 Index evidence, 37, 55, 157, 210, 237, 254, 258, 280, 283, 285 evolution, vii examinations, 51, 264 excitation, 81 exercise, 48, 49, 56, 70, 76, 137, 152, 154, 155, 156, 157, 158, 159, 160, 161, 162, 177, 178, 183, 186, 187, 189, 191, 199, 201, 202, 203, 206, 207, 208, 209, 210, 211, 269, 274, 290 exercise performance, 210 expertise, 253 exposure, 221, 252 extracellular matrix, 241 extraction, 20, 22, 238, 269 extrusion, 194 F FEM, 113, 114, 128, 129 fetus, 165, 168, 188, 189 fiber(s), 55, 128, 129, 134, 135, 137, 170, 173, 196, 217 fibrillation, 60 fibrosis, 70, 174, 178, 183, 220 fibrous cap, 226, 227, 230 fibrous tissue, 34 fidelity, 57, 58, 59, 141, 193 finite element method, 113, 128, 134, 136, 279 finite volume method, 99, 113, 136 fitness, 210 flow field, 24, 64, 71, 113, 268 Flow Velocity, 4, 73, 288 flow visualization, v, vii, 3, 4, 17, 19, 20, 23, 25, 26, 38, 39, 51, 62, 66, 79, 88, 89, 229, 263, 264, 266, 267, 268, 285 fluctuations, 127 Fluid Dynamics, foams, 228 foramen, 166, 167, 169, 187, 188 foramen ovale, 166, 167, 169, 187, 188 force, 11, 15, 18, 29, 32, 69, 90, 104, 105, 114, 129, 142, 152, 181, 182, 184, 190, 192, 193, 194, 199, 200, 202, 203, 204, 208, 217, 232, 234, 279 formation, 64, 65, 69, 91, 95, 116, 120, 121, 142, 178, 181, 182, 198, 211, 228, 230, 275, 281, 289 formula, 39, 58, 224 Fourier analysis, 68 fragments, 88 Frank-Starling mechanism, 161 freedom, 275 Freud, 169, 185 friction, 18, 64, 92 functional separation, 166 295 G gadolinium, 178, 189, 241 gene expression, 96, 190 genetic disorders, 170 geometry, 8, 20, 21, 24, 47, 48, 58, 59, 69, 75, 104, 123, 126, 129, 130, 131, 132, 133, 154, 178, 189, 194, 198, 221, 232, 268, 269, 270, 271, 272, 273, 274, 275, 277, 278, 285 gestures, 275 glycogen, 259 glycolysis, 252 graph, 67 gravity, 288 grids, 113, 114, 115, 117, 123 growth, 91, 168, 275 growth factor, 91 guidelines, 60, 170, 174, 184, 190 H half-life, 238 hardness, 217 harvesting, 249, 251, 257 head injuries, 260 healing, 246 health, 189, 209 heart and lung transplant, 260 heart disease, 25, 37, 54, 56, 57, 60, 62, 64, 71, 72, 74, 95, 134, 160, 165, 169, 170, 173, 174, 184, 187, 188, 190, 191, 201, 202, 207, 209, 210, 230, 232, 234, 235, 242, 246, 263, 267, 268, 271, 272, 276, 277, 283, 286 heart failure, 7, 29, 38, 48, 49, 54, 55, 56, 58, 60, 61, 69, 70, 71, 72, 73, 74, 75, 76, 77, 138, 145, 151, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 167, 168, 179, 184, 186, 192, 202, 204, 207, 208, 209, 210, 211, 212, 250, 275 heart rate, 9, 38, 46, 108, 137, 142, 145, 150, 152, 157, 167, 175, 180, 188, 202, 221, 235, 253, 255, 256, 257 heart rate (HR), 253, 256 Heart Transplant, 250, 251, 261 heart transplantation, 250, 251, 252, 253, 255, 257, 258, 259, 260 heart valves, 128, 283 heat transfer, 135 height, 124 helicity, 31, 42, 47 helium, 102 hematocrit, 100, 103 hematoma, 83 296 Index Hemodynamic Indices, hemodynamic instability, 251, 255 hepatic fibrosis, 183 hepatocellular carcinoma, 46 heterogeneity, 206 high blood pressure, 228 histology, 183 history, 44, 45, 54, 186, 192, 206, 275, 287 hospitalization, 56, 60 human, 5, 9, 24, 30, 46, 52, 53, 58, 73, 75, 96, 134, 135, 188, 192, 208, 210, 217, 228, 250, 252, 254, 259, 272, 288 human body, 52 human right, 210 hydrocephalus, 97 hydrogen, 80, 252 hydrops, 168, 189 hyperemia, 222, 223, 225, 232, 244 hyperlipidemia, 91 hyperplasia, 228 hypertension, 15, 76, 93, 96, 155, 166, 169, 189, 229 hypertrophic cardiomyopathy, 55, 57, 70, 71, 72, 73, 76 hypertrophy, 45, 55, 57, 70, 71, 72, 76, 154, 170, 173, 177, 180, 189, 190, 203, 222, 243 hypoplasia, 169 hypothermia, 253 hypothesis, 173, 193, 228 hypoxia, 170, 188, 260 I ideal, 131, 249, 255 identification, 258 idiopathic, 204 imaging modalities, 19, 23, 127, 130, 237, 263, 264 impairments, 193 improvements, 19, 25, 46, 160, 199, 208 in utero, 184, 189, 190 in vitro, 48, 68, 183, 189, 286 in vivo, 25, 46, 71, 72, 76, 88, 135, 183, 186, 206, 266, 268, 289 incidence, 230 individual differences, 275 individuals, 60, 75, 202, 278 inducer, 170 induction, 158 industries, 19, 114 inertia, 102, 104, 106 infancy, 186, 209 infants, 169, 172, 173, 204, 250, 268 infarction, 25, 34, 44, 60, 72, 222, 225, 226, 237, 241, 243, 244, 245, 246, 247, 264, 276 inferior vena cava, 37, 141, 166, 167, 176, 178, 179, 183, 188, 273 inflation, 141, 166, 168 inheritance, 268 inhibition, 184 inhibitor, 91 injections, 141 injuries, 260 injury, 34, 249, 250, 251, 253, 258, 259, 260, 261, 267 insertion, 6, 179, 221 insulin, 228 insulin resistance, 228 integration, 258 integrity, 237, 239, 251, 252, 253 intensive care unit, interface, 128, 134 interference, 238 intervention, 56, 68, 168, 169, 187, 225, 245, 246, 251, 263, 281, 283 intima, 216 intracellular calcium, 96, 252 Intraventricular Pressure Difference, 192 inversion, 246 investments, 253 ionizing radiation, 240 IPR, 88 irradiation, 82 ischemia, 150, 193, 207, 214, 222, 226, 232, 237, 238, 239, 240, 241, 242, 245, 249, 250, 251, 252, 253, 254, 255, 256, 257, 258, 259, 288 Ischemia-Reperfusion (I/R) Injury, 250, 252, 253, 259 isolation, 147 issues, 99, 128, 138, 153, 258, 284 iteration, 132 IVPD, 28, 29, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206 J Japan, vii, 175 K kidney, 93, 250, 252 kinetic model, 238 L lactate dehydrogenase, 255, 257 Index laminar, 30, 34, 39, 83, 87, 89, 104, 105, 124, 128, 130, 132, 172, 216, 230 LDL, 228, 230 lead, 71, 166, 168, 171, 195, 204, 252, 267, 275, 283 learning, 99 left atrium, 25, 57, 95, 138, 145, 150, 155, 166, 167, 191, 192, 193, 199, 201, 214 left ventricle, 9, 46, 47, 49, 73, 75, 76, 128, 137, 138, 142, 146, 147, 148, 153, 160, 162, 166, 167, 170, 171, 173, 176, 177, 178, 180, 181, 182, 189, 191, 192, 193, 201, 207, 208, 209, 211, 217, 231, 253 legend, 220 lesions, 91, 93, 170, 172, 187, 219, 226, 245, 277 life expectancy, 165, 178 light, 86, 102 linear model, 217 liver, 179, 184, 250, 252 localization, 45, 79 lumbar spine, 94 lumen, 3, 4, 7, 16, 19, 22, 23, 25, 32, 83, 133, 221, 227, 276, 278, 280, 281, 282, 286 lung transplantation, 260 Luo, 76 LV diastolic stiffness, 137 LV end-systolic elastance, 61, 137 LV pressure, 8, 56, 58, 61, 70, 137, 138, 139, 140, 141, 142, 143, 145, 146, 147, 149, 155, 157, 158, 194, 195, 196, 202, 210, 254, 255, 257 LV stroke, 137, 141, 151, 157 lymphocytes, 228 M macrophages, 228 magnetic field, 80, 81, 82, 83, 84 magnetic moment, 80, 81, 82 magnetic resonance, 7, 23, 45, 47, 54, 64, 71, 72, 80, 81, 86, 88, 96, 97, 131, 141, 149, 165, 183, 185, 186, 241, 244, 245, 253, 263, 265, 266, 287 magnetic resonance imaging, 7, 23, 45, 47, 54, 64, 72, 86, 96, 97, 131, 141, 149, 165, 183, 185, 244, 245, 253, 263, 265, 266, 287 magnetization, 80, 81, 82 magnitude, 23, 66, 86, 89, 106, 193, 194 majority, 166, 280 mammals, 205 management, 3, 5, 54, 60, 91, 169, 179, 184, 190, 261, 264, 272 mapping, 7, 24, 26, 27, 28, 46, 47, 48, 49, 63, 64, 65, 73, 75, 76, 165, 170, 172, 186, 244, 268, 287, 289 Marfan syndrome, 91 mass, 17, 18, 21, 64, 114, 134, 154, 170, 188, 202, 235, 241 297 mathematics, matrix, 58, 131, 153, 195, 230, 241 matrix metalloproteinase, 230 matter, 129 mechanical properties, 278 mechanical stress, 173, 217, 228, 231, 278 meconium, 169 media, 141, 216 median, 61 medical, 5, 19, 20, 23, 26, 54, 130, 135, 165, 168, 232, 233, 271, 272, 281 medication, 34, 38, 189, 280, 283 medicine, 4, 20, 79, 139, 140, 142, 144, 146, 147, 148, 161, 188 mellitus, 228 memory, 132, 268 mesh, 20, 21, 99, 114, 123, 124, 128, 129, 130, 132, 265, 270, 271, 275, 284, 290 meta-analysis, 210 metabolism, 9, 184, 202, 238, 259 metabolizing, 138, 153 metalloproteinase, 230 methodology, 137 mice, 162 microcirculation, 225, 238, 239, 244 microspheres, 166, 238 MIP, 86 mission, 237 mitochondria, 260 mitral regurgitation, 56, 60, 74, 95, 148, 159, 161 mitral stenosis, 151 mitral valve, 8, 25, 27, 46, 58, 69, 71, 72, 76, 95, 138, 145, 149, 150, 158, 160, 180, 181, 192, 193, 194, 195, 198, 199, 201, 207, 208, 253, 283, 284 mitral valve prolapse, 95 mixing, 105, 169 MMP(s), 230 MMP-3, 230 modelling, 58, 289 models, 11, 21, 37, 58, 61, 127, 128, 134, 135, 183, 210, 217, 232, 234, 238, 254, 277 modifications, 179, 273 modulus, 217 molecular biology, 190 molecules, 100 momentum, 17, 18, 21, 106, 114, 134 Moon, 183 morbidity, 184, 192, 206, 250, 264 morphological abnormalities, 180 morphology, 182, 187, 232, 276, 284 mortality, 56, 179, 184, 187, 192, 206, 250, 264, 272, 280, 288 mortality rate, 179, 250, 264, 272, 280 298 Index MPI, 241 MRI, v, 7, 20, 22, 23, 25, 31, 38, 49, 79, 84, 85, 86, 87, 88, 94, 96, 97, 131, 134, 135, 175, 176, 177, 182, 183, 207, 210, 237, 241, 263, 265, 266, 268, 273, 274, 275, 276, 277, 278, 280, 281, 282, 283, 284, 285, 286, 287, 289, 290 multidimensional, 54, 55 muscle contraction, 182, 234 muscle mass, 188, 202 muscle relaxation, 234 muscles, 4, 157, 182 musculoskeletal, musculoskeletal system, myocardial infarction, 25, 34, 44, 60, 72, 219, 222, 225, 226, 237, 243, 244, 245, 246, 247, 264, 276 myocardial ischemia, 150, 207, 222, 237, 241, 245 myocardial necrosis, 244 Myocardial perfusion, 214, 235, 239 myocardium, 53, 54, 55, 57, 142, 155, 170, 176, 185, 194, 195, 209, 211, 213, 223, 235, 240, 242, 267, 276 myocyte, 194 myosin, 142, 194 N Na+, 252 NAD, 47 necrosis, 228, 244 neonates, 169, 173 nervous system, 173, 174 neurohormonal, 178 New England, 188, 259, 261 Newtonian fluid, 17, 33, 90, 99, 101, 102, 103, 104, 114, 116, 130, 131 nitric oxide, 169 nitrogen, 238 NMR, 287 nodes, 108, 114, 115, 117, 128, 132 North America, 97 NSAIDs, 166 nuclei, 80 nucleus, 80 null, 80 numerical analysis, 207, 211, 278 nutrient, 214 nutrition, O obstruction, 177, 179, 203, 221, 225 occlusion, 96, 141, 143, 144, 194, 281 oil, 217 omission, 122 one dimension, 28, 63, 100 open heart surgery, 20, 267, 272 optimization, 21, 37, 71, 277, 289 ores, 132 organ(s), 4, 8, 18, 79, 88, 166, 167, 234, 249, 250, 251, 255, 257, 258, 260, 261 organelle, 194 oscillation, 97, 104, 106, 116, 232 ostium, 169, 221 outpatient, overlap, 114, 195 ox, 166, 167 oxidative stress, 228 oxygen, 4, 8, 34, 35, 138, 152, 154, 157, 160, 166, 167, 169, 180, 184, 187, 202, 209, 235, 236, 238, 243, 252, 257, 260 oxygen consumption, 152, 154, 157, 160, 184, 209, 235, 236, 243, 257 P pacemaker, 67 pacing, 158, 167, 207, 211 palliative, 188, 268, 273 pancreas, 250, 252 parallel, 66, 90, 91, 107, 132, 134, 142, 173, 176, 196, 219, 258, 279 partial differential equations, 108, 124 patent ductus arteriosus, 173 pathline, 25, 79, 89, 268 pathogenesis, 93, 133, 214, 246 pathophysiological, 3, 170, 173 pathophysiology, vii, 4, 26, 38, 64, 138, 154, 161, 182, 235 pathway(s), 185, 186, 221, 264, 279, 282 PC MRI, 22, 23, 38, 79, 87, 263, 265, 268, 273, 274, 275, 276, 280, 281, 282, 283, 285 peptide, 178, 185, 186 perfusion, 20, 213, 214, 222, 223, 231, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 249, 250, 253, 254, 255, 257, 258, 259, 260, 261 pericarditis, 57, 73 perinatal, 168, 169, 189 peripheral blood, 126 peripheral vascular disease, 96, 222 permeability, 252 permission, 55, 57, 59, 61, 65, 67, 70 permit, 257, 258, 264 personal computers, 99 PET, 237, 238, 240, 242, 243 Index pH, 252 Phase Contrast Magnetic Resonance Imaging, 79 phase shifts, 83, 84 Philadelphia, 139, 140, 142, 144, 146, 147, 148, 161, 209 phosphorylation, 194, 252 physical activity, 206 physical characteristics, 101, 145 physicians, viii, physics, vii, 3, 4, 18, 19, 47, 100, 128, 131, 192 physiological mechanisms, 8, 166 physiology, vii, 3, 5, 10, 18, 20, 21, 47, 71, 100, 138, 179, 184, 185, 187, 188, 189, 190, 244, 268, 273 pilot study, 49 pitch, 221 placenta, 166, 167 plaque, 32, 34, 35, 38, 46, 213, 219, 220, 221, 222, 226, 227, 228, 230, 231, 232, 235, 244, 246, 276, 290 plasma proteins, 103 plasminogen, 185, 260 platelets, 103 plexus, 216 PM, 46, 75, 96, 160, 183, 184, 185, 207, 208, 209 polar, 39, 40, 82, 83, 84, 265 polarity, 83 policy, 177 polymers, 238 polymorphism, 246 population, 56, 58, 60, 204 portability, 267 positive correlation, 178 positron, 237 positron emission tomography, 237 post-transplant, 260 potential benefits, 260 predictive accuracy, 60 pregnancy, 168, 188, 189 preparation, 27, 184, 257 preschool, 268 preschool children, 268 preservation, 17, 18, 21, 177 Pressure, v, 4, 6, 8, 9, 11, 28, 60, 67, 120, 123, 137, 139, 141, 143, 150, 156, 159, 170, 189, 191, 192, 206, 208, 225, 226, 267 pressure gradient, vii, 11, 18, 37, 46, 49, 53, 57, 67, 70, 106, 107, 127, 136, 138, 139, 141, 150, 155, 158, 160, 170, 172, 192, 193, 196, 200, 207, 208, 209, 210, 212, 264, 267, 283 Pressure-Volume Loop, 137, 143 prevention, 96, 162 principles, 51, 99, 193 probe, 226, 265 299 procurement, 250, 251, 253, 254, 257, 258, 259, 260 professionals, viii prognosis, 25, 54, 56, 74, 180, 204, 225, 232, 264, 266, 281, 283 prolapse, 95 propagation, 13, 14, 15, 64, 65, 69, 112, 151, 199 prostaglandin(s), 166, 169, 187 prostheses, 244 prosthesis, 32, 71 protection, 251 proteins, 103 protons, 79, 80, 81, 82, 83, 84, 252 pulmonary arteries, 166, 178, 180, 183, 273 pulmonary artery, 5, 12, 37, 45, 48, 158, 167, 177, 178, 183, 186, 244, 287 pulmonary artery pressure, pulmonary capillary wedge pressure, 5, 57, 73, 145, 148 pulmonary circulation, 11, 169, 188 pulmonary hypertension, 15, 166, 169, 189 pulmonary stenosis, 26, 168, 170 pulmonary vascular resistance, 166, 169, 178 Q quality of life, 250 quantification, 46, 48, 64, 73, 74, 96, 135, 183, 208, 221, 246, 247, 282, 289 quartile, 61 R radiation, 221, 222, 237, 238, 240 radius, 107, 108, 267 rate of change, 139, 149, 150, 157, 177 reactive oxygen, 34, 252, 260 reality, 100, 102, 124 recall, 118 recognition, 16, 192 reconstruction, 47, 88, 179, 186, 221 recovery, 37, 170, 183, 189, 225, 249, 252, 253, 254, 256, 257, 258, 259, 260, 283, 286 red blood cells, 52, 53, 66, 100, 101, 103, 108, 129, 238 regenerate, 194 regeneration, 34, 232 regression, 60 rehabilitation, 162 relativity, 102 relaxation, 15, 24, 56, 57, 58, 59, 60, 67, 68, 70, 74, 75, 80, 81, 137, 138, 140, 149, 150, 151, 152, 155, 156, 157, 158, 160, 161, 187, 193, 194, 195, 300 Index 201, 202, 203, 204, 206, 207, 208, 209, 210, 211, 213, 232, 234 relaxation process, 208 relevance, 68, 243 reliability, 270 renal artery stenosis, 93 renal dysfunction, 179, 184 renin, 173 repair, 26, 171, 179, 184, 185, 186, 187, 189, 287 Reperfusion, v, vii, 249, 250, 253, 259 requirement(s), 113, 154, 170, 238, 250 research facilities, 169 researchers, viii, 3, 26, 99, 144, 174, 182, 206 resistance, 10, 12, 21, 39, 40, 51, 102, 103, 104, 144, 145, 146, 162, 166, 169, 176, 178, 180, 213, 222, 223, 224, 225, 226, 228, 232, 234, 235, 243, 245, 246, 268, 275, 276, 277 resolution, 21, 25, 29, 58, 62, 66, 68, 76, 84, 86, 87, 88, 96, 198, 221, 237, 238, 240, 242, 265, 266, 268, 276, 280, 282, 284 resources, 100, 127, 128, 132, 133 respiration, 48, 182, 183, 186, 187, 252, 275, 288 response, 8, 11, 56, 101, 128, 140, 148, 150, 156, 158, 168, 170, 171, 173, 174, 175, 180, 182, 199, 201, 202, 203, 244 restoration, 198, 202 restrictions, 282 restrictive cardiomyopathy, 57 reticulum, 194 rheology, 103, 135 rhythm, 142, 190 right atrium, 166, 167, 178, 204 right ventricle, 37, 45, 66, 142, 166, 167, 170, 173, 176, 177, 178, 179, 185, 193, 205, 210, 214, 273, 279 Right Ventricle, 165, 176, 204 risk, 38, 45, 55, 56, 58, 61, 91, 183, 196, 213, 228, 230, 231, 235, 237, 267, 278, 280, 281, 286, 287, 289 risk assessment, 286 risk factors, 91, 183 root, 31, 58, 171, 184, 187, 189, 278 roughness, 105 routines, 62 Royal Society, 44 rubidium, 238 S saturation, 152, 267 scaling, 205 schema, 239 scope, 106 sediments, 230 Senate, 168 sensing, 91 sensitivity, 25, 55, 56, 60, 86, 156, 237, 242 sepsis, 169 septum, 71, 169, 173, 214 shape, 19, 103, 150, 193, 195, 215, 219, 226, 230, 231, 235, 264, 267, 275, 276, 277, 282 shareholders, 209 shear, 30, 32, 34, 43, 45, 46, 47, 79, 90, 91, 92, 93, 96, 102, 103, 104, 124, 127, 129, 132, 133, 134, 213, 228, 229, 232, 244, 245, 246, 264, 265, 268, 276, 279, 286, 287, 289, 290 shear rates, 103 sheep, 185, 188, 189 shock, 102 showing, 101, 109, 129, 196, 265 signalling, 96 signals, 80, 85, 102 simulation(s), 11, 19, 21, 45, 46, 48, 64, 71, 76, 101, 103, 112, 113, 114, 124, 127, 128, 129, 130, 132, 135, 136, 179, 187, 207, 223, 235, 264, 266, 268, 270, 274, 275, 281, 284, 286, 288, 290 Single Ventricle, 165 skeletal muscle, 157, 202 smoking, 91 smooth muscle, 216, 228 smooth muscle cells, 228 smoothing, 130, 269, 285 smoothness, 114, 129 society, 184, 190 sodium, 58, 73, 194 software, 26, 64, 79, 88, 114, 124, 127, 130, 132, 242, 270, 271, 275, 278 solution, 44, 99, 106, 108, 112, 114, 124, 129, 132, 250, 251, 268 sound speed, 102 space-time, 136 special relativity, 102 species, 252, 260 speculation, 193, 194 spin, 82 spindle, 91 spine, 94 stability, 114, 123, 127, 226, 228, 230, 231, 238, 245, 279 standard deviation, 285 stasis, 65, 69, 281 state(s), 5, 7, 38, 100, 125, 130, 132, 135, 138, 143, 144, 148, 153, 154, 210, 225, 228, 241, 263, 275 stent, 135, 217, 243, 246 stimulation, 150, 157, 167, 174, 202, 203 stimulus, 236 Index storage, 123, 194, 249, 253, 254, 257, 260 stratification, 56, 237 streamline, 29, 30, 31, 41, 79, 89, 179, 180, 181, 182, 197, 198, 235, 264, 273, 277 stroke, 61, 137, 141, 145, 146, 147, 148, 149, 151, 153, 154, 157, 158, 161, 162, 170, 171, 174, 189, 202, 226, 242, 267 stroke volume, 61, 137, 141, 145, 146, 147, 148, 149, 151, 153, 154, 157, 158, 161, 170, 171, 174, 189, 202 structural changes, 128 structure, 3, 19, 20, 26, 30, 31, 42, 51, 64, 65, 68, 74, 103, 114, 127, 128, 129, 135, 136, 153, 176, 182, 195, 207, 209, 216, 218, 270, 280, 286, 289, 290 style, 88 subacute, 83 substitution, 106 substrates, 138 subtraction, 86, 109, 121 Sun, 204, 211 superfluidity, 102 superior vena cava, 45, 166, 167, 176 surface area, 43, 170, 274 surgical intervention, 56 surgical technique(s), 165, 179 survival, 37, 72, 165, 186, 204, 207, 252, 273, 281, 283, 288 survival rate, 252, 283 survivors, 185 Swan-Ganz catheter, 5, sympathetic nervous system, 173, 174 symptoms, 61, 70, 202, 203 synchronization, 82 syndrome, 45, 91, 166, 168, 170, 182, 183, 184, 185, 187, 188, 189, 190, 211, 213, 228, 245 synthesis, 166 systolic pressure, 9, 143, 144, 145, 146, 147, 155, 156, 162, 171, 174, 209, 254, 255, 257, 267, 278 T tachycardia, 157, 177, 207 target, 259, 286 Task Force, 160, 161, 190 tau, 8, 56, 57, 194, 195, 198, 204, 205, 207 technetium, 237 technician, 221 techniques, 3, 7, 19, 62, 88, 128, 133, 136, 141, 165, 179, 185, 199, 237, 238, 253, 258, 264, 267, 276 technological developments, 62 technologies, 4, 79, 96, 99, 263 technology, vii, 25, 49, 141, 213, 286 temperature, 42, 102 301 tension, 145, 187 territory, 245, 288 testing, 221 tetralogy, 170, 172, 183, 184, 185, 186, 187, 189, 287 textbook, vii, viii, 139, 140, 142, 144, 146, 147, 148 TGA, 169 thallium, 237 therapeutic effect, 48, 289 therapeutic interventions, 38 therapy, 38, 56, 67 thermodynamics, 43 thinning, 170, 196 third dimension, 64 thoracic surgeon, 184, 190 thoracotomy, 188 three-dimensional space, 210 thrombosis, 179, 273, 275, 281 thrombus, 91, 187, 227, 278, 281 time increment, 129, 132 time resolution, 21 time use, 197 tissue, 25, 34, 52, 54, 57, 60, 74, 75, 76, 77, 142, 151, 152, 161, 162, 185, 204, 209, 210, 216, 217, 221, 226, 238, 241, 242, 246, 249, 250, 253, 260 tissue plasminogen activator, 185 topological structures, 133 topology, 65, 270, 272 torsion, 31, 54, 75, 200, 204, 211, 284 total energy, toxicity, 56 TRA, 93 tracks, 68 training, 160, 161, 209, 210, 249 trajectory, 82, 87, 88 transducer, 53, 62, 63, 114 transformation, 246, 290 transfusion, 168, 187, 188, 189, 190 translation, 258 transmission, 66, 238, 239, 240 transplant, 250, 253, 258, 260 transplant recipients, 250 transplantation, 249, 250, 251, 253, 254, 255, 257, 258, 259, 260 transport, 5, 64, 69, 73, 127, 249, 254, 257 transportation, 254 treatment, 56, 113, 165, 168, 187, 250, 258, 276, 278, 280, 283, 286 trial, 60, 161, 270 triangulation, 63 tricuspid valve, 178, 187, 193, 284 trisomy, 169 tumor, 38 302 Index turbulence, 30, 91, 106, 108, 127, 128, 131, 235, 267, 275 twins, 168 twist, 77, 113 U Ukraine, 271 ultrasonography, ultrasound, 45, 46, 51, 52, 53, 62, 63, 66, 68, 69, 71, 72, 73, 74, 75, 76, 188, 198, 217, 219, 232, 238, 244, 245, 246, 247, 276 underlying mechanisms, 30 uniform, 18, 40, 270 updating, 128 V validation, 47, 48, 58, 64, 66, 68, 72, 75, 76, 232, 247, 250, 270, 276, 288, 289 valvular heart disease, 56, 62, 184, 283, 286 variables, 114, 116, 120, 124, 127, 139, 141 variations, 133 vascular diseases, 133 vascular wall, 90, 91, 92 vasculature, 4, 17, 157 vasodilator, 91, 236 vector, 17, 19, 22, 24, 26, 27, 33, 38, 41, 43, 46, 47, 48, 49, 62, 63, 64, 65, 68, 72, 73, 75, 76, 79, 80, 88, 89, 90, 94, 125, 170, 172, 186, 208, 268, 283 vein, 12, 151, 166, 167 ventilation, 169 ventricular arrhythmias, 185 ventricular septal defect, 66, 169, 175, 177, 186, 188 ventricular septum, 169, 173 ventricular tachycardia, 177 vessels, 5, 10, 11, 13, 25, 35, 43, 46, 47, 49, 79, 81, 83, 88, 91, 93, 100, 108, 124, 126, 130, 133, 168, 214, 221, 224, 232, 234, 235, 263, 264, 267, 268, 270, 275, 277, 278, 285, 287, 288 vibration, 105 Virtual Surgery, 263, 270 viscosity, 11, 17, 18, 90, 92, 101, 102, 103, 104, 106, 108, 127, 130, 131, 134, 135, 213, 265, 283 visualization, vii, 3, 4, 16, 17, 19, 20, 23, 25, 26, 38, 39, 47, 49, 51, 54, 74, 79, 132, 213, 229, 263, 264, 265, 266, 267, 268, 273, 285, 286, 290 VSD, 169, 170, 173, 174, 175, 176 vulnerability, 219, 276 W wall shear stress, 30, 34, 47, 79, 91, 93, 124, 129, 132, 133, 213, 228, 244, 246, 264, 265, 279, 286, 287, 289, 290 water, 80, 81, 83, 102, 225, 238 wave propagation, 13, 14, 15, 112 white blood cells, 103 wires, 267 Wisconsin, 260 workflow, 130, 131 workload, 38, 47, 168, 173, 186 workstation, 215, 221 Y yield, 60, 103, 109, 119, 121, 270 young adults, 211 ... Fisk NM Clinical and echographic features of in utero cardiac dysfunction in the recipient twin in twin-twin transfusion syndrome British heart journal 1994; 72: 74-79 In: Advances in Hemodynamics... Heart 20 06; 92: 1 827 1830 Cingolani OH, Yang XP, Cavasin MA, Carretero OA Increased systolic performance with diastolic dysfunction in adult spontaneously hypertensive rats Hypertension 20 03;41 :24 9 -25 4... vortex, indicating that the blood flow in the inner part of the vortex can preserve the kinetic energy Figure 6.11 The results of streamline and energy loss analysis in the main ventricle of an infant