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Chaotic behavior in cardiovascular dynamics was thought to be one of the important information to analyze the circulatory regulatory system. Several investigators studied the attractor in the signals of the electrocardiogram, and found the strange attractor, suggesting dynamics compatible with deterministic chaos, by the use of the non-linear mathematics. It is interesting problem to analyze the hemodynamic parameters by the use of non-linear mathematics for the determination of the physiologically optimal circulatory condition. In this study, Chaos analyzing system was developed to identify the deterministic chaos in cardiovascular regulatory system by the use of the non-linear mathematics including phase plane plots, embedding, and lyapunov exponents. Time series data of the hemodynamic parameters in the chronic animal experiments was analyzed by this system, and satisfactory attractor was obtained by the use of the phase plane plots and embedding techniques. Furthermore, calculation of the lyapunov exponents showed the existence of the deterministic chaos in arterial blood pressure in the chronic animal experiments using adult goats, suggesting this tool is useful for analyzing cardiovascular dynamic behavior.

The vibrating electromagnetically driven univalved artificial heart, which provided more than 10 1/min at 10 Hz/sec. vibration, was developed in our team. This vibrating electromagnetic pump (VEMP) produced the original flow pattern compared with the flow pattern of the natural heart, so that circulatory regulatory system during maintain the circulation with VEMP must be investigated before the clinical application. In order to assess the effect of high frequency blood flow produced by the VEMP from the neurophysiological point of view, power spectral analysis of the hemodynamics was performed. VEMP was implanted as the total left heart bypass in adult goats and right heart circulation was maintained by natural hearts. In arterial blood pressure during maintain circulation by the high frequency blood flow, Mayer waves (0.01-0.15 Hz) were significantly decreased, though respiratory waves (0.25-0.40 Hz) were not significantly changed. These results suggest that circulatory regulatory system was influenced by the high frequency blood flow produced by the VEMP.

For patients for whom the conventional percutaneous transluminal coronary angioplasty (PTCA) did not adequately improve stenosis, or sufficient angioplasty was impossible because of occurrence of dissection, we attempted using a long-time balloon inflation for more than 10 minutes. In order to allow the use of this balloon, we instituted an active rehabilitation program using a bicycle ergometer to promote the development of the collateral circulation up to the time of performing diagnostic angiography and PTCA, while attempting to use a perfusion balloon catheter for those patients not developing sufficient collateral circulation. Of the 134 patients undergoing PTCA, unsatisfactory angiographic results were obtained in 13 patients. Of these patients, long-time balloon inflation was performed in seven and primary success was achieved in six. From this study, we believe that the long-time balloon inflation in PTCA can improve the primary success rate and reduce postoperative complications.

Newly developed long time digital Holter ECG system utilizing a stamp-size non-tracking (NT) tape which can be used for 192 hours as 2ch recording, was evaluated in the clinical cases. The system has employed newly developed VLSIs and NT technology which enables to obtain reliable long time recording with smaller and lighter Holter system of ECG and variety of biological signals. The results indicated that good data reproduction was shown in this system.

To evaluate the various basic designs of the pump chambers used in the ventricular assist devices (VADs), hydrodynamic endurance test was performed from the viewpoint of the durability of the prosthetic valves used in the VAD. For the hydrodynamic analysis, we designed three basic types of pump (sac type, diaphragm type, and pusher plate type) using the same material and having the same capacity and shape. Prosthetic valves in these VADs were tested from the standpoint of the water hammer effect, which affects the valve durability, to determine which pump design would be most durable as a prosthetic valve in the VAD. The water-hammer phenomenon was evaluated using the maximum pressure gradient (MPG) across the prosthetic valve in the moc circulatory loop. Maximum pump output was recorded when we used the diaphragm type model, and minimum MPG in the commonly used driving condition of the VAD were recorded when we used the sac type model. The results suggest that the sac type VAD model is the most durable design for the prosthetic value.

To assess the effect of left ventricular assistance on cardiac-related sympathetic nerve activity, renal sympathetic nerve activity was analysed using power spectrum and coherence function. Our TH-7B pneumatically driven sac type Ventricular Assist Device (VAD) was used in the acute experiment of 7 adult mongrel dogs. VAD were inserted between the left atrium and the descending aorta as left heart bypass. RSNA was detected by use of the bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were measured at the cardiac rhythm and VAD pumping rhythm. Before the left ventricular assistance, coherence at the cardiac rhythm and the pumping rhythm were 0.62 +/- 0.15, 0.23 +/- 0.18 (mean +/- SD), respectively. With the VAD pumping, these values became 0.09 +/- 0.05, 0.53 +/- 0.20, respectively. These results indicate that arterial pressure wave which was created by the VAD assistance contributed to the post ganglionic sympathetic activity.

To assess the influence of the total artificial heart replacement on autonomic nervous system, sympathetic neurogram was analyzed by power spectrum and coherence function. Two pneumatically driven sac-type ventricular assist devices were implanted as biventricular bypass (BVB) in adult mongrel dogs. After the BVB pumping, natural heart was electrically fibrillated to constitute the BVB type TAH model. Renal sympathetic nerve activity (RSNA) was recorded using the bipolar electrode attached to the left renal sympathetic nerve. RSNA was amplified and integrated by the use of R-C integrator. Power spectra of the RSNA and the values of squared coherence between the arterial pressure waveform and the RSNA were calculated by the computer system. In animal with TAH, coherence at the cardiac rhythm frequency was decreased, and coherence at the TAH pumping rhythm frequency was increased. These results indicate that the arterial pulse wave which was observed in TAH animal contributed to sympathetic neurogram.

An vibrating electromagnetically driven univalved artificial heart was newly developed in our team. The fluid mechanical, hematological, and hemodynamical properties of this pump was evaluated in the moc circulation and animal experiments using adult goats. This vibrating electromagnetic (VEM) pump could generate more than 101/min with 10 Hz vibration, and could obtain the 2 kinds of flow and pressure patterns, such as constant peak and periodical peak patterns. The values of free Hb showed within acceptable values. We concluded that this pump is useful for totally implantable artificial heart.

TH-7B pneumatically driven sac-type ventricular assist device and drive system including automatic control system were developed and evaluated in the chronic animal experiments. The blood-contacting surfaces of the blood pump are coated with either Cardiothane or Cardiomat. In the chronic experiments using adult goats, only one of fifteen goats showed sudden thrombus formation after 34 pumping days. No gross findings of thrombus formation were observed in any of the cases, except for a thin circular thrombus at the junction of the connectors and the sac of the blood pump. These results suggest that antithrombogenicity of this system was satisfactory for clinical use.

From 1980 to March in 1989, there were 177 clinical application of ventricular assist device in Japan. Original diseases were 50% ischemic heart disease and 37% valvular disease. Duration of assistance ranged from one hour to 70 days. Thirty-one cases weaned from ventricular assistance and 11 cases became long-time survivors.