Artère coronaire

Résumé

Les artères coronaires, dont le nom vient de leur disposition en couronne autour du cœur, sont des artères recouvrant la surface du cœur, permettant de vasculariser (irriguer), et par conséquent de nourrir, le muscle cardiaque (myocarde). On distingue l'artère coronaire gauche et l'artère coronaire droite, toutes deux prenant naissance de l'aorte. Anatomie Elles naissent de la face antérieure du début de l'aorte thoracique ascendante au niveau du sinus de Valsalva et restent à la surface du cœur où elles cheminent dans les sillons cardiaques. Leur calibre est petit ( dans les premiers centimètres, suivant l'artère), légèrement inférieure chez la femme, même en tenant compte de la corpulence. Les deux artères peuvent être partiellement obstruées par les valvules aortiques antérieures lors de la systole. C'est pourquoi le débit coronaire se fait essentiellement en diastole. Ce sont des artères terminales, c'est-à-dire que chaque portion du myocarde est irriguée par une se

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Coronary waves during valsalva maneuver measured during catheterization

Maria Cristina Rolandi

The mechanical interactions between heart contraction and perfusion of the heart are difficult to study in humans because of the restrictions in inducing changes in hemodynamic and cardiac mechanics parameters during catheterization. We hypothesize that the Valsalva maneuver can induce such alterations in the cardiac-coronary mechanical interaction and that these variations can be studied with the Wave Intensity Analysis. In order to interpret eventual changes in the wave intensity, a deep understanding of the effect of the Valsalva maneuver on the coronary circulation is needed. A particular attention has to be payed on the effect of the control of the microvascular resistance that is known to compensate for eventual alterations in the surrounding hemodynamic conditions when vessel tone is intact. In the catheterization laboratory, coronary pressure and flow velocity signals were recorded simultaneously by a new guidewire developed by Volcano Corporation. Aortic pressure, left ventricular pressure and ECG were acquired by the catheterization laboratory setup and recorded together with coronary hemodynamic signals. Left ventricular performance parameters were derived per beat from the noninvasive recording of the finger pressure using the Nexfin monitor developed by BMEYE B.V. In order to match the output data of coronary hemodynamic and left ventricular performance parameters, a dedicated program has been written in Delphi. An analysis of the per-beat data was performed in order to study the relative dependence of the parameters during the Valsalva maneuver. Pilot results of the Wave Intensity Analysis were obtained with an existing custom-made program also written in Delphi. Our study shows that the Valsalva maneuver caused a profound stress in the whole cardiovascular system. The well-known changes of the aortic pressure were transmitted also to the left ventricle and the coronary microcirculation. The data show that this stress caused a small but significant decrease in the flow velocity. As expected, the microvascular resistance varied with the same pattern as the coronary pressure trying to keep the flow constant. With respect to the decrease in stroke volume, cardiac output and contractility, the left ventricular performance was strongly compromised: pulse pressure generation and cardiac contraction were almost annulled. The decrease in systolic left ventricular pressure of almost 40% and the 2 fold increase in the end-diastolic left ventricular pressure confirm the decrease in the pumping action. Consequentially, the oxygen consumption of the heart decreased to 40% of the baseline level but only after an initial increase at the onset of the strain by 10%. The results also show that the timing of variation of the parameters was not the same. Especially the left ventricular end-diastolic pressure changed more rapidly than the perfusion pressure. Pilot results on Wave Intensity Analysis (WIA) show that the Valsalva maneuver gave rise to changes in the Wave Intensity pattern suggesting that the speed of the reflected waves has indeed been altered. Our results agree with previous studies that reveal a slight decrease in the flow velocity due to the Valsalva maneuver. Nevertheless, our results contradict the belief that ascribes the decrease in flow velocity to the decrease in oxygen consumption. We assume that the flow decrease is due to mechanical factors, especially the rise of left ventricular end-diastolic pressure. The results shown on WIA are pilot results and some work is still needed in this direction to obtain more information on the coronary-cardiac interaction. However, these results give confidence about the use of the Valsalva maneuver as an intervention affecting external parameters and thus they are useful in the study of coronary-cardiac interaction in humans.

2009

Chargement

This thesis aims at better understanding the role played by vascular smooth muscle cells (VSM) in the biomechanics of the arterial wall. Current models assume that under maximal vasodilation VSM carry no load, or the so-called "active stress" is zero. Biomechanical tests on arterial segments, where VSM cells were either chemically removed or structurally weakened have shown that VSM are playing a determinant role in the biomechanical properties of the arterial wall and carry important load even when maximally dilated. Based on these results a new model of the arterial wall biomechanics is proposed that takes into account the passive structure of the arterial wall constituents. The entire thesis consists of three distinct studies, either published or submitted and under review for publication. The first paper presents the effects of decellularization on the biomechanical properties of porcine common carotid arteries. The decellularization was performed by a detergent-enzymatic procedure, which preserves the extracellular matrix scaffold. Rupture tests were conducted. Inner diameter and wall thickness were measured by echotracking during pressure inflation from 10 to 145 mmHg. Distensibility and incremental elastic modulus were computed. At 10 mmHg, mean inner diameter of decellularized arteries was substantially higher than controls, whereas both decellularized and control arteries reached the same internal diameter value at 145 mmHg. Removing cellular elements from media lead to changes in arterial dimensions. The incremental elastic modulus increased, and the collagen fibers engaged more rapidly during inflation, thus yielding a stiffer vessel. Distensibility and compliance were therefore significantly lower in decellularized vessels, reaching a factor three reduction in the physiological range of pressures. The conclusion of this paper is that decellularization yields vessels able to withstand high inflation pressures with, however, markedly different geometrical and biomechanical properties. The second paper proposes an interpretation of the data collected in the experiments conducted in the first paper. This initial work on decellularized arteries revealed the existence of significant residual stresses within the arterial wall, which are released upon chemical removal of vascular smooth muscle in normal arteries causing substantial radial expansion. Hence, the often-used Hill's model describing active and passive stresses within the wall does not hold true, because the existence of prestresses precludes the fundamental assumption of zero active stress when the vascular smooth muscle is inactive. A new mathematical model based on a modified Hill's model was developed, where the total wall elastin is partitioned in two parts: one in-parallel to vascular smooth muscle and collagen and one connected in-series with vascular smooth muscle. Based on experimental evidences, compressive prestresses were assumed to exist on the parallel elastic component and tensile prestresses on the series elastic component. Further, it was assumed that the elastic constants of elastin and collagen and the statistical description of collagen engagement are not affected by decellularization. Excellent fits of the pressure-diameter curves of normal and decellularized arteries were obtained. The model predicts that the majority of elastin is in-series with the vascular smooth muscle (74±8%) and thus only about one-fourth of elastin acts in parallel to the vascular smooth muscle. The conclusion of this paper is that correct biomechanical modeling of the arterial wall requires the knowledge of the zero stress state of both the series and parallel elastic components. The third and last paper analyzes the effects of cytoskeleton destruction, after administration of Cytochalasin D, on the biomechanical properties of porcine common carotids. Compared to untreated, maximally dilated controls, Cytochalasin D-treated arteries have shown a marked increase in compliance in the elastin-dominated, 10-150 mmHg, pressure range. After weakening the vascular smooth muscle stress-bearing cytoskeleton by Cytochalasin D the artery would expand, reaching a new equilibrium state. This study brings further evidence that VSM is under tension, even when it is under zero load and at maximal vasodilation. This residual tension was released upon partial destruction of the cytoskeleton with Cytochalasin D. From a biomechanical standpoint, this means that the Zero Stress States of the in series and parallel elastic components are substantially different.

EPFL2008

Chargement

Biomechanics of Vascular Wall

Rana Saitta-Rezakhaniha

This thesis contributes to the field of biomechanics of vascular wall. The focus is particularly on the microstructure of vascular elastin and collagen constituents and their contribution to the macroscopic mechanical behavior of the wall. The analysis is done in the framework of continuum mechanics. The work characterizes structural features of elastin and collagen fibers using microscopy techniques and introduces these features to constituent-based constitutive models. The models are applied to the experimental data, derived from inflation-extension tests, to predict the gross mechanical behavior of the tissue. The developed constitutive models could be further used to study in detail the mechanics of vascular tissue in health and disease. The thesis is presented in form of an introduction, four chapters (corresponding to four papers) and a conclusion. The introduction provides the motivation for this thesis as well as the background on vascular wall structure and mechanics. A brief description of the imaging techniques used is presented. Also, structural constitutive modeling of vascular wall is briefly discussed with particular attention to the modeling of elastin and collagen constituents. The first paper focuses on anisotropic properties of elastin in veins. We show that earlier constituent-based strain energy functions (SEFs), where elastin is modeled as an isotropic material, fail in describing accurately the tissue response to inflation-extension loading. We hypothesize that these shortcomings are partly due to unaccounted anisotropic properties of elastin. We extend the previously developed biomechanical model in our laboratory (Zulliger et al., 2004, J. Biomech., 37(7): 989-1000 (2004)) to account for elastin anisotropy and present an anisotropic strain energy function for elastin with one family of fibers in the longitudinal direction. The model is validated using experimental data from inflation-extension tests on rabbit facial veins. The tissue is tested under a fully relaxed smooth muscle state, for longitudinal stretch ratios ranging from 100% to 130% of the in vivo length. The model with the anisotropic elastin fits well the data for a wide range of longitudinal stretch ratios. The main finding of this paper is that the anisotropic description of elastin is required for a full 3-D characterization of the biomechanics of the venous wall. The second paper addresses the role of elastin in anisotropic properties of arteries with particular attention to the structural organization of elastin. A constituent-based model including an anisotropic elastin, with one family of fibers in the circumferential direction, is presented. Micro-structural imaging, based on electron microscopy techniques, is used to support this anisotropy. Inflationˆextension tests, on intact and elastase-treated arteries, provide a data set to validate the model and to study the effect of elastin removal. We show that the SEF, with an anisotropic elastin part, characterizes more accurately the mechanical properties of the arterial wall as compared to models with simply an isotropic elastin. Transmission electron microscopy (TEM) and serial block-face scanning electron microscopy (SBF-SEM) show interlamellar elastin fibers in the circumferential direction and therefore support the nature of the assumed anisotropy. The model predicts an earlier engagement of collagen in elastase-treated arteries compared to the intact arteries and thus suggests a clear functional interaction between the elastin and collagen component that is often neglected in constituent-based SEFs. The third paper presents a structural constitutive model of the vascular wall which integrates both waviness and orientational dispersion of collagen fibers. We extend the model of Zulliger et al., which already accounts for collagen waviness, to include orientational distribution of collagen. We study the effect of parameters related to the orientational distribution on macro-mechanical behavior of the tissue during inflation-extension tests. The model is further applied to the experimental data from rabbit facial veins. The model accurately fits the experimental data of veins, but it does not improve the quality of the fit compared to the one without dispersion. We show that the orientational dispersion of collagen fibers can be compensated by a less abrupt and shifted to higher strain collagen engagement pattern. This should be taken into consideration when the model is used to fit experimental data and model parameters are used to study structural modifications of collagen fiber network in physiology and disease. In the fourth paper, we measure and quantify the waviness and orientational distributions of collagen in rabbit carotids. Quantification of collagen orientation distributions at the zero stress state of arteries is needed to develop realistic and precise biomechanical models. Using the fluorescence collagen marker CNA38-OG488 and confocal laser scanning microscopy, we visualize collagen fibers in adventitia of rabbit common carotids ex vivo. To get the properties related to the zero stress sate, the arteries are cut open along their longitudinal axes. We use semi-automatic and automatic techniques to measure parameters related to the waviness and fiber orientation. We show that the straightness parameter (i.e. the ratio between the distances of endpoints of a fiber to the fiber length) is distributed with a beta distribution. The shape of the probability density distribution does not depend on the mean angle orientation of fibers. In addition, our measurements reveal four axially symmetric families of fibers with mean orientations of 0°, 90°, 43° and -43° and circular standard deviations of 40°, 47°, 37° and 37°, with respect to the axial direction, respectively. To the best of our knowledge, this is the first study focusing on structural properties of collagen in the zero stress state and quantifying fiber waviness. The results of this study can be used to develop more precise structural models of the adventitia including waviness and orientational dispersion of fibers. The conclusion section summarizes the main results of the thesis, presents the improvements made over previous studies, and proposes future perspectives of this work.

EPFL2010

Chargement