Recombinant angiotensin II is an emerging drug therapy for refractory hypotension. Its use is relevant to patients with disruption of the renin–angiotensin–aldosterone system denoted by elevated direct renin levels. We present a child that responded to recombinant angiotensin II in the setting of right ventricular hypertension and multi-organism septic shock.

Amiodarone may be considered for patients with junctional ectopic tachycardia refractory to treatment with sedation, analgesia, cooling, and electrolyte replacements. There are currently no published pediatric data regarding the hemodynamic effects of the newer amiodarone formulation, PM101, devoid of hypotensive agents used in the original amiodarone formulation. We performed a single-center, retrospective, descriptive study from January 2012 to December 2020 in a pediatric ICU. Thirty-three patients were included (22 male and 11 female) between the ages of 1.1 and 1,460 days who developed post-operative junctional ectopic tachycardia or other tachyarrhythmias requiring PM101. Data analysis was performed on hemodynamic parameters (mean arterial pressures and heart rate) and total PM101 (mg/kg) from hour 0 of amiodarone administration to hour 72. Adverse outcomes were defined as Vasoactive-Inotropic Score >20, patients requiring ECMO or CPR, or patient death. There was no statistically significant decrease in mean arterial pressures within the 6 hours of PM101 administration (p > 0.05), but there was a statistically significant therapeutic decrease in heart rate for resolution of tachyarrhythmia (p < 0.05). Patients received up to 25 mg/kg in an 8-hour time for rate control. Average rate control was achieved within 11.91 hours and average rhythm control within 62 hours. There were four adverse events around the time of PM101 administration, with three determined to not be associated with the medication. PM101 is safe and effective in the pediatric cardiac surgical population. Our study demonstrated that PM101 can be used in a more aggressive dosing regimen than previously reported in pediatric literature with the prior formulation.

Understanding blood flow in human body’s cerebral arterial system is of both fundamental and practical significance for prevention and treatment of vascular diseases. The mechanism and treatment for the growth of daughter aneurysm on its mother aneurysm are not yet fully understood. Themain purpose of the present paper is to elucidate the relationships between hemodynamics and the genesis, growth, subsequent rupture of the mother and daughter aneurysm on the cerebral vascular. The intensified stents with different porosities and structures are investigated to reduce the wall shear stress and pressure of mother and daughter aneurysm. The simulation is based on a lattice Boltzmann modeling of non-Newtonian blood flow. A novel stent structurewith “dense in front and sparse in rear” is proposed,which is verified to have good potential to reduce the wall shear stress of both mother and daughter aneurysm. The simulation is based on a lattice Boltzmann modeling of non-Newtonian blood flow. A novel stent structurewith “dense in front and sparse in rear” is proposed,which is verified to have good potential to reduce the wall shear stress of both mother and daughter aneurysm.

A distributed-parameter (one-dimensional) anatomically detailed model for the arterialnetwork of the arm is developed in order to carry out hemodynamics simulations. This workfocuses on the specific aspects related to the model set-up. In this regard, stringentanatomical and physiological considerations have been pursued in order to construct thearterial topology and to provide a systematic estimation of the involved parameters. Themodel comprises 108 arterial segments, with 64 main arteries and 44 perforator arteries,with lumen radii ranging from 0.24 cm – axillary artery- to 0.018 cm – perforatorarteries. The modeling of blood flow in deformable vessels is governed by a well-known setof hyperbolic partial differential equations that accounts for mass and momentumconservation and a constitutive equation for the arterial wall. The variationalformulation used to solve the problem and the related numerical approach are described.The model rendered consistent pressure and flow rate outputs when compared with patientrecords already published in the literature. In addition, an application todimensionally-heterogeneous modeling is presented in which the developed arterial networkis employed as an underlying model for a three-dimensional geometry of a branching pointto be embedded in order to perform local analyses.

The reliable and effective assimilation of measurements and numerical simulations inengineering applications involving computational fluid dynamics is an emerging problem assoon as new devices provide more data. In this paper we are mainly driven by hemodynamicsapplications, a field where the progressive increment of measures and numerical toolsmakes this problem particularly up-to-date. We adopt a Bayesian approach to the inclusionof noisy data in the incompressible steady Navier-Stokes equations (NSE). The purpose isthe quantification of uncertainty affecting velocity and flow related variables ofinterest, all treated as random variables. The method consists in the solution of anoptimization problem where the misfit between data and velocity - in a convenient norm -is minimized under the constraint of the NSE. We derive classical point estimators, namelythe maximum a posteriori – MAP – and the maximum likelihood – ML – ones.In addition, we obtain confidence regions for velocity and wall shear stress, a flowrelated variable of medical relevance. Numerical simulations in 2-dimensional andaxisymmetric 3-dimensional domains show the gain yielded by the introduction of a completestatistical knowledge in the assimilation process.

Background: Exaggerated cardiovascular reactivity to stressful stimuli may be a risk factor for the development of hypertension. The genetic influence on blood pressure (BP) reactivity to stress and its control mechanisms has been receiving considerable support. This study aims at examining the heritability of BP and its intermediate hemodynamic phenotypes to acute stress in a homogeneous Arab population. Methods: Parameters were computed from continuous BP, electrocardiography and impedance cardiography measurements, during rest, word conflict (WCT) and cold pressor (CPT) tests. Heritability estimates (h2) were obtained using the variance components-based approach implemented in the SOLAR software package. Results: Reactivity scores for WCT and CPT increased significantly (P < .05) for systolic (SBP), diastolic (DBP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR). They decreased significantly (P < .05) for stroke volume (SV), left ventricular ejection time (LVET), end diastolic (EDI) and cardiac contractility (IC) indices. Univariate analysis detected heritability estimates that ranged from 0.19–0.35 for rest, 0.002–0.40 for WCT and 0.08–0.35 for CPT. Conclusion: In this unique cohort, resting as well as challenged cardiovascular phenotypes are significantly influenced by additive genetic effects. Heritability estimates for resting phenotypes are in a relatively narrow range, while h2 for their reactivity is somewhat broader with lower estimates. Further analyses of this study may offer important opportunities for gene finding in hypertension. What is Known About the Topic: (1) cardiovascular reactivity to stress predicts cardiovascular disease; (2) genetic susceptibility plays an important role in stress reactivity. Family studies using the cold pressure test reported significant heritability for blood pressure. What this Study Adds: (1) this cohort is from five highly consanguineous isolated Arab pedigrees with genetically verified genealogical records and environmental homogeneity; (2) This is the first study to estimate heritability of detailed intermediate hemodynamic phenotypes that make up normal blood pressure.

The parallel implementation of MUPHY, a concurrent multiscale code for large-scale hemodynamic simulations in anatomically realistic geometries, for multi-GPU platforms is presented. Performance tests show excellent results, with a nearly linear parallel speed-up on up to 32GPUs and a more than tenfold GPU/CPU acceleration, all across the range of GPUs. The basic MUPHY scheme combines a hydrokinetic (Lattice Boltzmann) representation of the blood plasma, with a Particle Dynamics treatment of suspended biological bodies, such as red blood cells. To the best of our knowledge, this represents the first effort in the direction of laying down general design principles for multiscale/physics parallel Particle Dynamics applications in non-ideal geometries. This configures the present multi-GPU version of MUPHY as one of the first examples of a high-performance parallel code for multiscale/physics biofluidic applications in realistically complex geometries.

The spatial domain of Molecular Dynamics simulations is usually a regular box that can be easily divided in subdomains for parallel processing. Recent efforts aimed at simulating complex biological systems, like the blood flow inside arteries, require the execution of Parallel Molecular Dynamics (PMD) in vessels that have, by nature, an irregular shape. In those cases, the geometry of the domain becomes an additional input parameter that directly influences the outcome of the simulation. In this paper we discuss the problems due to the parallelization of MD in complex geometries and show an efficient and general method to perform MD in irregular domains.

We analyzed retrospectively the relationship between coagulation profile, and either hepatic function or hemodynamics, in patients who had undergone a Fontan-type procedure, comparing them, first, with a control group of 12 patients without significant hemodynamic abnormality, and, second, with a group of 14 patients who had not undergone a Fontan procedure, but whose mean right atrial pressure exceeded 8 mmHg. Follow-up catheterization had been performed in all 30 patients submitted to the Fontan-type operation. Prothrombin time, and factor XIII, were significantly lower in those who had undergone the Fontan procedure than in the other groups. Those submitted to the Fontan operation also had lower levels of protein C than controls, and their levels of plasminogen were lower than the patients with high right atrial pressure. Both aspartate aminotransferase and alanine aminotransferase were higher in those undergoing the Fontan procedure than in the other groups, while gamma-glutamyltranspeptidase in these patients was higher than in the control group. Mean right atrial pressure was highest in those under-going the Fontan procedure, while cardiac index was lowest. Prothrombin time was correlated to some extent with aspartate aminotransferase, mean right atrial pressure, and cardiac index. Protein C correlated with both aspartate aminotransferase and mean right atrial pressure, while factor XIII correlated with alanine aminotransferase, mean right atrial pressure, and cardiac index. Aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase, parameters of hepatic function, correlated significantly with mean right atrial pressure. In those who had undergone the Fontan procedure, decreased synthesis of pro-and anti-coagulant factors is a risk factor for both thrombosis and bleeding. Abnormal hemodynamics, in the absence of a right sided pumping chamber, may predispose to subclinical hepatic dysfunction, leading to selective disturbances of protein synthesis.

Blood flow rheology is a very complex phenomenon. Hemodynamics owns Newtonian or non-Newtonian characteristic is still debatable. Recently, studies related to blood tend to classify blood as non-Newtonian fluid. In this research, power law, Casson and Carreau which are being the most popular non-Newtonian models are applied to investigate the hemodynamics variables that influence formation of thrombosis and predict damageability to blood cell. The branched arterial system is simplified as T-junction geometry and the computational fluid dynamics software Fluent 6.2 with finite volume method is utilized to analyze the blood flow rheology in cases of continuous and pulsatile flow. The analysis results are compared with that of Newtonian model and give out very interesting hemodynamics predictions for each model. The size of recirculation zone is different from each model that is observed significantly. The wall shear stress of Carreau model gets the highest value, 14% in case of continuous flow and around 17% in pulsatile case bigger than that of Newtonian model. The results of pulsatile flow show that the Newtonian model is closed to power law model while the Casson model is similar to the Carreau model.

Doppler derived systolic pressure gradients have become widely applied as noninvasively obtained estimates of the severity of aortic valvar stenosis. There is little correlation, however, between the Doppler derived peak instantaneous gradient and the peak-to-peak gradient obtained at catheterisation, the latter being the most applied variable to determine severity in children. The purpose of this study was to validate a mathematical model based on data from catheterisation which estimates the peak-to-peak gradient from variables which can be obtained by noninvasive means (Doppler derived mean gradient and pulse pressure), according to the formula: peak-to-peak systolic gradient=6.02+1.49*(mean gradient)−0.44*(pulse pressure). Simultaneous cardiac catheterization and Doppler studies were performed on 10 patients with congenital aortic valvar stenosis. Correlations between the gradients measured at catheter measured, and those derived by Doppler, were performed using linear regression analysis. The mean gradients correlated well (y=0.67 × + 11.11, r=0.87, SEE=6 mm Hg, p=0.001). The gradients predicted by the formula also correlated well with the peak-to-peak gradients measured at catheter (y=0.66 × + 14.44, r=0.84, SEE=9 mm Hg, p=O.002). The data support the application of the model, allowing noninvasive prediction of the peak-to-peak gradient across the aortic valvar stenosis.

We postulated previously that variables related to pulmonary flow are independent predictors of levels of atrial natriuretic peptide in children with congenital heart disease. The aim of this study was to test this hypothesis in relation to other hemodynamic and clinical variables.

During catheterization we measured the levels of plasma N-terminal atrial natriuretic peptide prohormone in the plasma of 68 children with congenital heart disease. All had undergone complete clinical, echocardiographic and invasive hemodynamic investigations. The influence on the prohormone was analyzed for 10 different variables in a multiple linear regression model. The variability could be explained in large parts (adjusted R2 = 77.2%) by variations in atrial pressures or sizes, together with the degree of excessive pulmonary blood flow and signs of heart failure.

A value for atrial natriuretic peptide prohormone above 800 pmol/1 predicted hemodynamic imbalance (defined as elevated pressures in left or right atrium or the pulmonary arteries, and/or Qp/Qs > 1.5) with a specificity of 94%, a sensitivity of 73%, a positive likelihood ratio of 12.2, and a negative likelihood ratio of 0.29.

In conclusion, variables related to pulmonary blood flow are influential determinants of the levels of atrial natriureic peptide in children with congenital heart disease. Atrial pressures, and symptoms of heart failure are also of major importance.

Twenty cases of aortopulmonary window are reported with special reference to some unusual modes of presentation and hemodynamics. Patients over 15 years of age accounted for 35% of the group. This delayed presentation may relate to referral patterns and socioeconomic conditions prevalent in India. Curiously, this elderly subset had two modes of presentation—either as large left-to-right shunts with low pulmonary vascular resistance (71.4%), or as Eisenmenger's syndrome (28.6%). The reasons for the low pulmonary vascular resistance in the majority of these older patients remain unclear. The echocardiographic features of these defects can be missed in presence of significant associated cardiac lesions. A careful search should, therefore, be made for an additional aortopulmonary window in all cases with evidence of intercirculatory shunting.

We describe a three-year-old boy who presented with recurrent expectoration of bronchial casts six months following creation of a fenestrated lateral tunnel Fontan circulation for pulmonary atresia with intact ventricular septum. Cardiac catheterization demonstrated elevated central venous pressure with two areas of stenosis within the Fontan circuit, specifically at the junction of the right superior caval vein and the right pulmonary artery, and between the atrial baffle and the right superior caval vein. Insertion of Palmaz stents in these areas resulted in a reduction in central venous pressure, and a transient reduction in production of casts. Eight weeks after catheterization, however, he produced further casts, which resulted in hypoxia, respiratory arrest and death. We reviewed the autopsied specimens obtained from patients with the Fontan circulation over an eleven-year period at our institution in order to ascertain the prevalence of subclinical production of bronchial casts. We found no casts in the thirteen patients examined. Hemodynamic assessment is vital in all patients who develop this syndrome, and should be the primary focus of investigation, rather than solely directing efforts at lysis of casts.