Search

Nearly 80 short papers originating from the 14th International Symposium on Intracranial Pressure and Brain Monitoring held in Tuebingen, Germany, in September 2010 present experimental as well as clinical research data related to the naming topics of the conference. The papers have undergone a peer-reviewing and are organized in the following sections: methods of brain monitoring and data analysis, methods of invasive and non-invasive ICP assessment, the role of autoregulation, the role of tissue oxygenation and near-infrared spectroscopy, hydrocephalus/IIH imaging and diagnosis, management and therapy of hydrocephalus, management and therapy of traumatic brain injury, management and therapy of subarachnoid and intracranial hemorrhage, experimental approaches to acute brain disease. The book gives a good overview on the latest research developments in the field of ICP and related brain monitoring and on management and therapy of relevant acute brain diseases.

The fields of biological and medical physics and biomedical engineering are broad, multidisciplinary and dyanmic. They lie at the crossroads of frontier - search in physics, biology, chemistry, and medicine. The Biological & Me- cal Physics/Biomedical Engineering Series is intended to be comprehensive, covering a broad range of topics important to the study of the physical, che- cal and biological sciences. Its goal is to provide scientists and engineers with textbooks, monographs, and reference works to address the growing need for information. Books in the series emphasize established and emergent areas of science - cluding molecular, membrane, and mathematical biophysics; photosynthetic - ergy harvesting and conversion; information processing; physical principles of genetics; sensory communications; automata networks, neural networks, and cellular automata. Equally important will be coverage of applied aspects of b- logical and medical physics and biomedical engineering such as molecular el- tronic components and devices, biosensors, medicine, imaging, physical prin- ples of renewable energy production, advanced prostheses, and environmental control and engineering. Elias Greenbaum Oak Ridge, TN M. Zamir Department of Applied Mathematics University of Western Ontario London, Ontario, N6A 5B7 CANADA zamir@uwo.ca Library of Congress Cataloging-in-Publication Data Zamir, M. (Mair) The physics of coronary blood flow / M. Zamir. p. cm. — (Biological and medical physics, biomedical engineering) Includes bibliographical references and index. 1. Coronary circulation. 2. Hemodynamics. 3. Blood flow. I. Title. II. Series. QP108.Z36 2005 612.1?7—dc22 2005042502 ISBN-10: 0-387-25297-5 e-ISBN: 0-387-26019-6 Printed on acid-free paper.

This book provides extensive information on the management of advanced heart failure, cardiogenic shock and mechanical circulatory support. In this regard, this book is unique in emphasizing the physiologic interaction between physician and technology, bridging the gap between theoretical physiology and its clinical application, with a focus on the practical aspects of cardiovascular physiology in advanced heart failure/cardiogenic shock, and focusing on each part of the patient's clinical ‘journey'. Hemodynamic Physiology in Advanced Heart Failure and Cardiogenic Shock integrates complex topics in advanced heart failure and cardiogenic shock, such as the man-machine interactive physiology and the theoretical physiology-clinical application. It therefore provides an accessible resource for cardiologists, surgeons, intensivists, specialist nurses and critical care practitioners, and is also suitable for trainees and more senior clinicians with an interest in a physiology-guided approach to advanced heart failure/cardiogenic shock and mechanical circulatory support.

Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease, Two Volume Set covers the principles, physiology, biologic pathways, clinical implications and therapeutics surrounding arterial stiffness and pulsatile hemodynamics, along with a thorough overview of the field. The book presents complex engineering concepts in a way that those in science and medicine can more easily understand. It includes detailed illustrations. Additionally, it presents advanced bioengineering concepts in boxes for readers who wants more in-depth biophysical knowledge. This is a must-have reference for students, researchers and clinicians interested in learning more about this field. Incorporates case studies and calculations/worked examples with mathematical principles explained in a conceptual manner without complicated formulas Features chapter contributions from leading international researchers and clinicians Covers principles, physiology, biologic pathways, clinical implications and therapeutics

This book aims to show how hemodynamic numerical models based on Computational Fluid Dynamics (CFD) can be developed. An approach to fluid mechanics is made from a historical point of view focusing on the Navier-Stokes Equations and a fluid-mechanical description of blood flow. Finally, the techniques most used to visualize cardiac flows and validate numerical models are detailed, paying special attention to Magnetic Resonance Imaging (MRI) in case of an in vivo validation and Particle Image Velocimetry (PIV) for an in vitro validation.

Personalized Computational Hemodynamics: Models, Methods, and Applications for Vascular Surgery and Antitumor Therapy offers practices and advances surrounding the multiscale modeling of hemodynamics and their personalization with conventional clinical data. Focusing on three physiological disciplines, readers will learn how to derive a suitable mathematical model and personalize its parameters to account for pathologies and diseases. Written by leading experts, this book mirrors the top trends in mathematical modeling with clinical applications. In addition, the book features the major results of the'Research group in simulation of blood flow and vascular pathologies'at the Institute of Numerical Mathematics of the Russian Academy of Sciences. Two important features distinguish this book from other monographs on numerical methods for biomedical applications. First, the variety of medical disciplines targeted by the mathematical modeling and computer simulations, including cardiology, vascular neurology and oncology. Second, for all mathematical models, the authors consider extensions and parameter tuning that account for vascular pathologies. - Examines a variety of medical disciplines targeted by mathematical modeling and computer simulation - Discusses how the results of numerical simulations are used to support clinical decision-making - Covers hemodynamics relating to various subject areas, including vascular surgery and oncological tumor treatments

An accessible and engaging review of board exam essentials Cardiology Board Review lays the groundwork for board exam success with its instructive and easy-to-read explanations of the pathophysiology, diagnosis, and treatment of patients with cardiovascular disease. Breaking topics down into case �unknowns,� this innovative revision aid provides examples of everyday cardiological issues and then explains how best to address the problem at hand. All content is complemented by clinical images and illustrations, as well as helpful summaries and key points. Featuring 56 different cases, this essential text: Places learning in a practical context. Information about disease states is presented in case-based format which leads to better retention. Covers topics including congenital heart disease, coronary artery disease, cardiomyopathies, valvular heart disease, arrhythmias, heart failure, peripheral vascular disease, and more Designed to present important concepts and information in a unique way to complement textbook learning Features electrocardiograms, angiograms, and pressure tracings Is applicable to those working towards certification in Cardiovascular Disease from the American Board of Internal Medicine or preparing for board examinations in other countries Is also suitable for those requiring MOC recertification Features cases on aortic insufficiency, atrial fibrillation, Brugada syndrome, carotid artery disease, myocardial bridging, congenital heart disease, electrolyte abnormalities, apical HCM, mitral regurgitation, RV outflow tract tachycardia, pulmonary hypertension, arrhythmogenic right ventricular dysplasia, aortic stenosis, atrial myxoma, atrial tachycardia, pulmonic insufficiency, Takotsubo, tricuspid regurgitation, Wolfe-Parkinson-White syndrome, pulmonic stenosis, coronary anomalies, ECG changes of hypothermia, endocarditis, pulmonary embolus, ventricular septal defect, hemodynamics of hypertrophic cardiomyopathy, complete heart block, heart failure, coronary artery disease, atrial septal defect, constrictive pericarditis, fractional flow reserve, dextrocardia, STEMI, early repolarization, giant cell myocarditis, peripheral arterial disease, pericardial tamponade, peripheral arterial disease, pericarditis, myocarditis, long QT syndrome, mitral stenosis, tetralogy of Fallot, and supraventricular tachycardia among others. Cardiology Board Review offers fellows a fresh and engaging approach to the information required to achieve success in board examinations.

This extensively revised second edition traces the development of the basic concepts in cardiovascular physiology in light of the accumulated experimental and clinical evidence. It considers the early embryonic circulation, where blood circulation suggests the existence of a motive force, tightly coupled to the metabolic demands of the tissues. It proposes that rather than being an organ of propulsion, the heart, serves as an organ of control, generating pressure by rhythmically impeding blood flow. New and expanded chapters cover the arterial pulse, circulation in the upright posture, microcirculation and functional heart morphology. Heart and Circulation offers a new perspective for deeper understanding of the human cardiovascular system. It is therefore a thought-provoking resource for cardiologists, cardiac surgeons and trainees interested in models of human circulation.

The first edition of the book was written employing mathematical techniques to formulate the physical principles involved in the structural and functional correlates of the underlying physiology.This current and self-contained second edition updates many of the new findings since its first edition a decade ago. It also includes a new chapter on the'Interaction with the Heart'. The dynamics of the arterial system, the venous system, the microcirculation and their interaction with the heart are quantitatively described in terms of their structures and functions. Clinical measurements, applications to the cardiovascular field and physiological mechanisms are clearly identified throughout the text. Most importantly, worked examples are provided, such that the readers can appreciate the application aspects of the underlying formulation.

The second edition of this key resource provides a broad and fundamental overview of basic cardiovascular (CV) hemodynamic principles with a focus on clinical assessment of CV physiology. Extensively updated, the book includes new coverage on noninvasive hemodynamic assessment and the effects of selected interventions on CV hemodynamics. It provides an introduction to the basic concepts such as preload, afterload, myocardial contractility, and cardiac output. Subsequent chapters examine the effects of interventions such as vasodilators, beta blockers, pressor agents, inotropes, and different forms of invasive circulatory support. The book also focuses on various methods of hemodynamic evaluation including echocardiography, CT/MRI, noninvasive hemodynamic assessment, and cardiac catheterization. The book concludes with a discussion of proper diagnosis, evaluation, and management of patients using hemodynamic data on a variety of specific disease states. An invaluable contribution to the Contemporary Cardiology Series, the Second Edition of Cardiovascular Hemodynamics: An Introductory Guide is an essential resource for physicians, residents, fellows, medical students, and researchers in cardiology, emergency medicine, critical care, and internal medicine.

First Published in 1981, this book offers a full, comprehensive guide to the operation of cardiovascular fluid systems. Carefully compiled and filled with a vast repertoire of notes, diagrams, and references this book serves as a useful reference for cardiologists, haematologists, students of medicine, and other practitioners in their respective fields.

This book describes various aspects of the basic physiological processes critical to tissue perfusion and cellular oxygenation, including the roles of the circulatory system, respiratory system, blood flow distribution and microcirculation. In the context of monitoring critically ill patients in the early hours of circulatory shock, it is essential to recognize changes in traditional parameters such as mean arterial pressure and cardiac output, and to assess the need for active intervention. However, even if global macrocirculatory variables are restored, abnormalities in tissue oxygenation may persist. Tissue hypoperfusion is connected to the development of organ failure and, if it goes unrecognized, may worsen the prognosis. As a result, there is a growing interest in methods for monitoring regional perfusion in peripheral tissues to predict or diagnose ongoing hypoperfusion. In this work, eminent experts from a range of disciplines convey a working knowledge of how regional monitoring in shock can complement the conventional global parameters of oxygen transport, and demonstrate that real-time bedside assessment of tissue oxygenation is readily achievable using noninvasive monitoring techniques. Accordingly, the book offers a valuable, easy-to-use guide for the entire ICU team and other clinicians.

A highly clinical focus and clear, vibrant illustrations make Textbook of Clinical Hemodynamics, 2nd Edition, by Dr. Michael Ragosta, the resource of choice for accurately analyzing hemodynamic waveforms generated in cardiac catheterization labs. This easy-to-use, disease-oriented reference—ideal for physicians, nurses, and technicians—offers the unparalleled detail and visual support you need for interpreting the findings you encounter in practice. New coverage throughout keeps everyone on the cardiac team up to date with the latest concepts and skills, ensuring more effective monitoring and treatment of patients with cardiac disease. - Provides a disease-oriented assessment of waveform data that demonstrates how both qualitative and quantitative interpretation can affect clinical decision making. - Features extensive updates throughout, with expanded coverage of aortic valve and mitral valve disorders, including new percutaneous valve treatments (TAVR, mitral clip); comparison of hemodynamic support devices; a new chapter on pulmonary hypertension; and expanded coverage of coronary hemodynamics. - More than 100 brand-new, full-color images provide clear visuals for a more complete understanding of complex concepts. - Includes a new Easy Reference Appendix with clinically useful formulas and data.

This new edition is written in the same quick reference style as its predecessor to help clinical and basic researchers, as well as graduate students, understand hemodynamics. Hemodynamics makes it possible to characterize, in a quantitative way and often with noninvasive techniques, the function of the heart and the arterial system, individually and in combination.Snapshots of Hemodynamics provides a thorough grounding in the discipline that will help any medical professional and researcher in the field. The authors have designed each chapter such that it gives a succinct overview of individual topics in a concise and understandable format. Each chapter of this new edition has been extensively updated while new chapters have been included on pulmonary hemodynamics and wave intensity analysis. The new edition presents the newest current information on hemodynamics in this ever-changing field.

Cardiovascular Hemodynamics for the Clinician, 2nd Edition, provides a useful, succinct and understandable guide to the practical application of hemodynamics in clinical medicine for all trainees and clinicians in the field. Concise handbook to help both practicing and prospective clinicians better understand and interpret the hemodynamic data used to make specific diagnoses and monitor ongoing therapy Numerous pressure tracings throughout the book reinforce the text by demonstrating what will be seen in daily practice Topics include coronary artery disease; cardiomyopathies; valvular heart disease; arrhythmias; hemodynamic support devices and pericardial disease New chapters on TAVR, ventricular assist devices, and pulmonic valve disease, expanded coverage of pulmonary hypertension, fractional flow reserve, heart failure with preserved ejection fraction and valvular heart disease Provides a basic overview of circulatory physiology and cardiac function followed by detailed discussion of pathophysiological changes in various disease states

This new, revised and updated edition takes into account the most recent advances in the understanding of human pathophysiology. The book presents the complex basic principles of vascular hemodynamics and its pathophysiologie in a direct and effective way, stressing the importance of the mechanical properties of large arteries in the origin of blood pressure. The readily understandable text, supported by helpful images, describes the elements that define blood pressure and explains such important concepts as pulse wave velocity, central blood pressure, reflected waves, and pulse pressure amplification. Entirely new chapters are included on the sympathetic nervous system and arterial stiffness and on the role played by arterial stiffness in influencing blood pressure variability. The book will enable the physician to answer some of the key questions encountered when addressing the problem of arterial hypertension in everyday clinical practice: How is blood pressure generated? How shouldblood pressure values be interpreted? Is systolic blood pressure of greater importance than diastolic blood pressure?

An evidence-based guide to hemodynamic monitoring procedures and patient care, Hemodynamic Monitoring: Evolving Technologies & Clinical Practice describes invasive, non-invasive, and minimally invasive techniques in monitoring blood pressure and oxygen levels within the circulatory system. It provides a clear, illustrated discussion of the anatomy and physiology related to hemodynamics, explains the technologies involved in each measurement, and includes quick-reference tables of normal and abnormal values. Written by cardiovascular nursing expert Mary E. Lough, Hemodynamic Monitoring is a detailed, comprehensive text designed for critical care nurses and respiratory therapists. - Case Studies in each clinical chapter include a patient scenario with assessment details, allowing you to envision real-life patient care and prepare for adverse outcomes or complications. - Coverage of patient safety includes a discussion of important measures that will help you provide safe and effective patient-centered care. - UNIQUE! Coverage of patient comfort includes a discussion of methods to increase patient comfort during invasive procedures. - Clinical Reasoning Pearls provide practical advice from experts and describe how to implement a procedure or improve patient care. - A table of Important Values and Formulas is located inside the back cover for quick and easy reference.

Praise for Hemo-Dynamics: “This book provides an elegant and intuitive derivation of the fundamental mathematics underlying fluid flow, and then applies these in a straightforward way to pulsatile blood flow in all its complexity. One of the triumphs of the book is that Zamir succeeds in making essential concepts such as the Navier-Stokes equations completely accessible to any reader with a knowledge of basic calculus. The author succeeds in conveying both the beauty of his subject matter, and his passion for the elegance and intricacies of fluid flow more generally.” Lindi Wahl, PhD, Professor of Applied Mathematics, The University of Western Ontario “Incredible, the figures alone are to die for… At first glance “Hemo-Dynamics” seems like a deep engineering and modeling dive into the mechanical properties of the cardiovascular system, blood, and how they interact to generate flow and pressure. However, the text is laid out in a stepwise manner and I was especially impressed in the way that the key conceptual figures illustrate the essential concepts. In keeping with the philosophical underpinnings of engineering, Professor Zamir has also constructed his book so that the format, text, equations and the figures are self-reinforcing. This isa book that will be of great use to those who seek to understand the cardiovascular system from a mechanical and modeling perspective.” Michael J. Joyner, MD, Professor of Anesthesiology, Mayo Clinic, Rochester, MN

HEMODYNAMIC MONITORING Made Incredibly VISUAL, Third Edition combines images and clearly written, concise text to make the complex concepts of hemodynamic monitoring easy to understand. Great for reference or review, it uses hundreds of detailed photographs, diagram, charts, and other visual aids to clarify essential cardiopulmonary anatomy and physiology - and demonstrate how to confirm that lungs are getting enough oxygen and how well the heart is pumping. Chapters cover vascular access and the monitoring of arterial pressure, central venous pressure, pulmonary artery pressure, cardiac output, and tissue oxygenation, as well as minimally invasive hemodynamic monitoring and circulatory assist devices.

This book discusses geometric and mathematical models that can be used to study fluid and structural mechanics in the cardiovascular system. Where traditional research methodologies in the human cardiovascular system are challenging due to its invasive nature, several recent advances in medical imaging and computational fluid and solid mechanics modelling now provide new and exciting research opportunities. This emerging field of study is multi-disciplinary, involving numerical methods, computational science, fluid and structural mechanics, and biomedical engineering. Certainly any new student or researcher in this field may feel overwhelmed by the wide range of disciplines that need to be understood.This unique book is one of the first to bring together knowledge from multiple disciplines, providing a starting point to each of the individual disciplines involved, attempting to ease the steep learning curve. This book presents elementary knowledge on the physiology of the cardiovascular system; basic knowledge and techniques on reconstructing geometric models from medical imaging; mathematics that describe fluid and structural mechanics, and corresponding numerical/computational methods to solve its equations and problems.Many practical examples and case studies are presented to reinforce best practice guidelines for setting high quality computational models and simulations. These examples contain a large number of images for visualization, to explain cardiovascular physiological functions and disease. The reader is then exposed to some of the latest research activities through a summary of breakthrough research models, findings, and techniques.The book's approach is aimed at students and researchers entering this field from engineering, applied mathematics, biotechnology or medicine, wishing to engage in this emerging and exciting field of computational hemodynamics modelling.

This book offers a comprehensive overview of up-to-date knowledge on vascular access surgery. Written by a senior author with more than 30 years of experience and by expert contributors, it covers both surgical and theoretical aspects. The author shares his expertise in a hands-on approach and presents his views on the difficulties that every clinician may encounter. The various options for vascular access creation are carefully reviewed. Detailed descriptions and numerous accompanying illustrations of AV fistulas, AV prosthetic grafts, and arterio arterial grafts are provided, and a chapter is also devoted to the use of central venous catheters. Potential complications and their management are explained, and advice is offered on how to deal with special patient groups requiring extra attention. Separate chapters on fluid dynamics (drawing on the author's own research) and vascular pathology cater for the needs of those with a particular interest in the pathophysiological principles.

Although, within neurosonology, study of both the extracranial and the intracranial circulation began at least 15 years ago, it is only in recent years that ultrasound evaluation of cerebral veins and cerebral venous hemodynamics has attracted wider attention. Nevertheless, the huge variability in venous outflow pathways in normal subjects means that the potential usefulness of this examination is still often neglected. This atlas provides concise descriptions of the main normal and pathological ultrasound features of the cerebral venous circulation for neurosonologists and clinicians. It is designed as a practical tool that will be of assistance in everyday practice in the ultrasound lab and will improve the knowledge of sonologists and the reliability of venous ultrasound studies. The multimedia format, with detailed images, explanatory videos, and short, targeted descriptions, ensures that information is clearly conveyed and that users will become fully acquainted with the variability of normal findings of venous examinations. The atlas will be of value both to trainees in this field of ultrasound and to neurosonologists who are beginning to perform venous examinations in addition to arterial extra- and intracranial examinations. ​

This book presents a new method for analyzing the structure and function of the biological branching systems of fractal trees, with a focus on microcirculation. Branching systems in humans (vascular and bronchial trees) and those in the natural world (plants, trees, and rivers) are characterized by a fractal nature. To date, fractal studies have tended to concentrate on fractal dimensions, which quantify the complexity of objects, but the applications for practical use have remained largely unexplored. This book breaks new ground with topics that include the human retinal microcirculatory network, oxygen consumption by vascular walls, the Fåhraeus-Lindqvist effect, the bifurcation exponent, and the asymmetrical microvascular network. Readers are provided with simple formulas to express functions and a simulation graph with in vivo data. The book also discusses the mechanisms regulating blood flow and pressure and how they are related to pathological changes in the human body. Researchers and clinicians alike will find valuable new insights in these pioneering studies.

​This book traces the development of the basic concepts in cardiovascular physiology in the light of the accumulated experimental and clinical evidence and, rather than making the findings fit the standard pressure-propulsion mold, let the phenomena ‘speak for themselves'. It starts by considering the early embryonic circulation, where blood passes through the valveless tube heart at a rate that surpasses the contractions of its walls, suggesting that the blood is not propelled by the heart, but possesses its own motive force, tightly coupled to the metabolic demands of the tissues. Rather than being an organ of propulsion, the heart, on the contrary, serves as a damming-up organ, generating pressure by rhythmically impeding the flow of blood. The validity of this model is then confirmed by comparing the key developmental stages of the cardiovascular system in the invertebrates, the insects and across the vertebrate taxa. The salient morphological and histological features of the myocardium are reviewed with particular reference to the vortex. The complex, energy-dissipating intracardiac flow-patterns likewise suggest that the heart functions as an organ of impedance, whose energy consumption closely matches the generated pressure, but not its throughput. Attention is then turned to the regulation of cardiac output and to the arguments advanced by proponents of the ‘left ventricular'and of the ‘venous return'models of circulation. Hyperdynamic states occurring in arteriovenous fistulas and congenital heart defects, where communication exists between the systemic and pulmonary circuits at the level of atria or the ventricles, demonstrate that, once the heart is unable to impede the flow of blood, reactive changes occur in the pulmonary and systemic circulations, leading to pulmonary hypertension and Eisenmenger syndrome. Finally, the key points of the nook are summarized in the context of blood as a ‘liquid organ'with autonomous movement.​

In humans, hemodynamic stability is essential to maintain homeostasis. In order to achieve this, atrial, ventricular, and vascular properties, their interactions are rigorously and, in a sense, elegantly controlled. Cardiovascular diseases are associated with impairments of one or more such properties and interactions, and they often lead to end-organ damage, including damage to the liver, kidney, and gastrointestinal system. Impairments of such organs can, in turn, influence the cardiovascular system and overall hemodynamics. Therefore, to better understand the underlying pathophysiology of several diseases and conditions of hemodynamic instability, each of the cardiovascular properties together with the organ functions other than those of the cardiovascular system should be precisely assessed. For this purpose, many researchers all over the world have put in efforts to develop the theory and applications of monitoring tools for hemodynamics. This book contains essential information regarding hemodynamic monitoring, encompassing issues from fetuses to adults, including experimental and clinical findings and data on invasive and non-invasive methodologies.

A basic understanding of cardiovascular physiology is essential for optimal patient care. This practical book provides a concise tutorial of all the essential aspects of cardiovascular hemodynamics and the techniques used to assess cardiovascular performance. A high-yield reference, this book is replete with figures, tracings, tables, and clinical pearls that reinforce the basic tenets of hemodynamics. From identifying key findings of the patient history and physical exam to correlating hemodynamic tracings with acute clinical presentations, this book arms the reader with the tools necessary to handle any hemodynamic-related situation.

Practical Cardiovascular Hemodynamics provides an in-depth understanding of waveforms and tracings seen in various disease states as well as pathophysiology behind those findings. Practical issues that are rarely discussed or focused upon in textbooks are highlighted in this book with detailed waveform analysis. Pitfalls in the hemodynamic assessment of valvular diseases, constriction, tamponade, pulmonary hypertension, shunt pathology, congenital heart disease, coronary disease, and right and left ventricular failure are provided. Practical Cardiovascular Hemodynamics also includes case-based and tracingbased self-assessment problems. e reader will learn to identify disease states and waveform subtleties from single tracings or from case studies and will increase skills in interpreting tracings, understanding notches and artifacts, and formulating a diagnosis. Practical Cardiovascular Hemodynamics Features: Complete presentation of basic and advanced hemodynamicsNumerous case studies allow the reader to learn real-life application of hemodynamic data in clinical decision makingQuestions and explanations provides the reader with self-assessment and problem-solving skills325 illustrations and 25 tables with detailed legends allowing for illustrated learning

Recently, several studies have shown the crucial role of viscoelastic properties of the aorta and large arteries in determining blood pressure values. A good knowledge of cardiovascular pathophysiology and vascular hemodynamics is necessary to understand these phenomena. However, available texts on this topic are very complex and difficult for medical practitioners to understand. The aim of this book is to enable the reader to comprehend the relation between cardiovascular pathophysiology and vascular hemodynamics and to become familiar with the more recent guidelines. While very complex physical concepts are involved, care has been taken to ensure that the explanations are as straightforward as possible. Complex analyses are presented separately and can be skipped by the reader without impairment of understanding. It is envisaged that the knowledge imparted will prove invaluable in improving the approach to hypertensive patients.

Vortex Formation in the Cardiovascular System will recapitulate the current knowledge about the vortex formation in the cardiovascular system, from mechanics to cardiology. This can facilitate the interaction between basic scientists and clinicians on the topic of the circulatory system. The book begins with a synopsis of the fundamentals aspects of fluid mechanics to give the reader the essential background to address the proceeding chapters. Then the fundamental elements of vortex dynamics will be discussed, explaining the conditions for their formation and the rules governing their dynamics. The main equations are accompanied by mathematical models. Cardiovascular vortex formation is first analyzed in physiological, healthy conditions in the heart chambers and in the large arterial vessels. The analysis is initially presented with an intuitive appeal grounded on the physical phenomena and a focus on its clinical significance.In the proceeding chapters, the knowledge gained from either clinical or basic science literature will be discussed. The corresponding mathematical elements will finally be presented to ensure the adequate diligence. The proceeding chapters ensue to the analysis of pathological conditions, when the reader may have developed the ability to recognize normal from abnormal vortex formation phenomenon. Pathological vortex formation represents vortices that develop at sites where normally laminar flow should exist, e.g. stenosis and aneurisms. This analysis naturally leads to the interaction of vortices due to the surgical procedures with respect to prediction of changes in vortex formation. The existing techniques, from medical imaging to numerical simulations, to explore vortex flows in the cardiovascular systems will also be described. The presentations are accompanied by the mathematical definitions can that be understandable for reader without the advanced mathematical background, while an interested reader with more advanced knowledge inmathematics can be referred to references for further quantitative analyses. The book pursues the objective to transfer the fundamental vortex formation phenomena with application to the cardiovascular system to the reader. This book will be a valuable support for physicians in the evaluation of vortex influence on diagnosis and therapeutic choices. At the same time, the book will provide the rigorous information for research scientists, either from medicine and mechanics, working on the cardiovascular circulation incurring with the physics of vortex dynamics.

The hemodynamic mechanisms of hypertension are often limited to the study of three dominant parameters: blood pressure, cardiac output and vascular resis­ tance. Accordingly, the development of hypertension is usually analyzed in terms of a'struggle'between cardiac output and vascular resistance, resulting in the classical pattern of normal cardiac output and increased vascular resistance, thus indicating a reduction in the caliber of small arteries. However, during the past years, the clinical management of hypertension has largely modified these simple views. While an adequate control of blood pressure may be obtained with antihypertensive drugs, arterial complications may occur, involving mainly the coronary circulation and suggesting that several parts of the cardiovascular system are altered in hypertension. Indeed, disturbances in the arterial and the venous system had already been noticed in animal hypertension. The basic assumption in this book is that the overall cardiovascular system is involved in the mechanisms of the elevated blood pressure in patients with hypertension: not only the heart and small arteries, but also the large arteries and the venous system. For that reason, the following points are emphasized. First, the cardiovascular system in hypertension must be studied not only in terms of steady flow but also by taking into account the pulsatile components of the heart and the arterial systems. Second, arterial and venous compliances are altered in hypertension and probably reflect intrinsic alterations of the vascular wall.

The noninvasive evaluation of hemodynamics in congenital heart disease is an application for which Doppler ultrasound is ideally suited. The pediatric cardiac sonographer has used 2D and TM imaging for several years to study the structural abnormalities associated with various lesions. Pulsed Doppler, continuous wave Doppler, and more recently, color flow mapping techniques have been used to study the pathophysiology, and to make quantitative measurements thereof. To those already working in pediatric echocardiography, this book is intended to serve as a guide to the applications of the various Doppler modalities in specific abnormalities. The other group for which this text is intended are the adult cardiac sonographers who see the occasional patient with congenital heart disease in their echocardiography laboratories. The incidence ofcongenital heart disease is not decreasing. As more patients survive to child bearing age, the adult cardiologist sees more and more referrals from the pediatric cardiologist to follow up the parent with corrected congenital heart disease, and in many smaller institutions, to examine their offspring as well. For this group, the book is intended to serve as a reference which gives a basic description of the pathology, the relevant parameters to observe, and a guide to the Doppler applications used to make these observations. While there are a few books available on the subject of echocardiography in congenital heart disease, they do not usually go into much detail on noninvasive assessment of the pathophysiology. It is our hope that this text fills that gap.

... we do not know a truth without knowing its cause. Aristotle Perhaps the greatest hope that may be entertained for a scientific work, whether experimental or theoretical, is that it leads to new thoughts and new avenues of investigation on the part of its readers. In microvascular mechanics, the interplay of rheology, anatomy, and cellular and organ function has only just begun to be addressed. To understand the operational behavior of microcirculation, there is a need to integrate studies at the cellular or molecu­ lar level with a quantitative, biomechanical description of the circulatory system. The symposium entitled'Frontiers in Cardiopulmonary Mechanics'held in June 1988 at the University of Virginia was intended to provide a fundamental approach to the description of the circulation from the per­ spective of microvascular mechanics and to examine new methodology that may advance this effort. This book arose out ofthe work presented at the symposium. Aristotle expressed well the need to pursue the causes of a phenomenon in order to achieve a truthful understanding of its nature. In this spirit has each of the quantitative sciences progressed, and in this spirit we hope that this book will provide some understanding of the microvascular events and bio­ mechanical mechanisms underlying the behavior of circulation in general, and of pulmonary and skeletal muscle microcirculation in particular. The integrated treatment of pulmonary and systemic microcirculation provided here is intended to encourage the cross-fertilization of these two research fields.