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1 Department of Surgery, Division of Cardiac and Thoracic Surgery, Duke University Medical Center, Durham, N.C., USA; Center for Emerging Cardiovascular Technologies, Duke University Medical Center, Durham, N.C., USA
2 Center for Emerging Cardiovascular Technologies, Duke University Medical Center, Durham, N.C., USA
3 Department of Surgery, Division of Cardiac and Thoracic Surgery, Duke University Medical Center, Durham, N.C., USA
* To whom correspondence should be addressed. E-mail: apasipou{at}duke.edu.
Functional imaging computational fluid dynamics simulations of RV inflow fields were obtained by comprehensive software using individual, animal-specific dynamic imaging data input from 3D real-time echocardiography (RT3D), on a CRAY T-90 supercomputer. Chronically instrumented, lightly sedated awake dogs (n=7) with normal (NWM) at control and normal or diastolic paradoxical septal motion (PSM) during RV volume overload were investigated. Up to the E-wave peak, instantaneous inflow streamlines extended from the tricuspid orifice to the RV endocardial surface in an expanding fan-like pattern. During the descending limb of the E-wave, large-scale (macroscopic or global) vortical motions ensued within the filling RV chamber. Both at control and during RV volume overload (with or without PSM) blood streams rolled up from regions near the walls toward the base. The extent and strength of the ring vortex surrounding the main stream were reduced with chamber dilatation. A hypothesis is proposed for a facilitatory role of the diastolic vortex for ventricular filling. The filling vortex supports filling by shunting inflow kinetic energy, which would otherwise contribute to an inflow-impeding convective pressure-rise between inflow orifice and the large endocardial surface of the expanding chamber, into the rotational kinetic energy of the vortical motion that is destined to be dissipated as heat. The basic information presented should improve application and interpretation of noninvasive (Doppler color flow mapping, velocity-encoded cine MRI, etc.) diastolic diagnostic studies, and lead to improved understanding and recognition of subtle, flow-associated abnormalities in ventricular dilatation and remodeling.
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