Intrapulmonary Shear Stress Enhancement: A New Therapeutic Approach in Pulmonary Arterial Hypertension

Nour, Sayed; Dai, Gang; Carbognani, Daniel; Feng, Minze; Yang, Dongzi; Lila, Nermine; Chachques, Juan Carlos; Wu, Guifu

doi:10.1007/s00246-012-0322-8

Cited by 11 publications

(11 citation statements)

References 51 publications

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“…We have been previously reported the hemodynamic benefits of the clinical applications of ESS with different pulsatile CAD (48)(49)(50). Particularly, in our study with a low-pressure pulsatile trouser device (51), we have shown that the RV subendocardial resistance vessels are more sensitive to mediators of vasodilatation and endothelium dependent dilators rather than increased transmural coronary flow (52)(53)(54).…”

Section: Discussionmentioning

confidence: 61%

Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest

2017

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Sudden cardiac arrest (SCA) remains a major problem for health authorities worldwide. Insufficiencies of current cardiopulmonary resuscitation (CPR) are most probably related to an inappropriate concept and applied methods that still concentrate on heartbeat as priority, instead of blood circulation to maintain organs' perfusions. The aim of this works is to propose a new therapeutic approach for SCA in a more effective and secure manner compared with current CPR methods. It correlates to a non-invasive circulatory flow restoration (CFR) device composed of a multilayered thoracic and infradiaphragmatic compartments that will be pulsated alternatively and in fixed frequencies using a low-pressure pneumatic generator. Proof-of-concept studies with different prototypes and methods of SCA, showed restoration of hemodynamics (BP ≥ 100 mm Hg) and increased urine output after 20 min of cardiac arrest in pediatric dogs and piglets. In summary, a CFR device can induce shear stress-mediated endothelial function to restore microcirculation and cellular metabolism. This represents a cost-effective method, predisposes to return of spontaneous circulation in case of SCA, adaptable for all age groups, in public and hospital environments.

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Section: Discussionmentioning

confidence: 61%

Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest

2017

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“…In contrast, in any abnormal hemorheological state, microcirculation presents behavior that approaches that of Bernoulli's 3rd equation, which is interpreted by the Fahraeus-Lindqvist effect [24], in which plasma becomes stuck at the inner vascular boundary layers, whereas erythrocytes move faster at the center [35]. These may explain clubbing fingers phenomena in cyanotic heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…Animals were premedicated and maintained on general anesthesia according to our previously published protocols [35]. After a median cervicotomy and tracheotomy, a 3.5–5 tracheal tube was inserted, followed by mechanical ventilation (PA-500 PuLang Technologies Inc) with 40% oxygen, 10–15 mL/kg/min of tidal volume, and frequency of 15/min.…”

Section: Methodsmentioning

confidence: 99%

Shear Stress, Energy Losses, and Costs: A Resolved Dilemma of Pulsatile Cardiac Assist Devices

Nour

Liu

Dai

et al. 2014

BioMed Research International

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Cardiac assist devices (CAD) cause endothelial dysfunction with considerable morbidity. Employment of pulsatile CAD remains controversial due to inadequate perfusion curves and costs. Alternatively, we are proposing a new concept of pulsatile CAD based on a fundamental revision of the entire circulatory system in correspondence with the physiopathology and law of physics. It concerns a double lumen disposable tube device that could be adapted to conventional cardiopulmonary bypass (CPB) and/or CAD, for inducing a homogenous, downstream pulsatile perfusion mode with lower energy losses. In this study, the device's prototypes were tested in a simulated conventional pediatric CPB circuit for energy losses and as a left ventricular assist device (LVAD) in ischemic piglets model for endothelial shear stress (ESS) evaluations. In conclusion and according to the study results the pulsatile tube was successfully capable of transforming a conventional CPB and/or CAD steady flow into a pulsatile perfusion mode, with nearly physiologic pulse pressure and lower energy losses. This represents a cost-effective promising method with low mortality and morbidity, especially in fragile cardiac patients.

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“…We have been previously reported the benefits of ESS applications in hemodynamic improvement with different pulsatile CAD tested in acute cardiogenic shock induced in thirtysix pediatric piglets divided equally (n=6) between groups, as follows (Table 1): Acute PAH, created with surgical aortopulmonary shunt [23]; Acute myocardial infarction (MI) [24], following permanent ligation of left anterior descending coronary artery (LAD) and Acute right ventricular failure (RVF) [25], following surgical disruption of pulmonary valve. As shown in (Table 2), there were significant improvement of hemodynamics and reduction of the pulmonary vascular resistances, within few minutes of device pulsations and without any pharmacological supports.…”

Section: Endothelial Shear Stress Versus Conventional Therapy In Ardsmentioning

confidence: 99%

Endothelial Shear Stress Enhancements: A Potential Solution for Critically Ill Covid-19 Patients

Nour¹

2020

Preprint

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Rationale: Most critically ill Covid-19 patients succumb to multiple organ failure and / or cardiac arrest as a result of comorbid endothelial dysfunction disorders which had probably aggravated by conventional mechanical assist devices. Even worse, mechanical ventilators prevent the respiratory pump from performing its crucial function as a potential generator of endothelial shear stress (ESS) which controls microcirculation and hemodynamics since birth. The purpose of this work is to bring our experience with ESS enhancement and pulmonary vascular resistance (PVR) management as a potential therapeutic solution in acute respiratory distress syndrome (ARDS). We propose a noninvasive device composed of thoracic and infradiaphragmatic compartments that will be pulsated in an alternating frequency (20/40 bpm) with low-pressure pneumatic generator (0.1-0.5 bar). Oxygen supply, nasogastric ± endotracheal tubes are considered. Proof-of-concept: prototypes were tested in pediatric models of refractory cardiac arrest (≥20min), showed restoration of hemodynamics (BP≥100 mm Hg) and urine output, regardless of heartbeats, pharmacological supports and mechanical ventilation. Conclusions ESS enhancement represents a more effective treatment to increase tissue oxygenation and improve hemodynamic in ARDS. A cost-effective method which could be induced with a non-invasive pulsatile device adaptable to cardiopulmonary-circulatory biophysics to maintain a fully functional respiratory pump and avoid confrontation of the opposite hydraulic circuits.

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Intrapulmonary Shear Stress Enhancement: A New Therapeutic Approach in Pulmonary Arterial Hypertension

Abstract: Induced with an appropriate device, intrapulmonary shear stress-mediated endothelial function enhancement provides a more effective nearly physiological therapy for PAH.

Cited by 11 publications

References 51 publications

Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest

Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest

Shear Stress, Energy Losses, and Costs: A Resolved Dilemma of Pulsatile Cardiac Assist Devices

Endothelial Shear Stress Enhancements: A Potential Solution for Critically Ill Covid-19 Patients

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