Handbook of Cardiac Anatomy, Physiology, and Devices Paul A Iaizzo Editor Handbook of Cardiac Anatomy, Physiology, and Devices Second Edition Foreword by Timothy G Laske 13 Editor Paul A Iaizzo University of Minnesota Department of Surgery B172 Mayo, MMC 195 420 Delaware St SE., Minneapolis, MN 55455 USA iaizz001@umn.edu ISBN 978-1-60327-371-8 e-ISBN 978-1-60327-372-5 DOI 10.1007/978-1-60327-372-5 Library of Congress Control Number: 2009920269 # Springer ScienceỵBusiness Media, LLC 2009 All rights reserved This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer ScienceỵBusiness Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer ScienceỵBusiness Media (www.springer.com) Foreword A revolution began in my professional career and education in 1997 In that year, I visited the University of Minnesota to discuss collaborative opportunities in cardiac anatomy, physiology, and medical device testing The meeting was with a faculty member of the Department of Anesthesiology, Professor Paul Iaizzo I didn’t know what to expect but, as always, I remained open minded and optimistic Little did I know that my life would never be the same During the mid to late 1990s, Paul Iaizzo and his team were performing anesthesia research on isolated guinea pig hearts We found the work appealing, but it was unclear how this research might apply to our interest in tools to aid in the design of implantable devices for the cardiovascular system As discussions progressed, we noted that we would be far more interested in reanimation of large mammalian hearts, in particular, human hearts Paul was confident this could be accomplished on large hearts, but thought that it would be unlikely that we would ever have access to human hearts for this application We shook hands and the collaboration was born in 1997 In the same year, Paul and the research team at the University of Minnesota (including Bill Gallagher and Charles Soule) reanimated several swine hearts Unlike the previous work on guinea pig hearts which were reanimated in Langendorff mode, the intention of this research was to produce a fully functional working heart model for device testing and cardiac research Such a model would allow engineers and scientists easy access to the epicardium and the chambers through transmural ports It took numerous attempts to achieve the correct osmotic balance and an adequately oxygenated perfusate, and to avoid poisoning the preparation with bacteria (which we found were happy to lurk anywhere and everywhere in the plumbing of the apparatus) This project required a combination of art, science, and dogged persistence In addition to the breakthrough achieved in the successful animation of numerous swine hearts, bigger and better things were in store Serendipitously, when faced with a need to see inside the heart, the research team found a fiberoptic scope on an upper shelf in the laboratory The scope was inserted into the heart and a whole new world was observed Due to the clear nature of the perfusate, we immediately saw the flashing of the tricuspid valve upon insertion of the scope We were in awe as we viewed the first images ever recorded inside of a working heart This is the moment when my personal revolution began The years that have followed have included numerous achievements which I attribute to the vision and persistence of Paul and the team The human hearts that Paul initially considered impossible to access and reanimate were soon functioning in the apparatus due to a collaboration with LifeSource Indeed, the team’s ‘‘never say never’’ attitude is at the heart of their pursuit of excellence in education and research v vi Foreword The Visible Heart Laboratory has evolved into a dream for engineers, educators, and cardiac physiologists as scientific equipment has been added (echocardiography, electrical mapping systems, hemodynamic monitors, etc.) and endoscopic video capabilities have improved (the lab is currently using video endoscopes with media quality recording equipment) The lab produces educational images, conducts a wide spectrum of cardiac research, and evaluates current and future medical device concepts each week Hundreds of engineers and students have worked and studied in the lab, countless physicians have assisted with procedures, and thousands of educational CDs/DVDs have been distributed (free of charge) Eleven years after the beginning of our collaborative effort, the Visible Heart Laboratory remains the only place in the world where a human heart can be reanimated outside of the body and made to work for an extended period of time This is a tribute to the efforts of Paul and his team in managing the difficulty it takes to make this happen Interestingly, the team currently works in the laboratory in which Lillehei and Bakken first tested the battery-powered pacemaker; the ‘‘good karma’’ lives on This book is a result of Paul’s passion for excellence in teaching and for innovation in the medical device field I am confident that the reader will find this book an invaluable resource It is a testament to Paul’s dedication to both education, collaboration, and the ongoing development of his current and past students By the way The personal revolution I referred to, fueled by my collaboration with Paul, has included numerous patents, countless device concepts accepted and/or rejected, several scientific articles, a PhD in Biomedical Engineering, and a collaboration in black bear hibernation physiology None of this would have happened had I not met Paul that day in 1997, and benefited from his friendship and mentoring over the years I can only imagine what the future will bring, but you can be rest assured that success is sure to come to those that associate themselves with Paul Iaizzo Minneapolis, MN Timothy G Laske, Ph D Preface Worldwide, the medical device industry continues to grow at an incredibly rapid pace Our overall understanding of the molecular basis of disease continues to increase, in addition to the number of available therapies to treat specific health problems This remains particularly true in the field of cardiovascular care Hence, with this rapid growth rate, the biomedical engineer has been challenged to both retool and continue to seek out sources of concise information The major impetus for the second edition of this text was to update this resource textbook for interested students, residents, and/or practicing biomedical engineers A secondary motivation was to promote the expertise, past and present, in the area of cardiovascular sciences at the University of Minnesota As Director of Education for The Lillehei Heart Institute and the Associate Director for Education of the Institute for Engineering in Medicine at the University of Minnesota, I feel that this book also represents a unique outreach opportunity to carry on the legacies of C Walton Lillehei and Earl Bakken through the 21st century Interestingly, the completion of the textbook also coincides with two important anniversaries in cardiovascular medicine and engineering at the University of Minnesota First, it was 50 years ago, in 1958, that the first wearable, battery-powered pacemaker, built by Earl Bakken (and Medtronic) at the request of Dr Lillehei, was first used on a patient Second, 30 years ago, in 1978, the first human heart transplantation was performed at the University of Minnesota For the past 10 years, the University of Minnesota has presented the week-long short course, Advanced Cardiac Physiology and Anatomy, which was designed specifically for the biomedical engineer working in industry; this is the course textbook As this course has evolved, there was a need to update the textbook For example, six new chapters were added to this second edition, and all other chapters were either carefully updated and/or greatly expanded One last historical note that I feel is interesting to mention is that my current laboratory, where isolated heart studies are performed weekly (the Visible Heart1 laboratory), is the same laboratory in which C Walton Lillehei and his many esteemed colleagues conducted a majority of their cardiovascular research studies in the late 1950s and early 1960s As with the first edition of this book, I have included electronic files on the companion DVD that will enhance this textbook’s utility Part of the companion DVD, the ‘‘The Visible Heart1 Viewer,’’ was developed as a joint venture between my laboratory at the University of Minnesota and the Cardiac Rhythm Management Division at Medtronic, Inc Importantly, this electronic textbook also includes functional images of human hearts These images were obtained from hearts made available via LifeSource, more specifically through the generosity of families and individuals who made the final gift of organ donation (these hearts were not deemed viable for transplantation) Furthermore, the companion vii viii Preface DVD contains various additional color images and movies that were provided by the various authors to supplement their chapters Since the first printing of this textbook, my laboratory has also developed the free-access website, ‘‘The Atlas of Human Cardiac Anatomy,’’ that readers of this text should also find valuable as a complementary resource (http://www.vhlab.umn.edu/atlas) I would especially like to acknowledge the exceptional efforts of our lab coordinator, Monica Mahre, who for a second time: (1) assisted me in coordinating the efforts of the contributing authors; (2) skillfully incorporated my editorial changes; (3) verified the readability and formatting of each chapter; (4) pursued requested additions or missing materials for each chapter; (5) contributed as a co-author; and (6) kept a positive outlook throughout I would also like to thank Gary Williams for his computer expertise and assistance with numerous figures; William Gallagher and Charles Soule who made sure the laboratory kept running smoothly while many of us were busy writing or editing; Dick Bianco for his support of our lab and this book project; the chairman of the Department of Surgery, Dr Selwyn Vickers, for his support and encouragement; and the Institute for Engineering in Medicine at the University of Minnesota, headed by Dr Jeffrey McCullough, who supported this project by funding the Cardiovascular Physiology Interest Group (many group members contributed chapters) I would like to thank Medtronic, Inc for their continued support of the Visible Heart1 Laboratory for the past 12 years, and I especially acknowledge the commitments, partnerships, and friendships of Drs Tim Laske, Alex Hill, and Nick Skadsberg for making our collaborative research possible In addition, I would like to thank Jilean Welch and Mike Leners for their creative efforts in producing many of the movie and animation clips that are on the DVD It is also my pleasure to thank the past and present graduate students or residents who have worked in my laboratory and who were contributors to this second edition, including Sara Anderson, James Coles, Anthony Dupre, Michael Eggen, Kevin Fitzgerald, Alexander Hill, Jason Johnson, Ryan Lahm, Timothy Laske, Anna Legreid Dopp, Michael Loushin, Jason Quill, Maneesh Shrivastav, Daniel Sigg, Eric Richardson, Nicholas Skadsberg, and Sarah Vieau I feel extremely fortunate to have the opportunity to work with such a talented group of scientists and engineers, and I have learned a great deal from each of them Finally, I would like to thank my family and friends for their continued support of my career and their assistance over the years Specifically, I would like to thank my wife, Marge, my three daughters, Maria, Jenna, and Hanna, my mom Irene, and siblings Mike, Chris, Mark, and Susan for always being there for me On a personal note, some of my inspiration for working on this project comes from the memory of my father, Anthony, who succumbed to a sudden cardiac event, and from the memory of my Uncle Tom Halicki, who passed away years after a heart transplantation Minneapolis, MN Paul A Iaizzo Contents Introduction General Features of the Cardiovascular System Paul A Iaizzo Anatomy 13 Attitudinally Correct Cardiac Anatomy Alexander J Hill 15 Cardiac Development Brad J Martinsen and Jamie L Lohr 23 Anatomy of the Thoracic Wall, Pulmonary Cavities, and Mediastinum Mark S Cook, Kenneth P Roberts, and Anthony J Weinhaus 33 Anatomy of the Human Heart Anthony J Weinhaus and Kenneth P Roberts 59 Comparative Cardiac Anatomy Alexander J Hill and Paul A Iaizzo 87 The Coronary Vascular System and Associated Medical Devices Sara E Anderson, Ryan Lahm, and Paul A Iaizzo 109 The Pericardium Eric S Richardson, Alexander J Hill, Nicholas D Skadsberg, Michael Ujhelyi, Yong-Fu Xiao and Paul A Iaizzo 125 Congenital Defects of the Human Heart: Nomenclature and Anatomy James D St Louis 137 Physiology and Assessment 145 10 Cellular Myocytes Vincent A Barnett 147 11 The Cardiac Conduction System Timothy G Laske, Maneesh Shrivastav, and Paul A Iaizzo 159 12 Autonomic Nervous System Kevin Fitzgerald, Robert F Wilson, and Paul A Iaizzo 177 Part I Part II Part III ix x Contents 13 Cardiac and Vascular Receptors and Signal Transduction Daniel C Sigg and Ayala Hezi-Yamit 14 Reversible and Irreversible Damage of the Myocardium: New Ischemic Syndromes, Ischemia/Reperfusion Injury, and Cardioprotection James A Coles, Daniel C Sigg, and Paul A Iaizzo 191 219 15 The Effects of Anesthetic Agents on Cardiac Function Jason S Johnson and Michael K Loushin 231 16 Blood Pressure, Heart Tones, and Diagnoses George Bojanov 243 17 Basic ECG Theory, 12-Lead Recordings and Their Interpretation Anthony Dupre, Sarah Vieau, and Paul A Iaizzo 257 18 Mechanical Aspects of Cardiac Performance Michael K Loushin, Jason L Quill, and Paul A Iaizzo 271 19 Energy Metabolism in the Normal and Diseased Heart Arthur H.L From and Robert J Bache 297 20 Introduction to Echocardiography Jamie L Lohr and Shanthi Sivanandam 319 21 Monitoring and Managing the Critically Ill Patient in the Intensive Care Unit Greg J Beilman 22 Cardiovascular Magnetic Resonance Imaging Michael D Eggen and Cory M Swingen 341 Devices and Therapies 363 A Historical Perspective of Cardiovascular Devices and Techniques Associated with the University of Minnesota Paul A Iaizzo and Monica A Mahre 365 Part IV 23 331 24 Pharmacotherapy for Cardiac Diseases Anna Legreid Dopp and J Jason Sims 383 25 Animal Models for Cardiac Research Richard W Bianco, Robert P Gallegos, Andrew L Rivard, Jessica Voight, and Agustin P Dalmasso 393 26 Catheter Ablation of Cardiac Arrhythmias Xiao-Huan Li and Fei Luă 411 27 Pacing and Defibrillation Timothy G Laske, Anna Legreid Dopp, and Paul A Iaizzo 443 28 Cardiac Resynchronization Therapy Fei Luă 475 29 Cardiac Mapping Technology Nicholas D Skadsberg, Bin He, Timothy G Laske, and Paul A Iaizzo 499 30 Cardiopulmonary Bypass and Cardioplegia J Ernesto Molina 511 31 Heart Valve Disease Ranjit John and Kenneth K Liao 527 646 Animal model for research (cont.) problems with, 395–396 in myocardial ischemia, 399 experimental methods for creating ischemia, 399–400 investigations, 401 localizing and quantifying, 400–401 perfusion fixed hearts, anatomical assessment of qualitative, 98–99 quantitative, 99–101 testing of mechanical devices, 404 FDA guidelines, 406 selection for, 405 in valve disease, 396–397 atrial fibrillation for, 398–399 Antegrade cardioplegia (ANTE), 519 Anterior descending artery, 20 Anterior mediastinum, 46 Antiarrhythmic drugs, 466 action potential phases and physiologic consequences, 458 mechanism of action, 390 on pacing thresholds, effect of, 457 Sicilian Gambit, 413 Vaughn-Williams classification, 413 Anticoagulation therapy, 513–514, 528, 529 Antitachycardia pacing therapy, 464 Aorta coarctation, 140–141 See also Congenital defects of human heart Aortic semilunar valve, 74–75 Aortic valve disease, 531–532 aortic regurgitation, 534–537 acute and chronic aortic regurgitation, 535–536 aneurysm repair, 537 dilatation of ascending aorta and, 537–538 root replacement, 536, 538 valve replacement in, 536–537 aortic sclerosis, 534 aortic stenosis, 532–534 aortic valve replacement, 533, 534 asymptomatic patient with, 534 balloon valvotomy, 533 cause and degree of, 532 detection of, 532–533 dobutamine stress echocardiography, 534 stress testing, 533 symptoms of, 532 Aortopulmonary window defect, 140 See also Congenital defects of human heart Appendage, see Auricle Areola, 56 Arrhythmias therapy for, 389 treatment algorithms for, 390 guidelines for, 389–391 Ashman phenomenon, 422 See also Atrial fibrillation (AFib) Aspirin antiplatelet agents, 386–387 Atheroma, 553 Atherosclerosis, 29, 110 Atrial fibrillation (AFib), 421–423 ablation of, 431 AV nodal modification and rate control, 431 catheter-based maze procedure, 431 evolution, 431–436 hybrid approach for, 433 Index adrenergically mediated AFib, 422 anticoagulation therapy in, 423 CHADS2 scheme, 423 ibutilide and flecainide, 423 pacing-induced animal model, 398 pharmacologic-induced animal model, 398 vagally mediated AFib, 422 Atrial flutter, 421 ablation of atypical atrial flutter, 430 incisional atrial tachycardia, 430 typical atrial flutter, 429–430 Atrial premature complexes (APCs), 414 Atrial septal defects (ASDs), 78, 138–139, 571, 573 history of, 573 surgical closure of, 573 See also Congenital defects of human heart Atrial tachycardia ablation, 429 Atrioventricular (AV) block, 426–427 acquired AV block in adults, recommendation for permanent pacing in, 451 and atrioventricular groove, 61 cushions, 27 implantation of pacemaker for, 452 junctional premature complexes, 414 valves, 71 Atrioventricular canal defects, see Atrioventricular septal defects Atrioventricular septal defects, 140 See also Congenital defects of human heart Atrium, sensed atrioventricular (SAV) interval, 455–456 AttainTM Deflectable Catheter System, 636 Auricle, 91 Autonomic nervous system, 177 adrenal medulla, 180 arteriolar pressure regulation, 186–187 baroreceptors, 180 arterial, 181 pressure regulation, 185 denervation effects on, 187 basal cardiac function, 188 exercise hemodynamics, 188 reinnervation, 188–189 effector pathways, 182 positive chronotropic effect, 183 heart rate, 183–184 homeostasis, 181–182 hypothalamic control, 182 parasympathetic (craniosacral) nervous system, 180 stroke volume and contractility Frank–Starling law, 184 sympathetic anatomy, 177 autonomic innervation of heart, 179 norepinephrine and epinephrine, 178 pathways of sympathetic motor fibers, 178 postsynaptic sympathetic neurons, 179 preganglionic sympathetic neurons synapse within, 178 presynaptic fibers, 178 AV nodal reentry tachycardia (AVNRT) ablation of, 433–436 Koch’s triangle, 433 left-sided concealed accessory pathway, 418 Axial flow pump impeller, 405 Azygos system of veins, 41 Index B Bakken’s transistor pulse generator, 373 Balloon valvuloplasty, 561 Basket catheter mapping, 504–505 Benzodiazepines as adjuncts of anesthesia, 236 Beta-adrenergic receptors (b-ARs) activation and cardiovascular function, 194–197 dromotropic and metabolic effects, 196–197 effect on activation of heart, 194 intracellular signaling mechanisms, 196 positive chronotropic effect, 194 positive inotropic effects, 194 positive lusitropic effects, 196 second messenger concept, 195–196 in vasculature, 197 and cardiac disease, 198–199 classification of, 193–194 in myocardial hypertrophy, 199–200 regulation desensitization and downregulation, 197 Beta blockers with indications for chronic heart failure, 389 Bezold–Jarisch reflex, 188 See also Autonomic nervous system Bicuspid (mitral) valve, 73–74 Bilateral brachiocephalic veins, 43 Bio-artificial and/or mechanical heart valves comparison with, 396 FDA and ISO guidelines, design and testing, 396 fluid dynamic testing, 397 Bio-Medicus centrifugal pumps, 515 Bipolar pacing systems, 469 circuit for, 448 Biv pacemakers activation map of LV, 492–493 acute hemodynamic responses, 491–492 atrial arrhythmias, 493 Biv antitachycardia pacing, 483 clinical and functional characteristics, 490–491 CRT efficacy and, 490 follow-up, 490 implantation considerations, 488–489 intraprocedural testing, 489 12-lead ECGs, 491 mechanical dyssynchrony, 492 pacing sites, 492 QRS duration, 491 risks and complications, 489–490 Black-blood imaging techniques, 344 Blind end-specialized lymphatic capillaries, 11 Blood, circulatory system, 10 flow, local blood flow, pathway of, Poiseuille equation and, heart, 7–8 vessels, 4–5 Body surface potential maps (BSPMs), 500 Bone marrow-derived stem cells, 615 Bradyarrhythmias, 425, 449 atrioventricular (AV) block, 426–427 sinus node dysfunction (SND), 426 Bretschneider solution (custodiol), 520–521 Bright-blood cine MRI, 345 British Pacing and Electrophysiology Group (BPEG) standard coding system, 449–450 647 Bronchi branching pattern, 53 Brugada syndrome, 412 Bulb ventricular loop, 137 C Calcium paradox, 519 See also Heart Canine transplantation model, 403 bone marrow-derived multipotent stem cell cardiomyoplasty, 407 open chest ameroid occluder, 400 ligated left anterior descending coronary artery in, 399 triphenyl tetrazolium chloride (TTC) staining and, 400–401 Capnometry, 338 Cardiac arrhythmias cardiac rhythms and, 444 clinical presentation and diagnosis, 412–413 electrophysiological study (EPS) and catheter ablation, 427–429 mechanism of, 411 treatment of, 413 Cardiac care, procedural improvements for, 637 cardiac imaging, 638 less invasive surgeries, 638 specialized surgical tools, 638 Cardiac cell action potentials Ca-and K-channel proteins, 155 excitation contraction coupling, 154–155 Goldman–Hodgkin–Katz equation, 154–155 ionic currents, 157 Nernst equation, 154 profiles for ventricular and nodal, 157 alpha-adrenergic receptors (-ARs), 199 beta-adrenergic receptors (b-ARs) activation and cardiovascular function, 194–197 and cardiac disease, 197–199 classification of, 193–194 in myocardial hypertrophy, 199 regulation, 197 cross-section of relationship of sarcoplasmic reticulum and transverse tubules (T-tubules), 149 energy metabolism, 151–152 force production, 152 and velocity, 154 gap junction, 148–150 G-protein-coupled receptor coupling and structure, 192 function and regulation, 192–193 signaling, 193 guanylate-cyclase-linked receptors membrane guanylyl cyclase A, 201 role in cardiac disease, 202 soluble guanylyl cyclase, 201 intercalated disks, 148 length–tension relationship practical applications of, 153–154 mammalian cell structure, 148 membranes of, 147–148 plaque of connexons on, 150 Z-disks at ends of sarcomere, 150 muscarinic receptors, 200 muscle cell acetylcholine effect on, 183 648 Cardiac cell (cont.) branched structure of, 150 morphology, 147 relaxation of, 156 myofibrillar structure, 150 pacemaker cells, 156–158 receptors, 192 cross-talk between, 201 thick filament, 151 thin filaments based mechanism, 151 tropomyosin (Tm) and troponin (Tn), 150 Cardiac conduction system, 159 action potentials, 165 ion flow during, 166 time courses of, 167 ventricular myocyte and underlying ion currents, 166 Aschoff’s nodule, 160 atrioventricular nodal region, 163 atrioventricular node and His bundle, 167–168 atrial repolarization/ventricular depolarization, 170 histological characteristics of nodal and perinodal tissues in canines, 169 histologic section, 170–171 bundle of Kent, 162 conduction velocities and intrinsic pacemaker rates, 164 gap junctions (cell-to-cell conduction), 167 and heart rate, 233–234 His bundle, 161 ion concentrations for mammalian myocytes, 165 Koch’s triangle, 160 node-to-node pathway, 161 rate control, 164–165 recording of action potentials and/or spread of excitation through myocardium, 172–174 sinoatrial node, 160 Tawara’s node, 160 ventricular conduction system, 164 Cardiac defibrillation external defibrillators, 459 ICD devices, 462–463 indications, 459 therapies, 464–465 implantable defibrillators, 459–461 indications/clinical trials, 466–467 leads for, 467 constructions, 469 electrodes, 471 endocardial and epicardial pacing, 469, 470 evolution of, 471 implanted configurations for, 468 placement in cardiac veins, 470 single-and dual-chamber endocardial lead configurations, 468 pharmacologic considerations in, 465–466 sensing and detection, 461–464 tachyarrhythmias, 456–458 antitachycardia pacing therapy, 464 detection intervals, 463 invasive and noninvasive diagnostic tools, 459 Cardiac devices and technologies, 631–632 cardiac computed tomography (CT) imaging, 567 3D cardiac electrical imaging (3-DCEI) approach, 508 cardiac electrophysiology intracardiac echocardiography, 438–439 magnetically directed catheter manipulation, 439 Index nonfluoroscopic electroanatomical cardiac mapping-CartoTM, 437–438 nonfluoroscopic navigation and mapping-EnSite System, 438 catheter-delivered devices, 635–637 electrical mapping, 499 implantable sensors, 637 implantable therapies, 634–635 medical device, design of, 632 novel agents, to coat devices, 637 procedural improvement in, 637–639 resuscitation systems and devices, 632–634 telemedicine, 639–641 training systems, 641–642 Cardiac metabolism myocardial oxygen consumption (MVO2), 219 temperature, influence of, 220 Cardiac pacing, 445 ACC/AHA (American College of Cardiology/American Heart Association) format, 449 antiarrhythmic drugs on pacing thresholds, effect of, 457 artificial electrical stimulation, 446–448 biventricular versus right ventricular pacing in heart failure patients with atrioventricular block (BLOCK-HF) trial, 485 drug interactions with, 452–454 dual-chamber pacing system, 446 electrical signals, 454 electrogram amplification and rectification scheme, 454 implantable pulse generators, 451–452 indications/clinical trials, 454–456 indications for, 448–449 NASPE/BPEG codes, 449–451 sensing algorithms, 452–454 Cardiac progenitor cells (CPCs) isolation of cardiosphere-derived cells, 619 cell surface stem cell marker c-kit expression, 617–618 Hoechst 33342 dye, effluxing of, 618–619 Islet-1 gene, expression of, 619 stem cell antigen-1 (Sca-1) expression, 618 myocardial regeneration from, 620–621 number of, 619 origin of, 619–620 Cardiac resynchronization therapy (CRT), 476 after AV nodal ablation, 484–485 application of, 485 Cardiac Resynchronization-Heart Failure (CARE-HF) trial, 481 clinical trials on, 478–481 cost-effectiveness of, 493–494 effects on autonomic activity, 482 cardiac arrhythmias, 483 cardiac energetics, 482–483 mortality, 484 effects on cardiac function, 478 mechanical remodeling, 481 and ICD therapy, 479 management of non-responders, 493 mechanisms of, 477–478 pacemaker-defibrillator (CRT-D), 481 patient population eligible for, 478 physiologic pacing, 476 reverse remodeling in, 481 Index Cardiac rhythms and arrhythmias cardiac function and, 443 conditions of atrioventricular node, 444 sinoatrial node, 444 Cardiac surgery CABG operations, 552–553 cardiopulmonary bypass, side effects of, 552–553 complications, 551 history of, 551 incision size, impact of, 551–552 less invasive cardiac surgery, 551 non-touch techniques, 553–554 OPCABG surgery, 553 technological innovations in, 554 aortic non-touch techniques, 555–556 endoscopic robotics, 556–558 minithoracotomy and thoracoscopy, 554 OPCABG improvement, 555 sternum sparing surgery, 554 Cardiac tamponade, 128–130 See also Pericardium CardioNet1 mobile outpatient cardiac telemetry, 412 Cardioplegia, 518 adjunct topical hypothermia, 524–525 Birmingham solution, 520 Bretschneider solution (custodiol), 520–521 cold blood cardioplegia, 522 glucose–insulin–potassium (GIK) solutions, 521–522 solution administration, 522–524 St Thomas II solution, 520 substrates of, 522 types of solutions, 519–520 Cardiopulmonary bypass anticoagulation, 513–514 arterial return, 512–513 heart–lung machine, 515 priming, 516–517 hemodilution, 515 hemodynamics, 517–518 machine, 551 perfusion pressures, 514–515 temperatures of, 514 procedure, 527 venous drainage, 511–512 Cardiopulmonary resuscitation (CPR), 583–584 active compression decompression CPR, 590–593 AHA guideline for, 587 and cardio-pulmonary-cerebral interactions, 586 incomplete chest wall recoil, effect of, 587–589 ITD use, 584–585, 589–590 purpose of, 584 standard CPR, 584 and therapeutic hypothermia, 587 Cardiovascular system anatomy of orthogonal planes, 15–16 cardiac resynchronization therapy (CRT), 476 cardiac tamponade, 63 cardiopulmonary circulation, 65–66 cardiospheres, 619 components blood, 3–7 heart, 7–9 649 coronary circulation, 10–11 3D cardiac electrical imaging (3-DCEI), 508 determinants of cardiac output, 333 feedback and feed-forward mechanisms, 299 left atrium, 72 left ventricle, 72 aortic semilunar valve, 74–75 bicuspid (mitral) valve, 73–74 lymphatic system, 11 metabolism of, 219 3D reconstruction of chamber endocardial geometry, 502 right atrium, 66–69 right ventricle pulmonary semilunar valve, 72 tricuspid valve, 70 swine left ventricular isopotential activation map and isochronal activation map, 507 Carmeda bioactive surface, 516 Carotid artery disease, 553 Carotid sinus massage, 426 CARTOTMXP sequential mapping system, 501 Catheter-based maze procedure, 431 Catheter-delivered devices, 635 catheter-delivered leads, 636 endocardial ablation devices, 636–637 stents, 635–636 Cerebral perfusion pressure (CePP), 587–588 Chagas disease in South America, 412 Chaotic atrial tachycardia, see Multifocal atrial tachycardia Chemoreceptors, Chiari network, 77–78 Chronic aortic regurgitation, 535 clinical diagnosis of, 535 left ventricular systolic function and, 535 natural history of, 535 vasodilating agents, use of, 536 Chronic heart failure (CHF) ACC/AHA staging in evolution, 388 neurohormonal activation in, 388 NYHA functional classification of, 387–388 therapy for, 388 treatment guidelines for, 388 Chronicle1, 637 Circle of Vieussens, 81, 83 Clamshell/CardioSEAL device, 577 Clavicle, 34, 36 Clinical Disorders of the Heart Beat, 259 Clopidogrel antiplatelet agents, 386–387 Coapsys, 565 Cochrane database systems review, 332 Cold blood cardioplegia, 522 Collaterals, 113 Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial, 480–481, 494 Conductance catheters, 278–279 Congenital defects of human heart, 137–138 aortopulmonary window defect, 140 atrial septal defect, 138–139 atrioventricular septal defects, 140 coarctation of aorta, 140–141 congenital heart disease, 571–572 Ebstein’s anomaly, 142 interrupted aortic arch, 141 persistent truncus arteriosus, 143 pulmonary atresia with ventricular septal defect, 142 tetralogy of Fallot, 141–142 650 Congenital defects of human heart (cont.) total anomalous pulmonary venous connection, 143 transposition of great vessels, 142–143 tricuspid atresia, 142 ventricular septal defect (VSD), 139–140 Congestive heart failure (CHF), 475, 605 end stage, therapy for, 605 pacing in patients with pacing-induced CHF, 484 VAD, use of, 605 See also Ventricular assist devices (VAD) Constellation1 multielectrode basket catheter, 505 CONTAK-CD trial, 480 Continuous mapping systems, 501 basket catheter mapping, 504–505 noncontact mapping technologies, 505–507 Contractility, 274–275 Convex-hull algorithm, 506 CO2 partial rebreathing technique, 338 CorCapTM Cardiac Support Device, 635 Coronal plane, 15 See also Cardiovascular system Coronary arteries, 109 anatomical description, 110 coronary artery bypass grafting (CABG), 552–553 disease angina pectoris, 111 atherosclerosis, 110 eccentric vascular constriction, 400 myocardial infarction and ischemia, 111 pharmacological approaches, 111 plaques, histologic view of anterior arterial branch, 111 epicardial fatty deposits and, 119–120 microanatomy of, 113 percutaneous transluminal coronary angioplasty balloon catheter, 115 restenosis of, 115 STAR (subintimal tracking and reentry) technique, 115 stenting procedure, 115 transmural distribution of, 298 Coronary heart disease (CHD) ACC/AHA classification of recommendations, 384 clinical data, 383 evidence designations, 384, 385 evidence-based medicine, 383 hypertension and, 383 agents with compelling indications for, 386 classification of blood pressure, 385 effects on myocardium, 385 lifestyle modifications, 384–386 therapy for, 384 treatment guidelines for, 384–386 risk factors for, 384 Coronary perfusion pressure (CPP), 587–588 Coronary steal syndrome, 234 Coronary vascular system blood flow, 109–110 cardiac capillaries, 111 coronary arteries, 109 anatomical description, 110 disease, 110–111 microanatomy of, 113 coronary veins anatomical description, 111–112 disease, 113 Index microanatomy of, 113 valves, 112 differences between coronary arteries and veins, 114 engineering parameters and design criteria associated with, 116 branch angle, 120 cross-sectional profile, 117–118 diameter, 117 motion characteristics, 120–121 ostial anatomy, 118 relationship with myocardium, 119–120 tortuosity, 118–119 vessel length, 118 wall thickness, 119 and medical devices for coronary arteries, 115 for coronary veins, 115–116 long-term effects of, 116 and visualization of heart with catheterization, 114–115 Coronary veins anatomical description great cardiac vein, 112 posterior interventricular vein, 112 sinus, 111 Thebesian valve, 112 valve of Vieussens, 112 CRT and pacing for, 116 disease, 113 epicardial fatty deposits and, 119–120 lead extraction and, 116 microanatomy of, 113 valves, 112 Coumadin, 634 C-PortxA Flex device, 555, 556 Creatine kinase shuttle hypothesis, 310 Crista terminalis, 69 Critically ill patient in intensive care unit, 331 monitoring strategies, 332–333 clinical end points of resuscitation, 332 Crossbridge cycle, 152 Crura, 38 See also Respiratory diaphragm Crux cordis, 61 D Dacron graft for aortic root replacement, 538 David procedure for aortic root replacement, 538 DDD pacing, 476–477 De Anatomicis Administrationibus, 87 DeBakey MicroMed LVAD, 608 DeBakey roller-type pumps, 515 Deep hypothermia technique, 513 Defibrillation systems implantable pacing and, 444–445 Deltoid muscle, 37 Deltopectoral groove, 37 Demifacets, 34 Descending thoracic aorta, 48 Desflurane as anesthetics, 234 DeWall–Lillehei disposable bubble oxygenator, 369 Diagonal arteries, 81 Diltiazem calcium channel blocker, 386 Distal coronary artery anastomotic device, 555 Index E Ebstein’s anomaly, 142 See also Congenital defects of human heart Echocardiography (EKG), 533 clinical applications of cardiac ultrasound standard transthoracic cardiac echocardiogram, 325–326 transesophageal echocardiography, 324–325 transthoracic echocardiography, 325 transvaginal and transabdominal fetal echocardiography, 324 two-dimensional and M-mode images, 327 two-dimensional apical four-chamber view, 328 imaging modalities color Doppler flow mapping, 322 continuous wave Doppler, 321 Doppler ultrasound, 321 M-mode echocardiography, 320 myocardial performance index, 322 pulse wave Doppler, 321–322 quantification of pressure gradients using Doppler shift measurements, 322 tissue Doppler imaging, 322–324 two-dimensional imaging, 320–321 resolution of structures, 320 ultrasound imaging of tissues, 319–320 Edge-to-edge technique, 565 Einthoven’s triangle, 258–259, 265 Electroanatomical mapping technologies, 501–502 Electrocardiogram (ECG), 257–258 computers for analysis of, 267–268 devices, 258 history of, 258–260 interpretation of, 266–267 lead placement in clinical setting, 267 long-term recording devices, 268–269 measuring, 261 bipolar limb leads, 262 electrical axis of heart, 262–263 12-lead ECG, 264–266 waveform, 260–261 Electron transport chain (ETC), 308 Electrophysiological (EP) mapping procedures, 500 Embryoid bodies, 614 Embryonic stem cells (ESCs), 613–614 Endocardial cushion defects, see Atrioventricular septal defects Endocardial tube and splanchnopleuric-derived myocardium, 24 Endocytosis, 5–6 Endo suction device, 556 Endothelial progenitor cells (EPCs), 616–617 EnGuide1 locator technology, 505 Enoxaparin drug, 386 Ensemble1 Transcatheter Delivery System, 562–563 EnSite NavXTM electrode-based navigation system, 507 EnSite13000 noncontact mapping system, 505 Epinephrine therapy, 593 ESCAMI trial, 226 Esophagus esophageal plexus, 46 structure of, 43 Etomidate for induction of anesthesia, 238 Eustachian valve, 88 Evaluation of Screening Techniques in Electrically-Normal, Mechanically-Dyssynchronous Heart Failure Patients Receiving CRT (ESTEEM) trial, 485 Excitation contraction coupling, 154–155 Exercitatio Anatomica De Motu Cordis et Sanguinis in Animalibus, 87 651 Exocytosis, Extracorporeal circulation, see Cardiopulmonary bypass F Fetal heart circulation, 76–77 Fibrous pericardium, 90 See also Pericardium Fibrous trigone, 75 Fick technique, 338 Floating ribs, 35 See also Thorax Fluoroscopy, 500–501 Focal Afib ablation, 431 Focal myocardial stabilization devices, 555 Foramen ovale, 78, 91 Fossa ovalis, 91 Frank–Starling mechanism, 9, 274 G Ganglion, 85 Gatekeeper function of capillaries, Gibbon’s system, 511 Glucose–insulin–potassium (GIK) solutions, 521–522 Glycolysis, 313–315 G-Protein-coupled receptor activation and coupling with adenylyl cyclase (AC), 195 coupling and structure, 192 function and regulation, 192–193 signaling, 193 Gradient echo (GRE) sequence, 345 Graphical user interface software for analysis of perfusion studies, 357 Gray and white rami communicantes, 49–50 Great cardiac vein, 83 Great vessels, 45–46 D-transposed, 138 transposition, 142–143 See also Congenital defects of human heart Guanylate-cyclase-linked receptors membrane guanylyl cyclase A, 201 role in cardiac disease, 202 soluble guanylyl cyclase, 201 GUARd During Ischemia Against Necrosis (GUARDIAN) clinical trial, 226 H Halothane as anesthetics, 234 Heart acute and obtuse margin, 62 anatomy anatomic lesions of, 138 atrial septal defect, 78 cardiac skeleton, 75 Chiari network, 77–78 fetal development, 75–77 internal anatomy of, 64 pericardium, 62–64 position in thorax, 60–62 ventricular atrial septal defect, 78–79 animal models in failure and transplantation, 401–402 orthotopic heart transplant, 403 anterior descending artery, 20 652 Heart (cont.) anterior position view, 17 anterior surface of, 62 apex, inferior angle, 61 atrial kick, 476 atrioventricular reconstruction with normal and pathologic, 162 attitudinally correct position of, 17–19 autonomic innervation of, 84–85 as biologic pump, 527 blood flow, pathway of, 7–8 capillaries, 5, 111 capillary leak syndrome, cardiac cycle, 8, 271 electrical and mechanical events of single cardiac cycle within left heart, 272 pressure–volume diagram of, 273 cardiac output (CO), 443 cardiac troponin I, 30 cardiopulmonary circulation, 66–67 chambers of, 61 contributors for development, 24 coronary vasculature, 29 destination therapy, 404 developmental timeline of embryology, 25 dP/dtmax parameter of myocardial contractility, 476 effective pumping action of, effects of ventricular pacing on myocardial contractility in, 476 electrical and mechanical events of single cardiac cycle within left heart, 272 embryology and development, 23 heart pump, heart-torso volume conductor model, 508 intercalated discs, 65 intermediary metabolism and bioenergetics in normal heart electron transport chain and oxidative phosphorylation, 308–309 fatty acid metabolism, 303–304 glucose metabolism, 301–303 mitochondria, 303 myocardial carbon substrate selection, 306–307 regulation of carbon substrate metabolic pathways, 305–306 TCA cycle, 307–308 internal anatomy of, 65 interstitial myocardium and cushion mesenchyme, 29 left circumflex arteries, 20 looping process, 25–26 mammalian heart cardiac valves, 94–95 conduction system, 96 coronary system, 95 left and right ventricles, 91–94 lymphatic system, 95–96 right and left atria, 91 maturation, 29–30 metabolism in abnormal myocardium in hypertrophied and failing hearts, 313–314 ischemic myocardium, 312–313 primary (genetic) myocardial metabolic abnormalities, 314–315 NCM system and, 507–508 and neonatal heart, 29–30 net dipole of, 264 neural crest and outflow tract, 26 origin of, 27 persistent truncus arteriosus, 27 Index pericardium, relationship of, 45 posterolateral view of formalin fixed, 119 primary heart field and linear heart tube formation, 23–25 proepicardial organ and coronary artery development, 28–29 rate response to treadmill exercise, 188 3D reconstruction of atrioventricular (AV) junction, 162 regulation of, 9–10 resting heart system, 517 right and left atrial appendages, 62 SA node, 69 secondary heart field, outflow tract formation and cardiac looping, 25–26 similarities and differences in atrioventricular conduction system, between animals and human, 97 surgical therapies in end-stage heart failure, 404 sympathetic neural reinnervation of, 188–189 transplant, in CHF, 605 tones abnormal heart sounds, 250–251 auscultatory areas, 250 dynamic auscultation, 251–252 physiology and normal heart sounds, 249–250 specific murmurs, 252–254 tube fusion, 25 valentine position, 16, 20 valves of, 71, 527, 528 replacement, 527–531 valvular diseases, see Aortic valve disease; Mitral valve disease vasculature of cardiac veins, 81–84 left coronary artery, 81 myocardial bridges, 84 right coronary artery, 79–80 venous drainage of, 81–82 volumetric reconstructions from magnetic resonance imaging, 18–19, 21 HeartMate II LVAD (Thoratec), 608 HeartPort system, 554 Heart-skeletal muscle pump, Heart-string proximal seal system, 556 HEARTSTRINGTM Proximal Seal System, 638 Hematocrit, Hemodilution, 515 Hemoglobin, Heparinization, 514 See also HIT syndrome Hepatocyte growth factor (HGF), 620 Hibernating myocardium, 221–223 High right atrial pacing (HRA), 476 His bundle pacing, 485 His–Purkinje disease, 427 HIT syndrome, 513–514 Human patient simulator, 642 Hybrid catheter-based RF ablative approaches, 428 Hypertension (Blood pressure), 243 arterial blood pressure, monitoring invasive, 280–281 noninvasive, 279–280 bisferiens (biphasic) pulse, 248 cardiac output/cardiac index monitoring, 289–291 classification of, 385 diagnoses, 247–248 dicrotic pulse, 249 effects on myocardium, 385 Index flow monitoring, 292–293 implantable monitoring, 293–294 lifestyle modifications, 384–386 mixed venous saturation monitoring(SvO2), 291–292 noninvasive methods, measuring of, 244–247 physiology of, 243–244 pressure transducer system, 281–283 transducer catheters, 284 pulmonary artery pressure monitoring, 286–289 pulsus parvus et tardus, 248 treatment agents with compelling indications for, 386 algorithm, 387 guidelines for, 384–386 wide pulse pressure, 248 Hypertrophy, 617 Hypoxia, 63 I Impedance threshold device (ITD), 584 and ACD-CPR, 591–593 animal studies with, 585–586 cardio-pulmonary-cerebral interactions and, 586 concept of, 584–585 PEA and, 586 Implantable cardioverter defibrillator (ICD), 444, 478 depletion curve for silver vanadium oxide battery, 462 electric field between high-voltage electrodes during shock, 464 evolution of, 458 high-voltage capacitor, 465 indications for therapy, 460 inner workings of, 461 outaway view of, 453 tilt values, 465 Implantable defibrillation system and programmer, 445 Implantable pulse generator (IPG), see Implantable cardioverter defibrillator (ICD) Implantable sensors, 637 Implantable therapies, 634 cardiac remodeling, 634–635 left atrial appendage/atrial fibrillation therapy, 634 Inappropriate sinus tachycardia (IST), 415 ablation of, 429 Inflammation cross-talk between thrombosis, 210 molecular signaling and vascular interventions, 210–211 Institute for Engineering in Medicine and Center for medical devices Annual Design of Medical Device Conference, 378 Center for Medical Devices, 378–379 Institute for Engineering in Medicine (IEM), 378 Insulin-like growth factor (IGF-1), 620, 623–625 InSync/InSync ICD Italian Registry, 484 InSync Registry, 479 Integrated bipolar lead, 469 Intensive care unit (ICU), 331 cardiac hemodynamics arterial blood pressure measures, 338 CO2 partial rebreathing technique, 338 pulse contour wave processing (PiCCO), 336 ultrasonography/echocardiography, 336–337 cardiac output, changes in, 335 cardiac preload (PAOP), changes in, 335 invasive monitoring techniques in arterial blood pressure monitoring, 334 central venous pressure (CVP) monitoring, 333 653 complications of, 336 hemodynamic measurements, 335 pulmonary artery catheter, 334–336 monitor development FDA approval, 339 monitoring strategies, 332–333 perfusion monitors capnometry, 338 central venous O2 saturation monitors, 338–339 reflectance near-infrared spectroscopy, 338 systemic vascular resistance, changes in, 335 Intercostal muscles, 37–38 Interleukin-1beta (IL-1beta) as mediator of inflammation, 209 signaling of, 211 Internal and external intercostal muscle fibers, 37–38 Interrupted aortic arch, 141 See also Congenital defects of human heart Interventional cardiac catheterization, 571 Interventricular septum arterial supply, 80 Intracardiac echocardiography (ICE), 438–439, 638 Intrathoracic pressure regulator (ITPR) therapy, 594, 599–602 Intussusception, 28 IS-1 and DF-1 connector, 453 Ischemia, 29 Ischemic mitral regurgitation, 545 Ischemic preconditioning, 223 Ivalon plug, 571 J Journal of Anatomy and Physiology, 159 Jugular notch, 55 K Ketamine as adjuncts of anesthesia, 237 Koch’s triangle, 67–68 Kugel’s artery, 80 L Langendorff perfusion setup, 394–395 Lateral plate mesoderm, 23–24 Left circumflex arteries, 20 Left heart bypass, 512–513 Left ventricle based pacing, 482 left ventricular apical pacing (LVA), 476 left ventricular assist device (LVAD), 405–406 left ventricular ejection fraction (LVEF), 479 L-loop, 138 Left ventricular assist devices (LVAD), see Ventricular assist devices (VAD) Lepirudin drug, 514 Lidocaine sympathetic nerve blocks, 235 LIFEPAK1 devices LIFEPAK1 12 defibrillator/monitor series, 633 LIFEPAK1 1000, external cardiac defibrillator, 461 LifeScience Alley, 377–378 Lillehei–Kalke rigid bileaflet prosthesis, 376 Lillehei/Kaster tilting disk valve, 528 Lillehei–Nakib toroidal valve, 375 Local and targeted drug delivery, 391 LocaLisa1 mapping system, 501, 503 software, 504 654 Long QT syndrome, 412 Looping and septation of human primary linear heart tube, 25–26 Lovenox1, see Enoxaparin drug Lown–Guang–Levine syndrome, 419 Lungs, 51–54 lymphatic drainage of, 53 pattern, 54 mechanics of respiration, 54 pattern of structure entering and leaving root of, 53 surface anatomy of, 52 transition from fetal dependence on placenta for oxygenated blood to self-oxygenation, 28 and walls of thoracic cavity to pleural membrane, 50 Lyme disease, 412 Lymphatics, 47–48 Lymph nodes, 11 M Macrophage colony stimulating factor (M-CSF) and differentiation of blood monocyte, 209 Magnetic resonance imaging (MRI) of heart, 341 and biomedical devices performance assessment of, 352–353 real-time imaging and cardiovascular interventions, 351–352 safety and compatibility, 352 blood flow velocity, 349 cardiac anatomy of canine heart imaged with T2-weighted fast spin echo sequence, 344 cardiac morphology black-blood images, 344 Spin echo (SE) images, 344 circumferential strain quantified by MR tissue tagging in normal porcine heart, 353 delayed contrast-enhanced MRI (ce-MRI), 348–349 echo, 343 T2 weighting of gradient echo image, 344 fiber structure diffusion tensor MRI (DTMRI) imaging of freshly excised normal human heart, 350, 351 myofiber orientation, 349–350 pathological changes in, 351 phase contrast imaging of aorta, 350 image contrast, 343–344 myocardial perfusion, 347 viability, 347–349 quantitative analysis of cardiac MR, 353 myocardial scar size, 358–359 myocardial segmentation for end-diastolic and end-systolic phases, 354 perfusion analysis, 356–358 TrueFISP slices using 3D analysis protocol, 355 ventricular function, 354–355 wall motion and regional myocardial strain analysis, 355–356 resonance flip angle, 342 Larmor frequency, 342 radio frequency pulses, 342 ventricular function cine loops, 345 circumferential shortening and radial thickening, 346 global assessments of, 344–346 pass perfusion imaging, 347 regional myocardial function, 346–347 wall motion changes and thickening, 346 Index Manubrium, 35 Mapping catheter (NAVISTAR TM), 501 Marburg Attacher, 131 See also Pericardium Mayo Clinic’s heart–lung machine, 370 Maze procedure and catheter ablation, 423 MCP-1 subfamily of C–C chemokines-beta, 208–209 Mechanical prosthetic valves, 528–529 The Mechanism of the Heart Beat, 259 Medial and lateral arcuate ligaments, 38 Mediastinum, 33, 60–61 See also Thorax Medical Devices Center (MDC), 379–380 and medical device development, 632 Medical training systems endovascular implant simulators, 642 simulators/simulator mannequins, 641–642 Medtronic InSync pacemaker, 489 Melody1 Transcatheter Pulmonary Valve, 562 Mesenchymal stem cells (MSCs), 615–616 Mesodermal cells and heart development, 23 Methohexital barbiturates, 235 Michaelis–Menten kinetic model, 309 Microcirculation, Middle mediastinum great vessels, 45–46 pericardium, 44–45 Mild hypothermia, 514 MitraClip repair system, 565 Mitral annuloplasty, 565 Mitralign device, 565 Mitral valve disease, 538 mitral regurgitation, 543–545 acute severe form, 543 chronic, 543–544 ischemic mitral regurgitation, 545 surgical procedures for, 544–545 mitral stenosis, 538–542 and atrial fibrillation, 539–540 closed commissurotomy, 540 echocardiography and, 539 mitral valve replacement in, 541–542 open commissurotomy, 540 percutaneous balloon valvotomy for, 540–541 symptoms of, 539 M-Mode echocardiography, 320 Mobitz type I second-degree AV block, 426–427 Moderate hypothermia, 514 Moderator artery, 81 Monarc system, 565 Mosaic1 stented tissue valve, 397 Multicenter Automatic Implantable Defibrillator Trial (MADIT)CRT study, 467, 485 Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial, 478, 489 Multielectrode array catheter, 506 Multifocal atrial tachycardia, 414 Multisite Stimulation in Cardiomyopathy (MUSTIC) study, 478 Muscular ventricular septal defects, 577 Myocardial blood flow, 298 biologic signals regulating coronary circulation, 299–300 in diseased heart, 300–301 and myocardial bridges, 84 regulation of, 299 Myocardial infarction (MI), 614 MI catheter-guided stem cell therapy, 407 Index Myocardial ischemia, 10, 220 animal model, 399 experimental methods for creating ischemia, 399–400 investigations, 401 localizing and quantifying, 400–401 consequences of, 221 therapies calcium-channel antagonists, 227 glucose-insulin-potassium, 227 glutamate/aspartate, 228 growth factors, 227 Na+/H+ exchange (NHE) blockers, 227–228 Myocardial performance index, 322 Myocardial repair cells types bone marrow-derived stem cells, 615 cardiac stem cells, 617 regeneration capacity, of heart, 617 See also Cardiac progenitor cells (CPCs) embryonic stem cells (ESCs), 613–614 endothelial progenitor cells (EPCs), 616–617 mesenchymal stem cells (MSCs), 615–616 skeletal myoblasts, 614–615 umbilical cord blood stem cells, 617 Myocardial stunning, 220–221 N Na+/H+ exchange (NHE) blockers, 226–227 NavXTM software system, 507 New York Heart Association (NYHA) functional class and quality of life, 479 NiCCO device, 338 Nitinol alloy, 572 Nitroglycerin drug, 111 See also Coronary arteries Noncontact catheter mapping (NCM), 501 Nonfluoroscopic electroanatomical cardiac mapping-CartoTM, 437–438 Nonfluoroscopic navigation and mapping-EnSite System, 438 Nonhuman primate transplantation model, 404 Noninvasive cardiac mapping, 507–508 Noninvasive methods for measuring blood pressure arterial tonometry, 246 auscultation, 245 Doppler method, 245 oscillometry, 245–246 palpation, 244 plethysmographic method, 246 Nonparoxysmal junctional tachycardia, 425 Non-ST-segment elevation myocardial infarction (NSTEMI), 386 Non-touch techniques, during OPCABG, 553–554 Normothermia, 514 North American Society of Pacing and Electrophysiology (NASPE) standard coding system, 449–450 O Oblique pericardial sinus, 63 Octopus13 Tissue Stabilizer, 638 Off-pump beating heart coronary artery bypass grafting surgery (OPCABG), 553 Opioids as adjuncts of anesthesia, 236–237 Optimal pacing configuration AV delay, 486–487 His bundle pacing, 488 interventricular delay and sequential Biv pacing, 487–488 655 left ventricular versus biventricular pacing, 488 pacing site, 486 Orgaran drug, 514 Ostia of Thebesian veins, 84 Ovine model of normal bileaflet valve implantation, 397–398 Oxidative phosphorylation and transport of ATP, 309 P Pacemaker mode (NBG) code, 476 Paclitaxel microtubule-stabilizing agent, 207 Papaverine sympathetic nerve blocks, 235 Parkinson–White (WPW) syndrome ablation of, 435–436 preexcitation syndromes, 418–420 and related preexcitation syndromes, 418–420 Paroxysmal supraventricular tachycardias (PSVTs) atrial tachycardias (AT), 415–416 AV nodal reentry tachycardia (AVNRT), 416–417 ablation of, 433–436 AV reentry tachycardia (AVRT) using concealed accessory pathway, 417–418 sinus nodal reentry tachycardias, 415 PAS-Port device, 555–556 Patent ductus arteriosus (PDA), 571, 575 Amplatzer Ductal Occluder, use of, 575–576 coil occlusion of, 575 PATH-CHF study, 486 PAVE study, 484–485 Pectinate muscle, 91 Pectoral girdle, 36 Pectoralis major and minor muscle, 37 Percutaneous transluminal coronary angioplasty (PTCA), 203 endothelial cells, 207–208 late stent thrombosis, 213 pathobiology of, 204 role of inflammation in restenosis chemokines and proinflammatory cytokines, 208–209 cross-talk between inflammation and thrombosis, 210 leukocytes recruitment, 208 molecular signaling leading to inflammation due to vascular interventions, 210–212 systemic markers of inflammation and ISR, 209 smooth muscle cells (SMC) and, 204 cell cycle and proliferation, 205 extracellular matrix accumulation, 205 representation of cycle, 206 vascular biology of restenosis, 203–204 PerDUCER1 instrument, 131–132 See also Pericardium Performer CPB cardiopulmonary bypass machine, 515–516 Perfusion, 514–515 Pericardium, 7, 44–45 anatomy arteries of, 127 attachment to diaphragm, 126 comparition between and within species, 130–131 epicardium, 125 ligament of left vena cava, 126 oblique and transverse sinus, 127 posterior view of pericardial sac, 126 serous and fibrous, 125, 127 xenograft valves, 131 celomic cavity, 62 disorders balloon pericardiotomy, 130 656 Pericardium (cont.) congenital abnormalities, 128–129 iatrogenic disorders, 130 sources of, 130 fibrous, 63 intrapericardial therapeutics clinical pericardial access, 131–132 transatrial technique, 132 layers of, 90 mesothelium cells in, 63 pericardial pharmacokinetics diazeniumdiolate with bovine serum albumin, 134 diethylenetriamine/ NO, 134 5-fluorouracil dose, 133 procainamide doses, 134 physiology of mechanical effects of, 128 pericardial fluid, 127–128 serous fluid, 62 sinuses, 64 surgical uses of, 131 thickness of, 90 transverse pericardial sinus, 63 visceral and parietal, 63 Perimembranous ventricular septal defects, 578–579 Persistent truncus arteriosus, 143 See also Congenital defects of human heart Phenoxybenzamine sympathetic nerve blocks, 235 Phrenic nerve, 43 Plaque formation, in ascending aorta, 553 Platelets, cell fragments, Plavix1, see Clopidogrel antiplatelet agents Pleura, 50–51 Pleural cavities, 60–61 Posterior mediastinum azygos venous system in, 47 course of descending aorta in, 48 esophagus in, 46 phrenic and vagus nerve in, 43 thoracic duct in, 48 descending thoracic aorta, 48 esophagus and esophageal plexus, 46–47 thoracic duct and lymphatics, 47–48 thoracic sympathetic nerves, 48–50 vessels of, 42 Post-pump syndrome, 226 Postventricular atrial blanking (PVAB) period, 455–456 Postventricular atrial refractory period (PVARP), 455–456 Preload, end-diastolic ventricular volume, 274 Propofol for induction of anesthesia, 237–238 Propranolol drug, 111 See also Coronary arteries Prosthetic valves biological prosthetic valves, 529 vs mechanical valve, 529–530 endocarditis, 530–531 mechanical prosthetic valves, 528–529 Protamine sulfate drug, 514 Pulmonary artery catheter, 287–289, 334–336 complications associated with insertion of central access and, 337 Pulmonary atresia with ventricular septal defect, 142 See also Congenital defects of human heart Pulmonary veins circumferential isolation of, 432 segmental ostial isolation of, 432 Index Pulse contour wave processing (PiCCO), 336 Pulseless electrical activity (PEA), 586 Pyrolytic carbon valve leaflets, 528 Q QT syndrome, 456 Quadratus lumborum (lateral) and psoas major (medial) muscles, 38 R Rapamycin limus drugs, 205–207 Real-Time Position Management system (RPMTM), 501 Real-time position management technologies, 502–503 Reconstruction process, 502 See also Cardiovascular system Red blood cells (erythrocytes), 3–4 Reference catheter (REFSTAR TM), 501 Renin–angiotensin–aldosterone system, Reperfusion injury, 224 accelerated cell death, 225 arrhythmias, 225 microvascular damage and no-reflow, 225–226 myocardial stunning, 225 post-pump syndrome, 226 therapies antioxidants, 227 growth factors, 227 Na+/H+ exchange (NHE) blockers, 227–228 nitric oxide (NO), 228 Respiration mechanics, 54 participation of muscles in, 55 Respiratory diaphragm, 38 ResQGard1, 594 ResQPump1, 590, 591 Restenosis, role of inflammation in, 635 chemokines and proinflammatory cytokines, 208–209 cross-talk between inflammation and thrombosis, 210 leukocytes recruitment, 208 molecular signaling leading to inflammation due to vascular interventions, 210–212 shear stress on endothelial cells and link, effect of, 207–208 systemic markers of inflammation and ISR, 209 vascular biology, 203–204 Resuscitation systems and devices, development in, 632–633 external defibrillators, 633–634 Resynchronization reVerses Remodeling in Systolic left Ventricular dysfunction (REVERSE) trial, 485 Resynchronization Therapy in Normal QRS Clinical Investigation (RETHINQ) trial, 485 Retrograde (RETRO) administration of crystalloid cardioplegia, 524 ReValving system, 564 Reveal1 family implantable loop recorders, 412 Reveal Plus, 640–641 Rheumatic heart disease in Africa and Asia, 412 Rheumatic tricuspid disease, see Tricuspid valve Right atrium internal anatomy, 68 vagal innervation of, 179 Right ventricle D-loop, 138 right ventricular apical pacing (RVA), 476 Riva-Rocci method, 245 Rodent transplantation model, 403 Roller pumps of cardioplegia infusion system, 523 Ross procedure, 529 Index RPMTM system, 502 RV DDD pacing, 483 S Safe Medical Devices Act (SMDA), 377 Sagittal plane, 15 See also Cardiovascular system SAPIEN transcatheter valve, 564 Saturation-recovery magnetization preparation, 347 Scapula, 34, 37 Secundum ASD, 573 See also Amplatzer devices Secundum-type atrial septal defect, 138 Semicircular arch, 70 Senile aortic stenosis, 532 Septomarginal trabeculae, 70 Septum primum, 78 Sequences implementing image reconstruction techniques with sensitivity encoding (SENSE), 346 Sequential mapping systems electroanatomical mapping technologies, 501–502 LocaLisa1 technologies, 503–504 real-time position management technologies, 502–503 Serous parietal pericardium, 90 See also Pericardium Serratus anterior muscle, 37, 40 Seven-transmembrane-spanning receptors, see G-Protein-coupled receptor Sevoflurane as anesthetics, 234 Sheep thorax, orientation of heart, 90 Shock, 593 intrathoracic pressure regulator (ITPR) for, 594 intravenous fluids and vasopressor agents therapy, 593 and ITD for, spontaneously breathing patients, 594–599 Sick sinus syndrome, 425–426 Silent ischemia, 223–224 Simultaneous acquisition of spatial harmonics (SMASH), 346 Single aortic crossclamp technique, 553 Sinoatrial node (SA) location, 69 nodal artery, 80 Sinus node dysfunction (SND), 426 indications for permanent pacing in, 450 Sinus of Valsalva, 74 Sinus tachycardias inappropriate sinus tachycardia (IST), 415 ablation of, 429 physiological, 415 Skeletal myoblasts, 614–615 Sleuth1 family implantable loop recorders, 412 Smooth muscle cells (SMC), 204 cell cycle and proliferation, 205 extracellular matrix accumulation, 205 representation of cycle, 206 Somatopleuric layer, 23–24 Sonomicrometry crystal placement, 276–278 SPIDERTM Embolic Protection Device, 638, 640 Spinal nerve, communication of sympathetic nerves with ganglia via white and gray rami communicantes, 49 Splanchnopleuric layer, 23–24 StarfishTM Heart Positioner, 638 Steady-state free precession techniques, 345–346 Stem cell animal model, 406 delivery methods, 407–408 657 engraftment issues, 408 functional assessment of therapies, 408 Stem cell treatment, in heart disease clinical trials on, 621–622 mechanisms of beneficial effects of adverse remodeling, attenuation of, 622 extracellular matrix, modulation of, 623 immunomodulation of, infarct environment, 623 improved perfusion, 622 paracrine effects, 623 primary remuscularization, 622 techniques to enhance the efficacy of biomaterials, use of, 624–625 function and survival, 624 homing, 623 mobilization, 623 See also Myocardial repair cells types Stents, 635–636 Sternoclavicular joint, 37 Sternum and xiphoid process, 35–36 Steroid-elution technology, 637 Stromal cell-derived factor-1 (SDF-1), 624 ST-Segment elevation myocardial infarction (STEMI), 386 St Thomas II solution, 520 Subclavian veins anatomy, 57 Subclavius, 37 Subcostal muscles, 38 Succinylcholine depolarizing muscle relaxant, 239 Sudden cardiac arrest (SCA), 583 and CPR, 583–584 therapeutic hypothermia, benefit of, 587 ITD, use of, 584–587 Sudden cardiac death (SCD), 412 Superior mediastinum arteries in, 41–42 bilateral brachiocephalic veins, 43 course of phrenic and vagus nerve in, 43 nerves of, 43–44 pattern of innervation in, 44 thymus, 44 trachea and esophagus, 43 vessels of, 42 Supraventricular crest, 70 Swine transplantation model, 404 validation study of 3-DCEI, 508 Symmetry Bypass System, 638 Sympathetic ganglia, 48–49 T Tachyarrhythmias atrial fibrillation (AFib), 421–423 atrial flutter, 421 paroxysmal supraventricular tachycardias (PSVTs) atrial tachycardias (AT), 415–416 AV nodal reentry tachycardia (AVNRT), 416–417 AV reentry tachycardia (AVRT) using concealed accessory pathway, 417–418 Parkinson–White (WPW) syndrome and related preexcitation syndromes, 418–420 sinus nodal reentry tachycardias, 415 premature complexes, 413 atrial premature complexes (APCs), 414 AV junctional premature complexes, 414 multifocal atrial tachycardia, 414 ventricular premature complexes (VPCs), 414–415 658 Tachyarrhythmias (cont.) sinus tachycardias inappropriate sinus tachycardia (IST), 415 physiological, 415 ventricular tachyarrhythmias accelerated idioventricular rhythm, 424 nonparoxysmal junctional tachycardia, 425 Torsades de Pointes (TdP), 424–425 ventricular flutter and ventricular fibrillation, 424 ventricular tachycardia (VT), 423–424 Take Heart America program, 593 Tei index, see Myocardial performance index Telemedicine, 639 ambulatory heart monitors, 640–641 Tendon of Todaro, 75 Tetralogy of Fallot, 141–142 See also Congenital defects of human heart Thebesian valve and veins, 84, 88 Thiopental barbiturates, 235 Thoracic duct, 47 Thoracic sympathetic nerves, 48–50 Thoracic vertebra, 34 Thoracocentesis, 56 Thoratec HeartMate1 XVE LVAD, 606–607 Thorax anterior mediastinum, 46 cadaver dissection of, 61 inferior and superior aperture, 33 and lungs, 51–54 mechanics of respiration, 54 middle mediastinum great vessels, 45–46 pericardium, 44–45 pleura pulmonary cavities, 50–51 position of heart in, 60 posterior mediastinum azygos venous system in, 47 descending thoracic aorta, 48 esophagus and esophageal plexus, 46–47 thoracic duct and lymphatics, 47–48 thoracic sympathetic nerves, 48–50 pulmonary cavities and mediastinum, 34 superior mediastinum arteries in, 41–42 bilateral brachiocephalic veins, 43 nerves of, 43–44 thymus, 44 trachea and esophagus, 43 surface anatomy heart and great vessels, 56 vascular access, 57 vertical lines, 54–56 thoracic wall bony thorax, 34 intercostal muscles, 37–38 musculature of anterior thoracic wall, 36 nerves of, 39–40 pectoral girdle, 36 pectoral muscles, 36–37 respiratory diaphragm, 38–39 ribs form, 35 scalene and sternocleidomastoid muscle, 39 thoracic cage, 34–36 vessels of, 41 Thromboembolism, 528 Index Thymus, 44 Tissue Doppler imaging, 322–324 Tissue valve, see Ross procedure Toll-like receptors (TLR) and vascular pathogenesis, 212 Topical ultrasound devices, 553 Torsades de Pointes (TdP), 424–425 See also Tachyarrhythmias Total anomalous pulmonary venous connection, 143 See also Congenital defects of human heart Total circulatory arrest technique, 513 Trachea, 43 bifurcation of, 61 Transarterial approach, 563, 564 Transcatheter-delivered valve systems, 562 aortic valve, 563–565 imaging modalities for, 566–567 mitral valve, 565–566 pulmonic valve, 562–563 training systems for, 567–568 tricuspid valve, 566 Transcatheter valve replacement, 561 stents balloon-expandable devices, 562 self-expanding devices, 562 See also Transcatheter-delivered valve systems Transcytosis, Transducer catheters, 284 Transmural extent of infarction (TEI), 358 Transseptal approach, 564 Transthoracic echocardiography, 325 Transvalvular gradient, 528 Transvenous synchronized atrio-Biv pacing, 479 Transverse plane, 15 See also Cardiovascular system Transverses thoracis muscles, 38 Tricarboxylic acid (TCA) cycle, 307 Tricuspid atresia, 142 See also Congenital defects of human heart Tricuspid regurgitation annuloplasty, 546 Tricuspid valve, 70 disease, 545–547 True bipolar leads, 469 TrueFISP slices using 3D analysis protocol, 355 Tumor necrosis factor alpha (TNF-) role in inflammation and immunity, 209 signaling of, 211 Two-pump system, See also Heart U Umbilical Cord Blood Stem Cells, 617 Unipolar pacing circuit, 448 University of Minnesota’s department of surgery, 365–366 affiliated medical devices, 376 FDA regulations, 377 azygos flow studies, 369 bypass methods, 369 cardiovascular physiology, 379–380 Chairs/Interim Heads, 367 clinical open-heart operations, 369 controlled cross-circulation, 367, 369 department of physiology, 379 faculty and adjuncts, 380 DeWall–Lillehei disposable bubble oxygenator, 369–372 First Annual Bakken Surgical Device Symposium, 375 Index heart block and development of pacemaker, 372 Bakken’s transistor pulse generator, 373 battery-powered wearable pacemaker, 373 bipolar electrode and, 374 Black Box 5800 external pacemaker, 374 first model of 5800 pacemaker, 373 transistorized metronome from popular electrons as model, 373 White Box 5800 production model, 374 heart–lung machine, 368 heart valves, 375–376 Lillehei–Nakib toroidal valve, 375 St Jude bileaflet prosthesis, 376 King of Hearts, 370 LifeScience Alley, 377–378 Mayo Clinic’s heart–lung machine, 370 milestones of, 368 University of Minnesota VAD program, 610 V Vasodilating agents in severe aortic regurgitation, 536 Venous cannulation, 512 Ventricular assist devices (VAD), 605 axial flow pumps, 607–608 centrifugal pumps, 609 classification of, 606 future research program, 610–611 implantation techniques for, 609 management, 609 University of Minnesota program, 610 volume displacement pumps, 606–607 Ventricular atrial septal defect, 78–79 Ventricular fibrillation (VF), 583–584 Ventricular premature complexes (VPCs), 414–415 Ventricular refractory period (VRP), 455–456 Ventricular septal defect (VSD) inlet/atrioventricular canal-type, 139 perimembranous/paramembranous, 139 659 See also Congenital defects of human heart Swiss cheese defect, 140 Ventricular tachyarrhythmias accelerated idioventricular rhythm, 424 nonparoxysmal junctional tachycardia, 425 Torsades de Pointes (TdP), 424–425 ventricular flutter and ventricular fibrillation, 424 Ventricular tachycardia (VT), 423–424 ablation of bundle branch reentry tachycardia, 436 in clinically normal hearts, 436 in ischemic heart disease, 436 Verapamil drug, 386, 414 T6 Vertebra, 35 Visceroatrial situs, 137 Visible Heart1 techniques, 468, 567 Visible Heart1 Viewer CD, 17 Volatile anesthetics, 233–234 Voltage-dependent Ca2+ channel, 310–311 VVI pacing, 476–477 W Wall motion and regional myocardial strain analysis harmonic phase (HARP) MR technique, 356 regional myocardial strain with tagged MR images, 356 relative wall motion, 355–356 Warm-up phenomenon, 416 See also Atrial tachycardia Webster-Jenkins catheter, 505 Wenckebach phenomenon, 426–427 White blood cells (leukocytes), 3–4 Wolff–Parkinson–White syndrome, 162, 509 X Xenon as anesthetics, 234 Xiphoid process of sternum, 38 On the attached D V D-ROM, please find the “Companion” folder Exit the program and search the D V D-ROM with Windows Explorer © Humana Press, a part of Springer Science+Business Media, LLC 2009 This electronic component package is protected by federal copyright law and international treaty If you wish to return this book and the electronic component package to Springer Science+Business Media, LLC, not open the disc envelope or remove it from the book Springer Science+Business Media, LLC, will not accept any returns if the package has been opened and/or separated from the book The copyright holder retains title to and ownership of the package U.S copyright law prohibits you from making any copy of the entire electronic component package for any reason without the written permission of Springer Science+Business Media, LLC, except that you may download and copy the files from the electronic component package for your own research, teaching, and personal communications use Commercial use without the written consent of Springer Science+Business Media, LLC, is strictly prohibited Springer Science+Business Media, LLC, or its designee has the right to audit your computer and electronic components usage to determine whether any unauthorized copies of this package have been made Springer Science+Business Media, LLC, or the author(s) makes no warranty or representation, either express or implied, with respect to this electronic component package or book, including their quality, merchantability, or fitness for a particular purpose In no event will Springer Science+Business Media, LLC, or the author(s) be liable for direct, indirect, special, incidental, or consequential damages arising out of the use or inability to use the electronic component package or book, even if Springer Science+Business Media, LLC, or the author(s) has been advised of the possibility of such damages .. .Handbook of Cardiac Anatomy, Physiology, and Devices Paul A Iaizzo Editor Handbook of Cardiac Anatomy, Physiology, and Devices Second Edition Foreword by Timothy... blood cells (erythrocytes), white blood cells (leukocytes), and the cell P.A Iaizzo (ed.), Handbook of Cardiac Anatomy, Physiology, and Devices, DOI 10.1007/978-1-60327-372-5_1, Ó Springer ScienceỵBusiness... treatments often provide only temporary relief of the progressive symptoms of cardiac disease Optimizing therapies and/ or the development of new P.A Iaizzo (*) University of Minnesota, Department of