Passive Left Ventricular Constraint Devices
Both myocardial infarction and volume overloading associated with regurgitant valve lesions lead to eccentric left ventricular (LV) hypertrophy. The mechanism is presumed to be positive feedback between diastolic LV wall stress and eccentric LV hypertrophy. Further, in each case, an increase in LV size is an important adverse prognostic finding. The experience with skeletal muscle cardiomyoplasty led to the hypothesis that passive constraint of LV enlargement would interrupt the diastolic stress and eccentric hypertrophy cycle, in addition to halting and possibly reversing the adverse LV remodeling. A number of passive constraint devices such as the Acorn CorCap™ Cardiac Support Device (CSD), Paracor Medical HeartNet™ Ventricular Support System (VSS), and Myocor™ yosplint® have been used. Most recently, an Adjustable Fluid Filled Balloon CSD was proposed by Ghanta and colleagues. In this chapter we model the effect of passive constraint devices, with the exception of the Paracor Medical HeartNet™ VSS, on the LV stroke volume/end-diastolic pressure (Starling) relationship and regional distributions of stress in the local muscle fiber direction.
KeywordsFiber Stress Pump Function Fabric Orientation Hyperelastic Model Eccentric Left Ventricular Hypertrophy
This research was supported by National Institutes of Health grant 5R01 HL077921 (Dr. Guccione) and 5R01 HL063348 (Dr. Ratcliffe). We thank Ms. Kimberly S. Yan, a technical writing expert for proof-reading of this chapter.
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