Artificial Organs

Lecture 2
Cardiovascular assist systems

Suhaila Mohieldeen Abdelgadir

batch 39- Diploma of Biomedical Engineering 1

 Types of Cardiovascular assist systems

1-Artificial Heart Valves

2-Pumps
3-Ventricular Assist Device
4-Peacemaker

batch 39- Diploma of Biomedical Engineering 2

 1-Artificial Heart Valves

• Traditionally, valve replacement has required open-chest surgery with

a ‘heart–lung’ machine required to replace cardiorespiratory
function, but increasingly, minimally invasive procedures spare being
developed.
• There are 4 normal valves :
• Mitral
• Tri-cuspid
• Pulmonary
• aortic

batch 39- Diploma of Biomedical Engineering 3

batch 39- Diploma of Biomedical Engineering 4
• There are two potential sources of heart valve failure, each of which
requires years to develop:-
1. stenosis or narrowing
2. weakening of the valve leaflets

batch 39- Diploma of Biomedical Engineering 5

• For a replacement valve to operate effectively, the following
requirements must be met in its design:-
1. Haemodynamics
2. Closure mechanism
3. Materials
4. Ease of implantation

batch 39- Diploma of Biomedical Engineering 6

• Types of artificial heart valves
1. Mechanical valves
2. Biological valves

batch 39- Diploma of Biomedical Engineering 7

 Mechanical Valve
Valve material features

Caged ball Stainless steel 1. structurally strong and durable.

Titanium 2. need anticoagulation therapy
Silicone 3. frequently suffer from haemolytic anaemia
Pyrolytic Carbon
Titling disc • The angular opening 60 of this valve reduces
damage to blood cells.

bileaflet • valves open to 80◦

• correct the problem of central flow and blood cell
damage
• least resistance to flow and the least blood
damage.

batch 39- Diploma of Biomedical Engineering 8

FIGURE 2: Prosthetic ball valve in the closed position showing with the ball sitting in the
dacroncovered annular ring and the upper cage protecting the ball in the open position.

batch 39- Diploma of Biomedical Engineering 9

FIGURE 3: Tilting disk valve in the open position.

batch 39- Diploma of Biomedical Engineering 10

 3-bileaflet vaves

FIGURE 4: Bileaflet valve showing flanges where leaflet pins pivot within annular ring.

batch 39- Diploma of Biomedical Engineering 11

 2- Biological valves
• Over the past 30 years, various successful approaches have been
developed using biological valves. Occasionally, autologous grafts are
inserted.

batch 39- Diploma of Biomedical Engineering 12

 2- Pumps
• Mechanical pumps:
Mechanical pumps are required most commonly to support the body
during procedures such as dialysis or open chest surgery, but are being
used increasingly to support the failing circulation in ambulant patients.

batch 39- Diploma of Biomedical Engineering 13

Pumps for extracorporeal devices

1. Peristaltic (roller) pumps:- (normally used for dialysis) In these

pumps, two or more rollers rotate on arms through solid
semicircular tracks, compressing compliant tubing as they do so.
2. Rotary pumps These may be impellers or centrifugal pumps. To
avoid blood leakage, they are normally in the form of encased units
with a rotor driven magnetically by an external electric motor.

batch 39- Diploma of Biomedical Engineering 14

 Pumps for cardiac support
• Although the early pumps were external to be body, most of those
used today are placed in the abdomen. They are supplied by cannula
originating in the right atrium and deliver blood to the ascending or
descending thoracic aorta.
• More recent axial turbine pumps are small enough to be placed
within the left ventricle. Modern versions of centrifugal pumps use
rotors that are suspended hydrodynamically, thereby minimising the
shear that is applied.

batch 39- Diploma of Biomedical Engineering 15

• Most pumps support left heart function but a few others can support
both sides of the heart. It is possible to use a diaphragm pump to
operate in reciprocal mode, pumping to the lungs on a forward stroke
and systemic circulation as it moves backwards.

batch 39- Diploma of Biomedical Engineering 16

 Ventricular assist devices
• A commonly employed technique that obviates the need for major
surgery is to use an aortic balloon pump.
• A balloon is placed in the thoracic aorta (usually via a femoral artery
catheter) and rapidly inflated during diastole and rapidly deflated at
the beginning of ventricular ejection.

batch 39- Diploma of Biomedical Engineering 17

• Helium is used for inflation since its low density provides minimal
flow resistance during these rapid manoeuvres.
• By impeding flow to the lower half of the body during diastole,
coronary and brain perfusion are enhanced.

batch 39- Diploma of Biomedical Engineering 18

 VENTRICULAR ASSIST
DEVICE
Ventricular assist device, invented by Dr Michael DeBakey was implanted in 1966
at Methodist hospital in Texas.

Michael has pioneered the development of heart

pumps since the early 1960s.
In 1966, he performed the first successful
implantation of a ventricular assist device.
The patient's heart recovered while the VAD took
over its pumping chores.

batch 39- Diploma of Biomedical Engineering 19

3-pacemaker

batch 39- Diploma of Biomedical Engineering 20

 Natural pacemaker
• The natural pacemaker of the heart is the sinoatrial (SA) node, a
specialized group of cardiac muscle cells located in the wall of the
right atrium just below the opening of the superior vena cava.

batch 39- Diploma of Biomedical Engineering 21

 The SA node is considered specialized because it has the most rapid
rate of contraction, that is, it depolarizes more rapidly than any other
part of the myocardium (60 to 80 times per minute).
depolarization is the rapid entry of Na+ ions and the reversal of
charges on either side of the cell membrane.
The cells of the SA node are more permeable to Na+ ions than are
other cardiac muscle cells. Therefore, they depolarize more rapidly,
then contract and initiate each heartbeat.

batch 39- Diploma of Biomedical Engineering 22

From the SA node, impulses for contraction travel to the atrioventricular
(AV) node, located in the lower interatrial septum.

The transmission of impulses from the SA node to the AV node and to the
rest of the atrial myocardium brings about atrial systole.

batch 39- Diploma of Biomedical Engineering 23

• Recall that the fibrous skeleton of the heart separates the atrial
myocardium from the ventricular myocardium; the fibrous connective
tissue acts as electrical insulation between the two sets of chambers
• The only pathway for impulses from the atria to the ventricles,
therefore, is the atrioventricular bundle (AV bundle), also called the
bundle of His.
• The AV bundle is within the upper interventricular septum; it receives
impulses from the AV node and transmits them to the right and left
bundle branches.

batch 39- Diploma of Biomedical Engineering 24

From the bundle branches, impulses travel along Purkinje fibers to
the rest of the ventricular myocardium and bring about
ventricular systole.
The electrical activity of the atria and ventricles is depicted by an
electrocardiogram(ECG).

batch 39- Diploma of Biomedical Engineering 25

• If the SA node does not function properly, the AV node will initiate
the heartbeat, but at a slower rate (50 to 60 beats per minute). The
AV bundle is also capable of generating the beat of the ventricles, but
at a much slower rate (15 to 40 beats per minute).
• This may occur in certain kinds of heart disease in which transmission
of impulses from the atria to the ventricles is blocked.

batch 39- Diploma of Biomedical Engineering 26

Heart diseases
Arrhythmias are irregular heartbeats; their effects range from harmless
to life-threatening. may be the result of too much caffeine, nicotine,
or alcohol.
Much more serious is ventricular fibrillation, a very rapid and
uncoordinated ventricular beat that is totally ineffective for pumping
blood

batch 39- Diploma of Biomedical Engineering 27

 artificial cardiac pacemakers
What is a pacemaker?
• Artificial pacemakers are a two-part electrical system that includes a
pulse generator (pacemaker) and one or two leads which deliver
impulses to the heart. The leads also carry signals back from the heart.

• By "reading" these signals, the pulse generator is able to monitor the

heart's activity and respond appropriately.

• A pacemaker helps to pace the heart when the natural rate is too slow to
pump enough blood to the body (bradycardia).

batch 39- Diploma of Biomedical Engineering 28

Pacing Systems

Pulse
generator

Sensing and
Pacing lead

batch 39- Diploma of Biomedical Engineering 29

 Pulse generator
Pulse generator is responsible for generating the pulse at the proper time based on events
sensed

Main elements:
• Power source – provide the energy required for the
operation of the pacemaker
• Memory (RAM/ROM) to store data for diagnostic
purposes

• Antenna. Monitors relevant heart data and sends it,

for example, to doctor

• Microprocessor – controls all operations

batch 39- Diploma of Biomedical Engineering 30

Pacing Lead

• The generator is connected to heart through the

tiny wires called leads.
Connector
• Leads deliver the pulse to its destination in the
heart, sense and carry back information to the
pulse generator. Lead Body
Active Fixation
Mechanism
• Each lead has an electrode on its tip. That tip
actually burrows into heart wall
Tip
Electrode

batch 39- Diploma of Biomedical Engineering 31

Fixation Mechanisms
• Good contact with the heart wall.
• Achieve best results in pulse pacing of the heart

batch 39- Diploma of Biomedical Engineering 32

Electrode

• Effective interface between two systems, physiology and electronics, can be

done with electrode
• Material used for electrode tips is titanium
• Electrode housing is made from silicone rubbers
• Steroids needed to prevent inflammation process

Inflammation – process when, human body attempts to isolate a foreign object (est. põletik)
batch 39- Diploma of Biomedical Engineering 33
How does a pacemaker take over heart beat?
• The pacer's electrical pulses travel through leads to heart.
• The pulses are timed to flow at regular intervals just like heart's natural electrical signals would.
• Pacer has 2 functions: pacing and sensing (The third function is programming)
Pacing
Pacer sends electrical signals to heart through pacing leads. Each
electrical signal is called a pacing pulse. The pacing pulse begins heart
beat
Sensing
Leads send information about heart's electrical system back to the pacer.
This allows the pacer not to interfere with a natural, healthy heart beat
Sensing Functions:
- Level detection (amplitude)
- Filter (band-pass filter)
- Amplifier

batch 39- Diploma of Biomedical Engineering 34

Picture illustrates how pacemaker is connected to the heart and take control over heart`s beat

batch 39- Diploma of Biomedical Engineering 35

Types of artificial cardiac pacemakers

Unipolar system
Bipolar system
Single chamber - only one
Dual chamber - two leads are used.
chamber is regulated

batch 39- Diploma of Biomedical Engineering 36

 Implantation procedure

• The procedure is usually done under local anaesthesia

• The pulse generator is implanted under the skin

• The leads are inserted using x-ray control, via a vein

found in this area, and positioned in the appropriate
right sided heart chamber

• The leads are tested before the pulse generator is

attached

batch 39- Diploma of Biomedical Engineering 37

Programming

Pacemakers have many programmable functions that can be done with a special programmer. Unfortunately
there is no universal programmer and each manufacturer provides programmers that will work only with their
pacemakers

batch 39- Diploma of Biomedical Engineering 38

Living with an artificial cardiac pacemaker

• A person with an artificial cardiac pacemaker can live a normal life and can still do
• everyday activities.

• Most pacemakers last longer than five years. Before the pacemaker
• fails, a battery depletion indicator suggests that the pacemaker should be replaced.
• This is again performed under local anaesthesia.

batch 39- Diploma of Biomedical Engineering 39

How does magnet application affect a pacemaker?

• Magnet application disables the sensing amplifier, causing it to pace asynchronously.

• It is recommended that patients with a pacemaker keep at least 15 cm away from possible sources of magnetic
interference, e.g. mobile phones, magnetic pain therapy, stereo speakers

batch 39- Diploma of Biomedical Engineering 40

First pacemakers

First totally implantable

pacemaker by Senning (1958)

A model of Albert Hyman’s The battery operated

Pacemaker (1931) pacemaker by Lillehei and
Bakken (1957)

batch 39- Diploma of Biomedical Engineering 41

Thank you for attention
Questions?

batch 39- Diploma of Biomedical Engineering 42