What Is Pulsatile Flow?

Gordon Wright and Anthony Furness Ann Thorac Surg 1985;39:401-402 DOI: 10.1016/S0003-4975(10)61943-1

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The Annals of Thoracic Surgery is the official journal of The Society of Thoracic Surgeons and the Southern Thoracic Surgical Association. Copyright © 1985 by The Society of Thoracic Surgeons. Print ISSN: 0003-4975; eISSN: 1552-6259.

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and it has been suggested that this On might form the basis of a working definition [4]. as reviewed by one of us [l]and Mavroudis [2]. 2012 .. it is clear that some benefits can be obtained using pulsatile pumps that produce very bizarre arterial pressure and flow waveforms compared with normal (Fig 1) [51. the other hand. the products of pressure and flow at each harmonic level. University of Keele. It should be noted that the important point is what occurs in the aorta. and phase (harmonics) [6. The urgent requirement for a descriptive technique that is capable of distinguishing among different types of pulsatile flow is apparent. and Anthony Furness. The effect of this is that pulsatile flow meets a lower impedance than nonpulsatile flow. frequency. but the time domain description cannot provide a comprehensive definition of pulsatile flow because the morphology of the waveform is not included. some types of pulsatile flow are more effective than nonpulsatile flow in preserving tissue function while others are not.D. the flow of blood from the heart to the aorta is described as a time-history of events-an ejection phase and a recovery phase of ventricular action. such as tissue perfusion and the promotion of metabolic exchange. Ph. A more complete description can be obtained by the use of frequency domain techniques by which the complex pressure or flow waveform is transformed to a mean level plus a series of sine waves of differing amplitude. pulsatile flow produced by the normal left ventricle gives us two important and fundamental advantages over nonpulsatile flow. peak flow. and to the pulse repetition frequency (pulse rate). A compliant arterial line or a small-bore cannula can considerably modify the pulse. pulsatile flow contains more energy. frequency. Failures to detect advantages in some studies may be due to the fact that the frequency content (in terms of sine waves) of the pump output may not have been optimal for the patients on whom it was used. The most discerning authors pay only token acknowledgment to this problem by referring to the pressure pulse amplitude measured at some peripheral site by uncharacterized manometric techniques. The power of left ventricular ejection is then derived as the product of left ventricular mean pressure and flow plus From the Department of Biological Sciences. pulsatile flow is more easily transmitted to the peripheral vascular beds because the major arteries are compliant. and phase to describe pulsatile flow. 71. because nonpulsatile flow is completely represented by the mean value. Phase differences between pressure and flow for corresponding harmonics are caused by compliance and inertance in the vascular system. The transient storage of energy in the walls of the major arteries has the effect of off-loading the heart. This gives us a clue to one of the principal advantages of pulsatile flow: for equal mean blood flow rates. The dynamic properties of the vascular system are similarly obtained as the quotient of mean pressure and mean flow (peripheral vascular resistance) plus the quotients of the corresponding harmonics. Some of this energy is transmitted downstream where it performs work. there is a growing population of authors reporting that they have been unable to detect any notable differences between pulsatile and nonpulsatile flow [3]. 401 Downloaded from ats. or pump. because the cardiovascular system is predominantly compliant. no evidence that pressure pulse amplitude or pulse rate has any physiological significance has been presented. It should also be noted that currently available pulsatile pumps can be operated in a The most surprising feature of the literature and the prolonged discussions on the subject of pulsatile and nonpulsatile blood flow is that pulsatile flow has not been defined. As Figure 2 shows. In opposition. In common usage.EDITORIAL What Is Pulsatile Flow? Gordon Wright. The one type of pulsatile flow we can be confident about is the type produced in the aorta by the normal left ventricle. We may extend this description by adding factors such as ejection phase duration. The important consideration here is that unlike a purely resistive system. and pressure pulse amplitude. It is anomalous that scientific investigations and discussions can proceed with no clear demarcation of the factors being compared. Ph. These two factors may be responsible for the plethora of physiological and pathological advantages that have been reported in controlled pump trials. from the high-resistance peripheral vascular beds.D. aortic input impedance is dependent on the frequency content (in terms of sine waves) of the complex waveform. Thus. However. One reason for this dichotomy (and there are others) may be that different investigators have used different types of pulsatile flow. England. Second. Keele. It has real physiological significance and may be the most fundamental benefit of pulsatile flow.org by on March 2. pulsatile flow contains more energy (power x time). It is important to recognize that this is not just a mathematical trick. a system with compliant and inertive components is capable of both temporary storage and lateral transmission of energy. As suggested by Philbin [3]. The benefits of pulsatile flow are now well known and are prominent in the cardiopulmonary bypass literature. and some energy is directed radially where it encourages the movement of tissue fluids and the formation and flow of lymph.ctsnetjournals. at equal mean blood flow rates. whereas it is necessary to add a series of sine waves of different amplitude. Staffordshire ST5 5BG. so that our concept of "the pump" has to include the aortic line and cannula. First.

but in our opinion. certain fre- 1. Impedance spectrum in pig aorta. Tolloczko TS. The impedance modulus is v e y high for nonpulsatileflow (zero frequency). but it attempts to point the way in a field of unnecessary confusion. Thorax 37:324. March 1973. because this value is derived from the quotient of mean pressure and mean flow. but the type that is ideally matched to the cardiovascular system. it is difficult to determine the relevance of these studies to the discussions concerning the relative merits of pulsatile and nonpulsatile flow. and negative values indicate compliance. The type of pulsatile flow we need is not the type produced by a pump with that mode labeled on it. Arnold. The basic strategy in pulsatile flow studies is quite unreproachable. Second edition.ctsnetjournals. Taylor KM. 1978 3.402 The Annals of Thoracic Surgery Voi 39 No 5 May 1985 Pressure 3001 -100 I* B C 1s . thesis. 1982 4. Finally. . Comparative studies in which the pump output fails to approach this ideal may have demonstrable clinical benefits. the site of measurement is of great importance since the pressure and flow pulses vary considerably between the aorta and the peripheral arteries [6]. References ( Radians Phase 1 -2 1 Fig 2 . The modified roller pump can be operated in nonpulsatile or pulsatile mode with a continuous range of adjustment between these extremes. The only type of pulsatile flow we can be sure about at present is that generated by the normal left ventricle. This brief and oversimplified discussion has not answered the original question. . Mavroudis C: To pulse or not to pulse (collective review). University of Keele Ph. and does not include the considerable effects of compliance and inertance in pulsatile flow.--+-. Phase refers to the delay of flow behind pressure. even when an electromagnetic flowmeter is employed. et al: Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients. Positive values of phase indicate inertance. -. Baltimore. Some modes of operation may be better matched to the aortic input impedance than others. 2012 . it will be apparent from this discussion of impedance that measurements of peripheral vascular resistance are of little consequence. variety of modes (see Fig 1). Wright G: Brain damage in dogs resulting from pulsatile and non-pulsatile blood flows in extracorporeal circulation. Mdnor WR: Hemodynamics. Sanderson JM. Davidson KG. Williams & Wilkins. p 182 5.OOti 0 . et al: The MortonKeele pump: a hydraulically activated pulsatile pump for use in extracorporeal circulation. London. (B) a modijied roller pump (Stiickert).org by on March 2. "01 . Ann Thorac Surg 25:259. Fig 1 . and (0a positive-displacement pulsatile pump (Polystan). The importance of accurate measurements should be stressed. 1982 Downloaded from ats. Should we pulse? J Thorac Cardiovasc Surg M805.D. -0 O F 1 2 3 4 5 6 7 8 9 21 quency-dependent corrections are necessary. Also. Morton PG. McDonald DA: Blood Flow in Arteries. Med Biol Eng. 1982 6. Measuring pulsatile pump output from the pump meter display is totally inadequate. . Pressure and flow waveforms generated in a model of the human vascular system by (A) a conventional roller pump (Sarns). Bain WH. 1971 2. 1974 7. Philbin DM.

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