The 2012 Biomedical Engineering International Conference (BMEiCON-2012)

Effect of mechanical circulatory support in the heart

failure patient with left–right heart failure condition:
A simulation study

Phornphop Naiyanetr
Department of Biomedical Engineering
Faculty of Engineering, Mahidol University
Nakorn Pathom, Thailand
Phornphop.nai@mahidol.ac.th

Abstract— Mechanical circulatory support (MCS) is
increasingly used in the end-stage heart failure patients. The
rotary blood pump (RBP) is a novel technology of MCS that
currently used in the left ventricular (LV) failure patient. After
RBP implanted in LV, some patient immediately need another
RBP on the right side of the heart. The effect of LV-RBP or left
ventricular assist device (LVAD) on the right ventricle (RV) has
been simulated in both normal RV and pathology RV for
education proposes. This simulation was regulated the pathology
of the heart from normal heart (Maximum Elastance; Emax:
100%) to pathological heart (Emax: 50%) and the level of RBP
support in the LV (partial support and full support). The result
of this simulation showed the hemodynamics during LV-RBP
support. The end-diastolic volume of left ventricle was depended
on pump speed. The increasing of right ventricular volume
during support was showed in the pathological RV. In contrast,
the remaining of right ventricular volume during support was
showed in the normal RV. In conclusion, this computer
simulation can re-generated the hemodynamics and pressure-
volume loop heart failure patient with MCS.
Index Terms— Mechanical Circulatory Support, Rotary Blood
Pump, Emax, LVAD
I. INTRODUCTION
Mechanical circulatory support (MCS) is increasingly used
in patients with end-stage heart failure both in Unite State of
America and European countries. The rotary blood pump
(RBP) is a novel technology that used for left ventricular assist
device (LVAD). The application of MCS is using as bridge-to-
transplantation (BTT), bridge-to-recovery (BTR), and
destination therapy (DT) [1-3]. However, the study of MCS in
human body is difficult for regulate condition. Additionally,
the animal model is also expensive for implement in training
education. Therefore, the computer simulation that can
replicate the hemodynamic during MCS could be a useful tool
to educate clinical staffs and also patient itself in a topic of
LVAD management to prevent the over unloading [4-5]. The
other advantage of simulation is used to validate new clinical
treatments as a pre-limitary study [6-7]. In the present study,
the computer simulation of heart failure patients during MCS
at both pathology of the heart and two level of mechanical
circulatory support was developed.
II. MATERIAL AND METHODS
Using an electrical analog-lumped parameter of
cardiovascular system model, a numerical model of the whole
cardiovascular system including the RBP at the left side of the
heart was implemented in MATLAB Simulink®(MathWorks
Inc, Nick, MA) [8-9]. The simulation of hemodynamics was
included the normal heart (Maximum Elastance; Emax: 100%),
left heart failure without RBP support (low contractility (Emax:
50%), left heart failure with partial and full RBP supports
(pump speed: 7500 and 9000 rpm). The RBP model [10]
developed by using data from MicroMed-DeBakey LVAD
(MicroMed Cardiovascular Inc. Houston, TX). The RBP model
was implemented base on the normal operation in MCS
surgery by connecting the inflow of RBP model to LV model
and connecting the outflow of RBP model to aorta model.
The construction of cardiovascular system model with
MCS includes 18 parts; 1) Systemic veins, 2) Venae cave, 3)
Right atrium, 4) Tricuspid valve, 5) Right ventricle, 6)
Pulmonary valve, 7) Pulmonary arteries, 8) Pulmonary
capillaries, 9) Pulmonary veins, 10) Left atrium, 11) Mitral
valve, 12) Left ventricle, 13) Aortic valve, 14) Coronary
arteries, 15) Ascending aorta, 16) Descending arteries, 17)
Peripheral arteries, and 18) Rotary blood pump. The
mathematical equations of electrical analog-lumped parameter
and the pericardial dynamics are taken from the study of Sun
Y. et al [8]. The time varying elastance equations of the heart
are similar to Sun Y. et al but slightly modified by Liang F and
Liu H [9].
In heart failure model, The Emax (contractility index) of
both left ventricle (LV) and right ventricle (RV) are a
regulating parameter that related to Frl and Frr in time-varying
elastance equation of Liang F and Liu H [9]. Frl and Frr are
scaling factors accounting for the nervous reflex control of
both left and right ventricular contractility. In this model, the
cardiac contractility was regulated by vary the scaling factor Frl
(normal heart and pathological heart) of Frl as Emax. The
systemic vascular system (SVS), pulmonary vascular system

978-1-4673-4892-8/12/$31.00 ©2012 IEEE

(PVS), and heart valve parameters were keep constant as a
normal condition. The value of SVS, PVS and other parts were
adopted from Sun Y. et al [8]. The values of four chamber of
the heart (time varying elastance curve) were taken from Ling
F and Liu H [9].
The RBP simulation, the level of support was regulated by
speed of the pump model that adjusted to 7500 rpm and 9000
rpm (from partial support and full support) at pathological
condition. Partial support means the aortic valve opens during
systole. Full support means the aortic valve always closes
during cardiac contraction.
The pressure volume loop (PV-loop) is a normal
characteristic curve of heart. PV-loop is a plot between
pressure signal in time domain and volume signal in time Fig. 1. The left ventricular pressure (line) and aortic pressure (dotted line)
domain that can used in the study of cardiac physiologist. of the normal-LV, pathological-LV, pathological-LV with partial support, and
pathological-LV with full support (from upper to lower figures); partial
In this study, the PV-loop simulation of both LV and RV in support: pump speed is 7500 rpm, full support: pump speed is 9000 rpm, 50%
normal heart, LV failure condition (RV-normal), LV-RV of Emax is pathological condition
failure condition, and RBP support are implemented.

TABLE I. SIMULATION CONDITIONS

Sim
Conditions
No.
1. Normal LV Normal RV w/o RBP

2. Pathological LV Normal RV w/o RBP

Partial
3. Pathological LV Normal RV
support
Full
4. Pathological LV Normal RV
support
5. Pathological LV Pathological RV w/o RBP
Partial
6. Pathological LV Pathological RV
support
Full Fig. 2. The left ventricular volume of the normal-LV, pathological-LV,
7. Pathological LV Pathological RV pathological-LV with partial support, and pathological-LV with full support
support
(from upper to lower figures); partial support: pump speed is 7500 rpm, full
LV: left ventricle, RV: right ventricle, Normal LV and RV: normal cardiac support: pump speed is 9000 rpm, 50% of Emax is pathological condition
condition, Pathological LV and RV: LV failure and RV failure, w/o RBP:
without rotary blood pump, Partial support: RBP speed 7500 rpm, and Full
support: RBP speed 9000 rpm.

III. RESULTS
The left ventricular pressure (LVP) and aortic pressure
(AoP) of the normal-LV, pathological-LV (50% of Emax),
pathological-LV with partial support (pump speed: 7500 rpm),
and pathological-LV with full support (pump speed: 9000 rpm)
were shown in figure 1. In figure 2, left ventricular volume
(LVV) of the normal-LV, pathological-LV (50% of Emax),
pathological-LV with partial support (pump speed: 7500 rpm),
and pathological-LV with full support (pump speed: 9000 rpm)
were shown. Right ventricular pressure (RVP) and pulmonary
artery pressure (PAP) were shown in figure 3. The increasing Fig. 3. The right ventricular pressure and pulmonary artery pressure of the
normal-RV, pathological-RV, pathological-RV with partial support at LV, and
of right ventricular volume (RVV) in pathological condition pathological-RV with full support at LV (from upper to lower figures); partial
was shown in figure 4. support: pump speed is 7500 rpm, full support: pump speed is 9000 rpm, 50%
The PV-loop of LV and RV in different cardiac condition of Emax is pathological condition
were shown in figure 5 and 6, respectively. The effect of
breathing was shown in the figure 6, by changing of LVV with
time. For PV-loop, the effects of pump support condition
(partial support: 7500 rpm and full support: 9000 rpm) were
shown in figure 7 and 8.
 Fig. 4. The right ventricular volume of the normal-LV, pathological-RV,
pathological-RV with partial support, and pathological-RV with full support
(from upper to lower figures); partial support: pump speed is 7500 rpm, full
support: pump speed is 9000 rpm, 50% of Emax is pathological condition
Fig. 5. The pressure-volume loop of the normal-LV, pathological-LV; 50%
of Emax is pathological condition
Fig. 6. The pressure-volume loop of the normal-RV, pathological-RV; 50%
of Emax is pathological condition
Fig. 7. The pressure-volume loop of the normal-LV, pathological-LV;
pathological-LV with partial support, and pathological-LV with full support;
partial support: pump speed is 7500 rpm, full support: pump speed is 9000 rpm,
50% of Emax is pathological condition
Fig. 8. The pressure-volume loop of the normal-RV, normal-RV with
partial support at LV, normal-RV with full support at LV, pathological-RV;
pathological-RV with partial support at LV, and pathological-RV with full
support at LV (from upper to lower figures); partial support: pump speed is
7500 rpm, full support: pump speed is 9000 rpm, 50% of Emax is pathological
condition
IV. DISCUSSION
Based on clinical reports of end-stage heart failure patient
during support with RBP [11-13] and an animal experiment
[4,14], the pattern of LVP and AoP regulate by the level of
cardiac function and the level of RBP support. In this study, the
hemodynamics simulation similarly demonstrated the same
pattern as shown in figure 1-4. The maximal left ventricular
pressure (LVPmax) reduced following the level of RBP support
from partial support (7500 rpm) to full support (9000 rpm).
In figure 5 and 6, the PV-loop was shift to the higher
ventricular volume which is similar to the data from an animal
experiment [14-16] and clinical reports [1,13]. The breathing
effect mainly affected on right side of the heart as shown in
figure 6. In figure 5 and 6 , the breathing effect changes the
LVV and RVV that normally uses for the estimation of end-
systolic pressure volume relationship (ESPVR). ESPVR is an
original concept of Emax (Emax is a slope of ESPVR). In figure
5-8, PV-loops were shown the reducing slope of ESPVR
following the pathology of the heart. Therefore, the
cardiovascular system model can re-generate the pathological
condition.
In figure 7, LVPmax, LV-end-diastolic volume (EDV) and
PV-loop mainly depends on the level of pump support. In
figure 8, both RVPmax of normal-heart and RVPmax of
pathological heart were not significantly reduced in
comparison with left side of the heart (PV-loop of LV in figure
7). Therefore, LV-RBP support cannot induce the right heart
failure in the normal right ventricular condition. The right heart
failure should come from pathology itself.
In conclusion, our cardiovascular system model can
simulated the hemodynamic signal during RBP support. It
should be a tool for training the surgeon, cardiologist, and
nurse who works with the mechanical circulatory support
system.
ACKNOWLEDGMENT
This work was supported by the Mahidol University Young
Researcher Grant (Nov.2010-Nov.2011).
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