Investigation of hemodynamics in an in vitro system simulating left ventricular support through the right subclavian artery using 4-dimensional flow magnetic resonance imaging.

OBJECTIVES Left ventricular assist devices are an important treatment option for patients with heart failure alter the hemodynamics in the heart and great vessels. Because in vivo magnetic resonance studies of patients with ventricular assist devices are not possible, in vitro models represent an important tool to investigate flow alterations caused by these systems. By using an in vitro magnetic resonance-compatible model that mimics physiologic conditions as close as possible, this work investigated the flow characteristics using 4-dimensional flow-sensitive magnetic resonance imaging of a left ventricular assist device with outflow via the right subclavian artery as commonly used in cardiothoracic surgery in the recent past. METHODS An in vitro model was developed consisting of an aorta with its supra-aortic branches connected to a left ventricular assist device simulating the pulsatile flow of the native failing heart. A second left ventricular assist device supplied the aorta with continuous flow via the right subclavian artery. Four-dimensional flow-sensitive magnetic resonance imaging was performed for different flow rates of the left ventricular assist device simulating the native heart and the left ventricular assist device providing the continuous flow. Flow characteristics were qualitatively and quantitatively evaluated in the entire vessel system. RESULTS Flow characteristics inside the aorta and its upper branching vessels revealed that the right subclavian artery and the right carotid artery were solely supported by the continuous-flow left ventricular assist device for all flow rates. The flow rates in the brain-supplying arteries are only marginally affected by different operating conditions. The qualitative analysis revealed only minor effects on the flow characteristics, such as weakly pronounced vortex flow caused by the retrograde flow via the brachiocephalic artery. CONCLUSIONS The results indicate that, despite the massive alterations in natural hemodynamics due to the retrograde flow via the right subclavian and brachiocephalic arteries, there are no drastic consequences on the flow in the brain-feeding arteries and the flow characteristics in the ascending and descending aortas. It may be beneficial to adjust the operating condition of the left ventricular assist device to the residual function of the failing heart.

Behavioral Differences in the Upper and Lower Visual Hemifields in Shape and Motion Perception.

Perceptual accuracy is known to be influenced by stimuli location within the visual field. In particular, it seems to be enhanced in the lower visual hemifield (VH) for motion and space processing, and in the upper VH for object and face processing. The origins of such asymmetries are attributed to attentional biases across the visual field, and in the functional organization of the visual system. In this article, we tested content-dependent perceptual asymmetries in different regions of the visual field. Twenty-five healthy volunteers participated in this study. They performed three visual tests involving perception of shapes, orientation and motion, in the four quadrants of the visual field. The results of the visual tests showed that perceptual accuracy was better in the lower than in the upper visual field for motion perception, and better in the upper than in the lower visual field for shape perception. Orientation perception did not show any vertical bias. No difference was found when comparing right and left VHs. The functional organization of the visual system seems to indicate that the dorsal and the ventral visual streams, responsible for motion and shape perception, respectively, show a bias for the lower and upper VHs, respectively. Such a bias depends on the content of the visual information.