1963
Design of a Mechanical Cardiovascular
Summary-The purpose of this paper is to present the results of
a study to determine design values for the basic hydraulic parameters
of a mechanical pulse duplicator that reproduces as many of the signif-
icant source and load characteristics as possible.
The method of approach used in this study has been to first in-
vestigate the physiological system to find what parameters are im-
portant to the production of the dynamic pressure-flow situation in
the vicinity of the heart valves. A conceptual mechanical model was
then developed that would use these same parameters to model the
source and load characteristics. Finally, an electronic analog com-
puter was used to find design values for the mechanical model and
test its response as compared to published data on response of the
human cardiovascular system.
Design values are presented in tabular form. Waveform record-
ings of system responses are shown along with similar recordings
reported in the literature, and comparisons are made.
INTRODUCTION
URING THE PAST few years there have been
significant advances in the surgical techniques of
open-heart surgery using extracorporeal circula-
tion. Surgical technique has been developed and per-
fected to the extent that it is possible to make major
surgical repairs in any of the heart chambers or even to
transplant the heart from one individual to another.
However, successful organ transplantation must wait
for the immunological problems to be solved even
though the surgical technique is available.
The largest number of cardiac patients who will be
candidates for heart surgery in the future are those with
acquired heart disease. Because this type of heart dis-
ease is characterized by destruction of tissue, especially
valvular tissue, surgical repair depends on the avail-
ability of a reliable heart valve prosthesis. Since it is
now practical to implant a prosthetic component, con-
siderable incentive exists for the development of better
prosthetic heart valves than those presently available.
One research and development technique that is used
both to study intact normal valves and the response of
prosthetic valves is to operate the valves in a test ap-
paratus that duplicates the conditions of pressure and
flow that exist in the physiological system, and obtain
an objective measurement of surgical improvements
made on an organic valve, or the operating character-
istics of a prosthetic valve. Although several examples of
pulse duplicators are in use for this purpose [1], these
devices are not intended to provide detailed modeling of
the physiological system. They impose either a pre-
selected flow rate through the valve, or a preselected
pressure drop across the valve. Introductory Remarks
The human cardiovascular system varies consider-
*
Received June 5, 1963; revised manuscript received September ably among individuals, as discussed by Michels.1
20, 1963.
t Stanford Research Institute, Menlo Park, Calif.
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IEEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS 153
Sinulator*
PETER M. NEWGARDt
To be of the most benefit to medical researchers in
this field, the valve test apparatus should be a good
mechanical model of the physiological system that will
faithfully reproduce the dynamic pressure and flow situ-
ation in the region of both the mitral and aortic valves.
In addition, it should duplicate all passive control re-
sponses and have provisions to manually adjust those
parameters that are normally functions of vasomotor
control. With these capabilities, the apparatus would
maintain its analogy to the physiological system even
with severely damaged or abnormal valves by com-
pensating the system to provide the correct source and
load impedance at all times. Further, the test apparatus
must provide access for pressure and flow measuring
equipment, photographic recording of valve functions
and must allow the implacement of a wide variety of
organic and prosthetic valves.
This paper presents a study to determine design
values for the basic hydraulic parameters of a mechan-
ical pulse duplicator that reproduces as many as pos-
sible of the significant source and load characteristics of
the physiological system. Although this study was
initiated with reference to heart-valve testing, it has be-
come apparent that the information obtained and com-
piled in this paper may be of more general use. It is
hoped that the publication of nominal values of basic
hydraulic parameters of the human cardiovascular sys-
tem will be useful to researchers in related areas of
prosthetic heart development, to biomedical researchers
and to engineers who wish to obtain a fairly quantitative
understanding of the cardiovascular system in terms of
generally accepted engineering parameters. To this end,
the results are expressed in the rationalized mks system
of units.
The method used in this study has been to first in-
vestigate the physiological system to find what param-
eters govern the dynamic pressure and flow in the
vicinity of the heart valves. A conceptual mechanical
model was then developed using these same parameters
to model the source and load characteristics. Finally,
an electronic analog computer was used to find design
values for the mechanical model and to test its response
for comparison with published data on response of the
human cardiovascular system.
BASIC PHYSIOLOGICAL PARAMETERS
1 See Michels [2], pp. 1-28.
154 1EEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS October

Minor variations in topography of the system, such as PULMONARY UPPER

/ARTERY PULMONARY VEINS
location of peripheral arteries, can have little influence
on the functioning of the cardiac valves. Other varia- 4PULMONARYAOT
tions, however, include the fundamiiental parameters of /CAPILLIARY LEF VENOUS
AT LOWER
SYST
(L.A)
L
RESERVOIR
resistance, capacitance and inertance that determiiine the MITRAL VALVE VLVE
A

characteristic impedance of a hydraulic systemll, as de- LEFT VENTRICLE(L V SYSTEMIC

fined and discussed in [15].2 These paramneters exert \s ~~~~~~~~SYSTEMIC

CAPILLIARY /
considerable influence on the functioning of the valves. SYSTEM -
For the purpose of this study, it will be necessary to de-
fine a "normal" cardiovascular system as the basis for RETURN THROUGH RIGHT HEART
analysis and then, in any resulting mechanical model, Fig. 1-Ph) siological system.
provide means for adjusting the dominant parameters to
match individual characteristics where necessary.
A schemiatic representation of the normiial left heart
and arterial systemii physiology is shown in Fig. 1. Some 100
typical pressure and flow recordings and a diagranm 50-
LEFT VENTRICLE VOLUME (cc)
showing left ventricular volume as a function of time (FROM REF. 3) 0

are shown in Fig. 2. This representation of the response B

800
of a normal cardiovascular system has been compiled by
Wiggers [3], by direct cannulation and recording from LEFT VENTRICLE EJECTION FLOW (cc/sec) 4
dogs. These results have been found representative of
0

(FROM REF. 8)
human subjects at rest and are used as the basis for ex- 100
planation of the events of the cardiac cycle (see, for in- 50
stance, Ruch and Fulton [4]). The response character- LEFT VENTRICLE PRESSURE (mmHg) 0
istics shown in Fig. 2 have been used throughout this (FROM REF 3)

study to represent the "normal" system. 100

The hydrodynamics of the living cardiovascular sys- 50
tem is a most difficult problem to treat by detailed AORTIC PRESSURE (mmHg)
(FROM REF 3)
0
_

analysis, as explained by Fry [51. Some of the problems

which make such analysis virtually impossible are 100
50
ABDOMINAL AORTIC PRESSURE (mmHg)
1) A complex and variable flow geometry, (FROM REF II)
0

2) Nonlinear and variable visco-elastic conduits, 100

3) A fluid plasma containing a suspension of small
50 _
discoid particles. LEFT ATRIUM PRESSURE (mmHg) 0
(FROM REF 3)
For the practical solution of engineering problems 400
concerning this system, it is generally necessary to make 200
simplify ing assumiiptions to obtain an approxiniate AORTIC FLOW RATE (cc/sec) 0
theoretical solution that will be subject to experimental (FROM REF. 8)
200
verification. Throughout this study, the following as- 0
sumptions have been used. The working fluid is assumed TIME-seconds
084

to be a homogeneous incompressible fluid with constant

viscosity. It is assumied that distributed parameters, Fig. 2 Pressure, flow and volume records from
the physiological system.
such as artery capacitance, can be represented by a
small number of lumped parameters. The flow regimle is
assumed laminar throughout the system. It has been
shown3 that this is generally true except in the aorta dur- of these simplifying assumptions. Since the resulting
ing the period of peak ventricular ejection flow. mechanical model will use real valves, the flow regimiie at
A mechanical system would contain only lumped the aortic valve will duplicate the situation to be found
parameters and use a fluid such as a glycerine-water mix- in the physiological system using this samiie valve.
ture that closely approximates the assumed fluid prop- Therefore, the fact that no attempt is miade to miiodel a
erties. The ability of this nmodel or its strict electronic turbulent flow through this valve on the analog coIml-
analog to reproduce the response curves of Fig. 2 would puter should have little or no effect on the parameter
constitute experimental verification and justify the use values determined during the computer analy sis. It is
assumed that the valves would be imounted so that
normal enlargement of the valvular annulus during
^ See Coinsidiine [151 pp. 8-74.
Michels, op. cit. pp. 2-59. cardiac ejection would not be significantly imlpeded.

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1963 Newgard: Mechanical Cardiovascular Simulator 1 55

Operation of Major Components will not exceed some limiting pressure, which is approx-
imately 300 to 500 mm Hg in most individuals.
Blood is supplied to the left heart from the pulmonary The aorta is the main distribution conduit from the
veins. The pulmonary artery pressure, which varies left ventricle to the entire arterial system. Two major
from 25 to 7 mm Hg during the cardiac cycle for subjects groupings of arteries arise from the aorta. Branches of
at rest, is the source pressure that causes filling of the the aortic arch supply the head and upper extremities of
left heart. Blood from the main pulmonary artery passes the body. This group includes the innominate, left com-
through the pulmonary system, and its flow rate is de- mon carotid and left subclavian arteries.4 The second
termined not only by source pressure, but by pulmonary major grouping arises from the abdominal aorta to
resistance and capacitance, by left atrial back pressure supply the trunk and lower extremities through the
and by periodic changes in thoracic cavity pressure due parietal, visceral and terminal branches. The rapid dis-
to respiration. charge of blood into the aorta during ventricular ejec-
The left atrium operates as a variable capacitance to tion produces by far the largest fluid accelerations that
insure the availability of a large volume of blood for fill- occur anywhere in the cardiovascular system. Although
ing the left ventricle. During most of the cardiac cycle the particular ratio of passage length to cross sectional
it is a completely passive component with large capacit- area that determines the inertance (p(L/A)) [16] of fluid
ance. Toward the end of diastole the atrium contracts, in the aorta is not unique in the system, the imposition
decreasing its capacitance, and expelling blood into the of these extreme accelerations makes it necessary to
left ventricle. This active contraction generally accounts consider aortic inertance as one of the potentially im-
for about one sixth of ventricular filling, but under portant parameters. Inertance of the aortic valve is not
certain conditions may provide a much greater share. considered important due to its length.
In this respect, it acts as a booster pump. The systemic arterial distribution system is a complex
The left ventricle is the primary pump that generates network of vessels which carries blood from the aorta to
pressure to cause blood flow through the entire arterial the extremities of the body. Arteries arising from the
system. Unlike the less efficient atrial booster pump, aorta branch many times into successively smaller
the ventricle has both inlet and outlet check valves vessels called arterioles. Precapillary arterioles (the
(mitral and aortic valves). Ejection of blood from the smallest arterioles) pass the blood from arterioles to
ventricle into the aorta is caused by an active contrac- capillaries. Some precapillary arterioles are equipped
tion of the muscular ventricle wall that lasts about 0.25 with sphincters consisting of smooth muscle. In response
seconds. During the remainder of the cardiac cycle, the to vasomotor control, these sphincters are capable of
ventricle wall is completely relaxed and exhibits an ex- active contraction to restrict blood flow at the extremi-
ceptionally large capacitance so that it will accept blood ties. Capillaries are the smallest blood vessels of the
and increase in volume with very little increase in wall system. Their wall, a single cell in thickness, is a semi-
tension and therefore, develop almost negligible back permeable membrane that allows the passage of mate-
pressure. This extension of wall muscle fibers, however, rials to and from the blood. Arteries and arterioles are
is the primary factor that determines the vigor of the constructed of elastic smooth muscle fiber which, like
succeeding contraction. This is conveniently summar- the aorta, serves to allow the expansion of these vessels
ized by Starling's "law of the heart" (see [6]), which in response to an increased internal pressure; i.e., the
states that "energy of contraction is a function of the aorta, arteries and arterioles possess fluid capacitance.
length of the muscle fibers prior to contraction." Since Elasticity of artery walls is, however, not a constant
the ventricular pressure throughout diastole is generally property, such as Hooke's law for metals. Elasticity of
very near zero, it will accept all the blood that is avail- these vessels varies both with displacement and rate of
able from the pulmonary system. In this manner, the displacement. In other words, the arterial wall is a
stretch of ventricular muscle fibers, and hence contrac- nonlinear, visco-elastic material. Arterioles are by far
tion energy and stroke volume, is ultimately controlled the most resistive elements of the arterial system. About
by the availability of blood. One of the primary vaso- 80 per cent of the pressure drop from the aorta to the
motor control mechanisms to increase cardiac output is venous system occurs across the arterioles.
to increase the amount of blood available to the heart As a result of these various physiological properties,
by expelling blood from reservoirs, such as the spleen each of the two major groups of arteries arising from the
and liver, into the venous system. Another vasomotor aorta can be considered as a reservoir possessing both
control mechanism is the regulation of heart rate to capacitance and damping that exhausts through a high
maintain arterial system pressure by a feedback signal resistance. Any inertance of the aorta coupling these
from pressure sensors (receptors) of the carotid sinuses. two artery groups would result in a fluid system having
Another characteristic of the left ventricle that is im- the potential of exhibiting an oscillatory response to a
portant for this study is that there is a definite limit to sudden inflow. This inertance coupling effect of the
ventricular pressure determined by the maximum con- aorta has been used by Spencer and Dennison [7], [8]
tractive force that the wall muscles can exert. Thus, if
the aorta is completely blocked, ventricular pressure 4Ibid., pp. 1-123.

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 156 IEEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS Ot-tober

to explain the contour of the aortic pressure pulses. The left ventricle portion of the model is similar to
The venous system collects deoxygenated blood from the atrial section except for the inclusion of inlet anid
the capillaries which passes through venules and into exhaust valves. These valves, representing the imitral
veins. This system has a very large capacitance comI- and aortic valves of the physiological system, hlave the
pared to the arterial side of the capillaries. Although it nonlinear characteristics shown in Fig. 3. They presenit
normally contains about 75 per cent of the blood in the a nearly infinite resistance to backflow, but a verx low
entire cardiovascular system, it can sustain a very large resistance to forward flow, which causes only about 2
change in blood volume with very little change in inter- mm Hg pressure drop at peak flow rates.
nal pressure. In addition to a large passive capacitance, Active contraction is produced by rotation of caml Cl,
additional blood can be made available from the spleen which acts through spring K1 to iincrease ventricular
and liver through vasomotor control. The venous sys- pressure P,. At the beginninig of veintricular systole, the
tem, therefore, acts as a semi-infinite source of fluid at cam engages its canm rider and compresses spring K1
fairly constant low pressure. until ventricular pressure exceeds aortic pressure. FlLid
then flows out of the ventricle through the aortic valve
SYNTHESIS OF MJECHANICAL ANALOG R1 and into the aorta. At the end of ventricular ejectioni,
General Considerations the cam surface rapidly retracts fromii its rider allowinig
A mechanical analog designed to provide realistic spring K1 to expand to its free lenigth and pressure Pi to
source and load characteristics for the testing of pros- decrease to zero. As soon as ventricular pressure drops
thetic heart valve mechanisnms must, of necessity, be of below atrial pressure, valve R7 quickly opens and allows
unity scale to allow mounting of real valves. Although the ventricle to accept the fluid previously stored in the
this study has been confined to determining the basic atrium section. This results in a high initial filling rate
parameters and design values of these parameters, an that proceeds until the atrial capacitance is exhausted.
attempt has been imade to fornmulate the conceptual During the remainder of ventricular diastole, atrial anid
mechanical model in a form-l that represents some ap- ventricular pressure are very niearly equal anid fluid
proximation to the actual hardware that may ultimately must pass through the pulmonary resistance R5 to COmll-
be used in its construction. Fig. 3 shows the model in a plete ventricular filling. Both venitrical and atrial camlls
diagramatic form in which, for instance, a capacitance is Cl and C7 are permitted to lift free of their camii riders to
illustrated as a spring-loaded piston. It is felt that this avoid driving pressures PI and P7 negative. This facility
not only aids visualization, but emphasizes the practical also allows ventricular capacitance to becoime very
engineering necessity of utilizing existing, readily large while the ventricle is being filled. This results in
available hardware, such as linear springs. the end diastole volume of the ventricle being governed
by the availability of fluid supply to the ventricle. Since
Operation of llVajor Components and Their Relation to the maximum cam displacement is fixed, stroke voluimie is
Physiological System determined by end diastole piston position, julst as ill
The system that supplies blood to the left heart is the physiological system stroke volume is determiinied by
shown in Fig. 3 as a reservoir, normally held at pressure end diastole muscle stretch, as per Starling's "law of
P6 which is set to sinmulate pulmonary diastolic supply the heart." The primary difference in construction of
pressure. A cam C5 rotates at heart rate to periodically the ventricular and atrial cam systems is that the
displace a piston and increase P6 above its nornmal regu- ventricle spring K1 is quite stiff to insure fluid displace-
lated level by compressing an air cushioin above the ment, while regulating the maximum ventricular pres-
fluid. Resistor R5 represents the pulmonary system sure capability, and the atrial spring K7 is considerabl'y
resistance. Fluid flows to fill the left heart at rate Q5, weaker to provide an increase in atrial pressure muILIch
-which depends on the instantaneous pressure difference less dependent on fluid displacement. fixed to a commi-oni
(P6-P7) and on R5. The three cams, C,, C7, and C5, are
The left atriunm is represented in Fig. 3 by a cam- shaft to operate in a preset sequence. Heart rate is
operated pistoin. Passive capacitance of the atriuml is manually controlled by regulating the rate of camii shaft
modeled by the spring-loaded piston comlbination with rotation. Changes in the time relation of cam-i actions are
spring rate K7 and pistonI area A 7. These comIponents made by adjusting the phase angle of the camiis. Changes
in the amplitude, relative duration or shape of the camn
provide a capacitance of .4 72K/K7, [15 ].1 This capacitance be acconmplished by cUttinlg nlew
is intended to represent not only capacitance of the functions can only
atrium, but also includes capacitance of the pulmnonary camiis.
veins. Active contraction of the atrium is produced by The aorta is represented in Fig. 3 as a rigid tube of
rotation of camn C7 whichi compresses spring K7 to in- length L2 and cross sectional area A2. This gives it ani
crease atrial pressure P7. This causes an increased flow inertance of pL2/ A2, where p is the miass density of the
Q7 to aid in ventricular filling. working fluid. R2 represents resistance which restricts
flow Q2 through the aorta. Although the livinig aorta
5 Considine, op. clit. pp. S-76. has distributed capacitance duie to its elastic wall mla-

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1963 Newgard: Mechanical Cardiovascular Simulator 157

C7
--e -- @7-¶C-0 ~~~~~~~~~~~~~~P7&
K72
L E VEL X 0A7(X 6- X71
CONTROL P7 IX JAIK
R~ -*0 O
I -*LO' ]X7R
jc7
7F PI IRIX~
1
I10 GF
K3 - RXR2 ~
E
~ ~ (7A
~~~~~L2
WR

. !~ ~ ~ ~ ~ ~ ~ P
VENOUS
RESE RVOIR
Fig. 3 Analogous mechnical system. C-Cam, R Resistance, K-Spring Rate, A-Area, X Displacement, P-Pressure,
Q Flow Rate, D-Left Atrium, E Mitral Valve, F Left Ventrical, C Aortic Valve.

terials, this representation assumes that its capacitance 1) The equation of continuity: Q = 0
can be combined with that of the upper and lower artery 2) Dynamic flow equation: A\P=QR+QI
systems. 3) Force balance equation: F = O.
The use of lumped parameters throughout this model Where Q is flow rate, AP is a differential pressure, R is
will limit its ability to respond with fidelity to the higher hydraulic resistance, I is fluid inertance, and F, are
frequency components of pulsitile pressure and flow forces acting along a common axis.
oscillations. For the hydraulic system of Fig. 3 we may write the
Components modeling the two major artery groups following hydrodynamic equations:
are shown in Fig. 3 at the ends of the aorta tube. Arterial
Conservation of Mllatter (I Q = 0).
capacitance of each of the two major artery groups
arising from the aorta is represented by a spring-loaded Q7 + A1X, = Qi (1)
piston. Capacitance of the arteries arising from the
aortic arch to supply the head and upper extremities is Ql = A3X3 + Q3 + Q2 (2)
A32/K3, while capacitance of the arteries arising from Q2 = A4X4 + Q4 (3)
the abdominal aorta is A42/K4. Qs + A7X7 = Q7. (4)
Arterial wall damping is represented by the dashpots
b3 and b4. These components act to retard a change in Dynamic Flow Relation (AP = QR +QI).
arterial volume by a force proportional to the rate of
change of volume in a manner analogous to the arterial P1 - P3 = Q1Ri (5)
wall material that retards a change in length of that P3 - P5 = Q3R3 (6)
material by a force proportional to strain rate. P4 - P5 = Q4R4 (7)
Each of the fluid resistances R3 and R4 represents the
total series-parallel combination of all resistive passages P6 - P7 = Q5R5 (8)
from the aorta through the capillaries. P7 - P1 = Q7R7 (9)
The venous reservoir consists of a tank with an pL2-
internal pre3sure P5 held constant by a pressure regula- P3-P4 = Q2R2 + -Q2. (10)
tor. The value of P5 would be manually adjusted to A2
simulate any desired venous pressure. Force Balance (2: F., = 0).

Derivation of Governing Equations P1Al = K1(Xo - X1) (11)

P3A3 = K3X3 + b3X3 (12)
Using the basic assumption of Poiseuille resistance,
the hydrodynamics of the theoretical lumped parameter P4A4 = K4X4 + b4X4 (13)
model are governed by the following equations: P7A7 = K7(X6 - X7). (14)

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1 58 IEEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS October

Capacitance is one of the basic parameters affecting

the response of a hydraulic circuit. Since the capacitance
of the spring-loaded pistons used in the model can be
expressed as the square of pistoIn area divided by spring
rate (.A2/K), (11)-(14) are rewritten to form these
groups:

= A (Xo - X1) (11)

Al12]
P3 -] - A 3X3 [--)]X3 (12)

-A42- - A4b4]
P4 = +
A4X4F I~ (13)
LK4J K4

P7 K] = A7(X6 - X7). (14)

COMPUTER SIMULATION AND METHOD OF ANALYSIS

An analog computer simulation of the mechanical
system shown in Fig. 3 was used to examine the validity
of the theoretical model and establish design values for
its basic parameters.
A M\odel 3100 Donner electronic analog computer
was used for this portion of the study. Capacity of this
machine is limited to 30 operational amplifiers, each
with an accuracy of 0.1 per cent and a 10 mv output
noise level. Accessory equipment used to aid computer
representation included two Model 3751 Donner diode
function generators, an electrical sequence timer con-
sisting of cam-operated switches driven by a variable Fig. 4-Electronic analog computer system.
speed electric motor, and a Minneapolis Honeywell
Model 901-A Visicorder recorder with a frequency re-
sponse extending to 1000 cps. pressure in the atrium that does not exist in the physio-
Fig. 4 shows the final form of the computer diagram logical system. It is felt that the increase in atrial filling
used to simulate the mechanical system of Fig. 3. The that results from this brief negative pressure will not
earliest computer analysis showed that the required significantly affect the validity of the electronic analog
and any error that does result can be easily compensated
damping of aortic flow oscillations could be obtained by
any combination of b3 A32, b4/A42 and R2 so long as the by adjustment of resistance R5 in a final mechanical
total effective resistance
model.
Cam displacement functions are represented as stroke
/ b3 64 volume functions A 1X0, and A 7X6 on the two diode
Rt=-- + ---+R2 function generators. The final form of these functions
A32 A42
and their phase relation are illustrated in Fig. 5. Ven-
of the combination was the same. For the remainder of tricular ejection flow is nearly equivalent to the slope of
the computer study, R2 was chosen to represent system the A,Xo curve except for deflection of spring K1. Since
damping, even though it is probably the smallest con- the peak ventricular pressure is known for the "normal"
tributor in the physiological system, because this repre- system as it is defined by the response curves shown in
sentation allowed the conservation of several opera- Fig. 2, a normal deflection of K1 may be computed, and
tional amplifiers. the required maximunm slope of function A1Xo can be
The nonlinear functions K1A12, 1IR1, and h/R7 predicted with reasonable accuracy. This procedure was
shown in Fig. 3 were modeled by single-stage diode used to fix the maximum slope of the A1Xo function for
circuits assembled from components available at the the purpose of defining the general shape of the function
patch board of the computer. A linear K7/A 72 was used curve for initial programming of the diode function
to conserve computer capacity. This, in effect, restricts generator. Later, during the course of the computer
the atrial cam rider to follow the cam even when the analysis, the amplitude of A,Xo was adjusted to give
cam surface retracts and extends spring K7 beyond its the required 64 cc stroke volume for a given adjustment
free length. This results in a brief period of negative of K1. Then the maximum slope of A41Xo was adjusted

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 1963
z
UU
2
w
80
H_0
-J1 60
a.
40
0
0 10
Fig. 5-Atrial and ventricular
to give the required
rate.
The function A 7X6 was chosen to be a segment of a
sine wave to provide a smooth change in P7 similar to
the change in atrial pressure shown in Fig. 2 during
atrial systole.
As shown in Fig. 4, the A1Xo function was also used to
represent pulmonary artery pulse pressure by adding an
attenuated A1Xo signal to a dc level of pulmonary
artery diastolic pressure. This proved to be convenient
and practical because right and left ventricular systole
are nearly simultaneous, and the precise form of the
pulmonary artery pulse wave shape is not critical. It is
possible to obtain nearly identical atrial response even
when this waveshape is a square wave generated by
electrically switching from diastolic to systolic levels.
The majority of computer analysis was done in two
parts to simplify the computer operation and minimize
noise that developed due to inaccuracies in the nonlinear
resistance circuits 1 R1 and 1/R7. Reverse current cut-
off of these diode circuits was not sufficiently abrupt or
accurate. They produced a small negative output vol-
tage when the input was at the most negative levels
during the majority of ventricular diastole. This nega-
tive output voltage corresponded to leakage through
the closed valves.
The arterial system was modeled separately to avoid
this difficulty while its parameter values were deter-
mined. For this part of the study, a preselected ventricu-
lar ejection flow function was used to excite the arterial
system.
The pulnmonary supply and left heart was also
modeled as a separate unit. Parameters were adjusted
until ventricular ejection flow into a constant aortic
pressure matched the ventricular ejection flow function
used to study the arterial system.
Then, as a final check of the system, the entire circuit
was joined and minor modifications were made in the
amplitude of A,X0 to duplicate the results obtained in
each of the separate studies. Although operation of the
computer during this portion of the analysis was mar-
ginal with fairly high output noise levels, it was evident pressure.
that no large errors were introduced by treating the
arterial and heart systems separately during part of the system portion of the model to changes in cardiac
analysis. The electronic analog was operated to learn the output, systemic resistance and systemic capacitance.
effects produced by variation of each of the basic
parameters.
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20
PERCENT
800
Fig. 7 shows the aortic pressure response of the arterial
Using the parameter values tabulated in Table I
resulted in a computer model that produced the char-
Newgard. Mechanical Cardiovascular Simulator 159
Response of the arterial systemn was defined in terms
of aortic arch pressure which represents the load into
which the aortic valve operates and is, therefore, the
most significant variable of the arterial system for the
purpose of this study. Each parameter was varied inde-
pendently, and the resultant aortic arch pressure was
recorded. Graphs were plotted showing the systolic,
diastolic and mean aortic pressure as a function of each
30 40 50
parameter. Using these graphs as a guide, the param-
eters were adjusted to give an aortic arch pressure
OF CARDIAC CYCLE
cam displacement functions.
matching the corresponding curve of Fig. 2.
cc/sec peak ventricular ejection Response of the pulmonary supply and left heart por-
tion of the system was defined in terms of left venticular
ejection volume. Since the duration of ventricular sN-s-
tole, and the general shape of the ejection flow-rate
curve are fixed by the ventricular cam displacemleint
function, the ventricular ejection volume is the only re-
maining variable necessary to completely define flow
through the aortic valve.
Since the model is constructed in such a way that left
ventricular pressure is maintained at zero throughout
ventricular diastole, pressure drop across the mitral
valve during ventricular filling is completely estab-
lished by atrial pressure. Examination of the atrial
pressure curve was therefore used to indicate the
model's ability to reproduce the required pressure drop
across the mitral valve. Flow through the mitral valve
corresponds to the slope of the ventricular volume curve
at all times during ventricular diastole. Therefore, this
variable was also recorded, and was examined to test
the validity of parameter settings.
RESULTS AND DISCUSSION
Results
The primary result of this study is the compilation
of a set of design values for each of the basic parameters,
the input cam displacement amplitudes and pulmonary
supply pressure levels for the mechanical model. These
values are presented in Table I.
In addition to design values, the computer analysis
has provided information on the response of the model
to changes in the basic parameters about their design
values. This information may be used to adjust paramiie-
ter values during operation to duplicate a set of condi-
tions peculiar to a given patient or to vary flow and
pressure to test a particular valve over a range of con-
ditions.
Response of the left heart portion of the model is
shown in Fig. 6. In this figure, left ventricular ejection
volume is shown as a function of heart rate, atrial
capacitance, pulmonary resistance and mean left atrial
 160 IEEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS Oct-bob
200
!
I~~~~~~~~~~
SYSTOLIC
MEAN
DIASTOLIC

100

(a) I-
0 2 4 6 8 10 12 14 166
150

J
o
H
>
110 E_ 50

o
0

L
_
E 20 0
E

cr
(a)

cn SYSTOLIC
2 3 4 5 6 cn MEAN
t: ICO)O DIASTOLIC
(b) I

c 0
> 2
4
4

_ 0 0.2 0.4 0.6 0:8 1.0 1.2 1.4 i.66

F 0100 _
z
J WVo
LL D

)O~~~~~~~~
20
0 2 3 4 5 6
(c)
150 10 0 SYSTOLIC
MEAN
DIASTOLIC
100

50 1
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

(C)
0 2 3 4 5 6
Fig. 7 Arterial system response. (a) Cardiac outpuit (liters per
(dI) minute). (b) Systemic resistance X 10-8 (n-sec/m5). (c) Sy stemic
Fig. 6 Left heart response. (a) Heart rate (cycles per minute). capacitance (m5/n).
(b) Atrial capacitance X10-8 (m5/n). (c) Pulmonary resistance
X10-6 (n-sec/m5). (d) Mean left atrial presstire (mm-Hg).
normal stroke volume, cardiac output is still at 68
acteristic curves of pressure, flow and ventricular vol- per cent of its normal value of 5320 cc/min.
ume shown in Fig. 8. Fig. 6(b) shows an increase in left ventricle stroke
The frequency of aortic flow oscillation was found to volume resulting fromn an increase in atrial capacitance.
vary inversely with the square root of the product of An increase in atrial capacitance provides additional
aortic inertance and total capacitance. The values storage capacity during the period of ventricular systole
shown in Table I were selected to give a 5 cps oscilla- that results in increased ventricular filling flow during
tion which agrees with the values reported by Spencer, the initial rapid filling phase. This increased filling in
Johnston, and Dennison [8 ]). turn results in increased ejection.
It was determined that damping of the aortic flow An increase in pulmonary resistance causes a decrease
oscillation is completely determined by the value of in ventricular supply flow which results in a decrease in
b3/A32-+b4/A42+R2. The value of this total system damp- ventricular ejection as shown in Fig. 6(c).
ing given in Table I was selected to give a logarithmic Fig. 6(d) shows that left ventricle ejection volume
decrement of aortic flow oscillation equal to 1.7, to increases as mean left atrial pressure increases. An in-
match the flow recording published by Spencer, John- crease in atrial pressure results in an increased ventricu-
ston, and Dennison [8]. This value also produced the lar filling flow and hence an increased ejection. This
most realistic aortic pulse pressure wave shapes. relationship between stroke volumne and mean left atrial
pressure has been used to illustrate the operatioin of
Discussion Starling's "law of the heart." The result shown in Fig.
It can be seen from Fig. 6(a) that an increase in 6(d) corresponds quite well to results obtained fromn
heart rate causes a reduction in left ventricle ejection animal studies by Sarnoff and Berglund [6].
volume. This reduction in stroke volume is a result of de- Fig. 7(a) shows that aortic arch pressure increases as
creased ventricular filling during the shorter diastole cardiac output increases. This illustrates the response
period. Even though stroke volume decreases from 74 characteristic that is used to control arterial pressure in
cc at a normal 72 strokes per minute to 25 cc at 144 the physiological system. Pressure receptors of the carot-
strokes per minute, which is a decrease to 30 per cent of id sinuses respond to both pressure level and rate of

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1963 Newgard: Mechauical Cardiovascular Simulator 161

TABLE I 150

PARAMETER VALUES FOR MECHANICAL ANALOG 100

50-
Associated LEFT VENTRICLE VOLUME (cc)
Physiological
Mechanical Parameter
Parameter mks Units
Parameter Value 800 K
(See Fig. 1)
(See Fig. 3)
LEFT VENTRICLE EJECTION FLOW (cc/sec)
n -sec
Pulmonary resistance R5 3.35 X 10l
100
A72 )n2
Left-atrial caDacitance 3.19 X10-8 50
K7 LEFT VENTRICLE PRESSURE (mmHg) 0
Left-ventricle A 12 n
m?5
4.54 X 109
capacitance K, 100
Upper arterial system A32 U
m5
1.01 X 10-8 50
capacitance K3 AORTIC PRESSURE (mmHg) 0
Lower arterial system A42 n
3.64 X 10-9
capacitance K4 100
pL2 Kg 50
Aortic inertance 3.94 X 105
A9 1l4 ABDOMINAL AORTIC PRESSURE (mmHg) 0

Upper arterial system n -sec

R3 1.88 X 109 __

100 _
Resistance
Lower arterial system n - sec 50
R4 2.96 X 108 LEFT ATRIUM PRESSURE (mmHg)
resistance m5
n -sec 0

Aortic flow damping b + b4 + 5.70 X 106

R2 400
A,2 A42
Left ventricle cam 200
A Xo (max.) 1.56 X 104 m
m5s
AORTIC FLOW RATE (cc/sec) l
stroke volume
Left atrial cam stroke -200
A 7X6 (max.) 2.00 X 10-5 In
volume 0 0.84
TIME-seconds
Pulmonary artery Systolic-2960
Pressure
P6 Fig. 8 Pressure flow and volume records from
Diastolic-269 mI2
analog computer simulation.

change of pressure to control cardiac output by changing that the ratio of capacitance of the lower arterial system
heart rate and by changing the amount of blood avail- to capacitance of the upper arterial system should be
able for use in the venous system. A change of blood about equal to ten in order to duplicate the aortic pres-
volume in the venous system results in a change in sup- sure pulse shape observed in humans. During the course
ply pressure to the heart. As seen from Fig. 6, a change of the electronic analog parameter study described in
in the availability of blood to the heart will result in this thesis, it was found that this ratio of K4/A42 to
modified stroke volume. K3/A32 should be closer to three than to ten in order to
A convenient method of controlling aortic arch pres- give both aortic arch pressures and abdominal aorta
sure in the model proposed in this study is illustrated in pressures that correspond to those measured and re-
Fig. 7(b). An increase in systemic resistance causes an ported by Shirer [10] and Pressman and Newgard [II].
increase in aortic arch pressure while maintaining pulse The validity of the model described in this paper can
pressure (systolic-diastolic) nearly constant. probably best be determined by its ability to duplicate
Fig. 7(c) illustrates a method of adjusting pulse pres- several pressure and flow curves that characterize the
sure amplitude while maintaining mean aortic arch normal physiological system. Fig. 8 is a group of such
pressure nearly constant. An increase in capacitance will curves recorded from the electronic analog of the me-
result in a reduced pulse pressure amplitude. Taken chanical model. These may be compared to the curves of
together, systemic resistance and capacitance adjust- Fig. 2, which were recorded by direct measurement from
ments provide a means of modifying the pulse wave the cardiovascular system of dogs.
shape to correspond to a particular set of physiological The ventricular volume curve shows not only the
data that one may wish to model in detail. If it is re- magnitude of stroke volume, but also its slope shows the
quired to model further details, such as time position of rate of change of volume which is equal to flow rate into
the dicrotic notch, it would be necessary to adjust aortic or out of the ventricle at any time. It can be seen that
inertance to modify aortic flow oscillation frequency, as ventricular filling, while ventricular volume is increas-
discussed previously in this paper. ing, occurs in two phases as does filling in the physiologi-
Previous research by Spencer and Dennison [9] shows cal system. The rapid influx from the atrium immedi-

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162 IEEE TRANSACTIONS ON BIO-MEDICAL ELECTRONICS October

ately after the mitral valve opens results in the initially It is further considered probable that the pulimionary
high slope. After the atrium is exhausted, atrial pressure supply and arterial system portions of this model would
reduces to near zero and ventricular filling proceeds at a be suitable to allow its use in the studx of the dy nainic
slower rate. During ventricular ejection, the slope of the response of a comuplete prosthetic left heart imiechanism
ventricular volunme curve equals ejection flow rate as as proposed by Akutsu, Houstonl, and Kolff [13] aind
shown in the second curve of Fig. 8. This wave shape Kolff [14].
agrees quite well with those recorded and published by Several problems of practical machine design remain
Spencer, Johnston, and Dennison [8], and Shirer [to]. to be solved before an operational miiechanical miiodel
The left ventricular pressure recorded fromii the analog could be constructed from the design values reported in
computer shows a imore abrupt change of slope as it this paper. AMost im-iportant of these problemiis will be to
increases past arterial diastolic pressure than that re- obtain the required lumped paramleter values without
corded from the physiological system. However, its peak introducing significant extraneous resistaince, capaci-
aamplitude and duration match quite closely. tance and inertance components. Beyond this, it will be
Aortic arch pressure fromii the cotm1puter shows a less necessary to consider the more ordinary, miachinie design
abrupt dicrotic notch than the physiological system, but problems of providing convenient adjustments for the
again, its amplitude closely approximates the value variation of various paramneters at the discretioni of the
shown in Fig. 2. Abdominal aortic pressure has a much operator, designing for both physical and visual access
miore pronounced dicrotic notch and a slight oscillation to the heart valve areas and providing for ease of clean-
that results fromn the second cycle of aortic flow oscilla- ing and :naintenance.
tion. Although this is not evident in the aortic pressure
BIBLIOGRAPHY
diagram of Fig. 2, it is apparent in arterial pressure
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[12 , and by Pressman and Newgard [ Ii]. Merendinio, Ed., Thomas Press, Springfield, Ill., 1961.
Left atrium pressure shown in Fig. 8 has a higher [21 N. Michels "Normal heart and vessels," in C(ardiology, A. A.
Luisada, Ed. McGraw-Hill Book Co., Inc., New York, N. Y.,
systolic level, but exhibits a wave shape quite similar to vol. 1,1959.
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New York, N. Y.; 1952.
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fall to near zero pressure during the rapid ventricular physics," WV. B. Saunders Co., Philadelphia, Pa.; 1960.
[51 D. L. Fry, M.D., "Certain aspects of hydrodynamics as applied
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The oscillation of aortic flow rate is quite similar to ELECTRONICS, VOl. ME-6, pp. 252-259; Decem11ber, 1959.
[6] S. J. Sarnoff, MI.D., and Erik Burglund, M.D., "Ventricular
recordings published by Spencer, Johnston and Denni- function," Circulation, page 706-718; Vol. 9, Mav, 1954.
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flow pulse as related to differential pressture," Circulation Res.,
frequency and damping of this oscillation was adjusted vol. 4, pp. 476 484; July, 1956.
[81 M. P. Spencer, M.I)., F. R. Johnstoni, M.D., and A. B. Deinnisoni,
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[9] D. L. Tycer, Jr., Exec. Ed., "A Special Report oni the Growth of
Medical Instrumentation," Ampex Corp., Redwood City, Calif.;
SUMMARY AND CONCLUDING REMARKS April-May, 1961.
[10] H. W. Shirer, M.D., "Blood presstire measuring methods,"
One form of mechanical analog to the left heart and IRE TRANS. oN BIO-MEDICAL ELECTRcONICS, vol. BME-2, pp.
arterial system has been presented along with design [111
116-125; April, 1962.
G. L. Pressmani, and P. M. Newgard, 'A Tranisdtucer for the
values for its basic parameters. ContintoLus External Measurement of Arterial Blood Pressure,"
An analog computer simulation of this mnechanical NASA, Sunnyvale, Calif. Final Rept. oni NASA Contract
NAS 2-515; December, 1961.
model is described. The effect of changing parameter [121 X. C. Zariustorff, C. A. Castillo, and C. \W. Crumiiptonl "A phase-
values has been studied using the computer, and results shift uiltrasonic flowmeter," IRE FIRNNS. ON BIO-MEDICAIx
ELECTRONICS, vol. BME-9, pp. 199-204; JtulI, 1962.
are presented and compared to responses of the physio- 113] 'f. AklltSU, M.D., C. S. HoustoIn, M.D., an1d \XV. J. Kolff, M.).,
logical system. "Roller type of artificial heart within the chest, Amn. Heart J.,
vol. 59-5, pp. 731 736; May, 1960.
It is concluded that pressure levels adjacent to the [14] WV. J. Kolff, M.D., "Mock circulationi to test pUmllps designied for
mitral and aortic valves of this model and that flow permanenit replacement of damaged hearts," Clev,eland Clinic
Quart., vol. 26-4, pp. 223-226; October 1959.
through these valves are a suitable enough approxima- [151 D. M. Conisidinie, "Process Instruments anid Conitrols Hand-
tion to conditions that exist in the physiological system book,' McGraw-Hill Book Co., IInc., New York, N. Y.; 1957.
[16] V. l. Streeter, "Handbook of Fluid Dynamics" McGraw-Hill
to allow the use of this model to study the dynamic Book Co., Inc., New York, N. Y.; 1961. See especially sec. 2t),
operation of prosthetic heart valves. p. 11.

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