Blood Flow in the Heart and Large Vessels

229 Pages·1989·14.69 MB·English

by  Motoaki Sugawara (auth.)

M. Sugawara F. Kajiya
A. Kitabatake H. Matsuo (Eds.)
Blood Flow in the Heart
and Large Vessels
With 241 Figures, Some of Them in Color
Springer Japan KK
MoTOAKI SuGAWARA, Ph.D.
Associate Professor
Department of Cardiovascular Science
The Heart Institute of Japan
Tokyo Women's Medical College
Tokyo, 162 Japan
FUMIHIKO KAJIYA, M.D., Ph.D.
Professor
Department of Medical Engineering
Kawasaki Medical School
Kurashiki, 701-01 Japan
AKIRA KITABATAKE, M.D.
Associate Professor
The First Department of Medicine
Osaka University School of Medicine
Osaka, 553 Japan
HIROHIDE MATSUO, M.D.
Professor
The Second Department of Internal Medicine
Kagawa Medical School
Kagawa, 761-07 Japan
ISBN 978-4-431-66921-0
Library of Congress Cataloging-in-Publication Data
Blood flow in the heart and large vessels/Motoaki Sugawara ... [et al.) (eds.).
p. em. Includes bibliographical references.
ISBN 978-4-431-66921-0 ISBN 978-4-431-66919-7 (eBook)
DOI 10.1007/978-4-431-66919-7
I. Blood flow. 2. Blood- Rheology. 3. Heart. 4. Blood-vessels.
I. Sugawara, Motoaki.
[ DNLM: I. Blood Flow Velocity. 2. Coronary Circulation. 3. Coronary Vessels. WG 300 B655)
QP105.B548 1989 612.1'7-dc20 DNLM/DLC for Library of Congress
This work is subject to copyright. All rights are reserved, whether the whole or part of the
material is concerned, specifically the rights of translation, reprinting, reuse of illustra
tions, recitation, broadcasting, reproduction on microfilms or in other ways, and storage
in data banks.
©Springer Japan 1989
Originally published by Springer-Verlag Tokyo Berlin Heidelberg New York in 1989
Softcover reprint of the hardcover I st edition 1989
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Typesetting: Asco Trade Typesetting Ltd., Hong Kong
Preface
During the past 20 years, cooperative work among physical scientists, engineers,
medical scientists, and clinicians has greatly improved the understanding of the
fluid mechanics of the cardiovascular system. Nowadays, "cardiovascular fluid
mechanics" is not only an active field of experimental and theoretical research,
but also a tool of diagnosis, treatment, and prognosis for leading cardio- and
angiological specialists. A considerable amount of clinical and experimental data
on blood flow in the heart and large vessels have been accumulated. These were
obtained by various methods of measurement, such as ultrasound pulsed Dop
pler velocimetry including Doppler color flow imaging, catheter-tip electro
magnetic velocimetry, hot-film anemometry, and laser Doppler velocimetry.
The motivation for writing the present book was to offer a systematic textbook
which will introduce medical researchers and clinicians to the forefront of this
rapidly developing field and to allow them to apply the knowledge and methods
of fluid mechanics to practical medicine. Our fundamental policy in writing was
to use as many original illustrations and as much clinical and experimental data
as possible. There are several books on blood flow written in English, but they
contain little clinical and experimental data. In this regard, the present book is
unique.
It should be understood that a book coming from multiple pens may lack
coherence. However, it would be presumptuous for a single or even a few au
thors to attempt to cover all fluid mechanical phenomena in the heart and large
vessels considered important. It seemed more sensible for the authors to dele
gate to various colleagues those subjects in which they excel, and in which they
are actively working. As the book is the outcome of research meetings attended
by the authors, which were held bimonthly for 10 years, a lack of coherence,
hopefully, has been avoided. For the readers' convenience, extensive cross
referencing is provided among the sections and chapters.
June, 1989 ~OTOAKISUGAVVARA
FUMIHIKO KAJIYA
AKIRA KITABATAKE
HIROHIDE ~ATSUO
Table of Contents
1 Blood Flow in the Aorta . . . . . . . . 1 3.3 Results of Measurements . . . . . . 21
1.1 Time Variations of Flow-Rate 3.3.1 Blood Flow Pattern in the
and Pressure . . . . . . . . . . . . . . . . . . 1 Healthy Human Left Ventricle
1.1.1 Pressure Gradient and Measured by Color Doppler 21
Acceleration . . . . . . . . . . . . . . . . . . 1 3.3.2 Blood Flow in the Normal
1.1.2 Acceleration of Blood . . . . . . . . . 2 Human Left Ventricular
1.2 Velocity Distribution . . . . . . . . . . 2 Outflow Tract Measured with a
1.2.1 Velocity Distributions at Multisensor Catheter . . . . . . . . . . 21
Various Locations Along the 3.3.3 Intracardiac Blood Flow
Aorta . . . . . . . . . . . . . . . . . . . . . . . . . 2 Measurements with the Hot-
1.2.2 Effects of Aortic Curvature on Film Anemometer . . . . . . . . . . . . . 23
Velocity Distribution . . . . . . . . . . 3 3.4 Spike Observed in the Blood
1.3 Closure Mechanism of the Velocity Waveform Measured in
Aortic Valve . . . . . . . . . . . . . . . . . . 6 the Left Ventricular Outflow
Tract.......................... 24
3.4.1 Introduction . . . . . . . . . . . . . . . . . . . 24
2 Blood Flow in the Pulmonary 3.4.2 Preejection Flow in Sinus
Artery . . . . . . . . . . . . . . . . . . . . . . . . 7 Rhythm....................... 25
2.1 Time Variations of Flow-Rate 3.4.3 PE Flow in Atrial Fibrillation . . 26
and Pressure . . . . . . . . . . . . . . . . . . 7 3.4.4 PE Flow in Atrioventricular
2.2 Velocity Distribution . . . . . . . . . . 9 Block . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.5 Temporal Relationship Between
PE Flow and ECG or PCG in
3 Blood Flow in the Left Various Rhythms . . . . . . . . . . . . . . 27
Ventricle . . . . . . . . . . . . . . . . . . . . . . 11 3.4.6 Relationship Between PE Flow
3.1 Dynamics of Transmitral Blood and Mitral Valve Movement . . . 28
Flow . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3.4.7 PE Flow and Mitral Valve
3.1.1 Introduction . . . . . . . . . . . . . . . . . . . 11 Closure . . . . . . . . . . . . . . . . . . . . . . . 29
3.1.2 Methods . . . . . . . . . . . . . . . . . . . . . . 11 3.5 Hemodynamics of
3.1.3 Analytical Approach . . . . . . . . . . 12 Atrioventricular Sequential
3.1.4 Discussion of Illustrative Results Pacing . . . . . . . . . . . . . . . . . . . . . . . . 30
from Dog Studies . . . . . . . . . . . . . . 13 3.5.1 Introduction . . . . . . . . . . . . . . . . . . . 30
3.1.5 Summary...................... 16 3.5.2 Computer Experiment . . . . . . . . . 31
3.2 Closure Mechanism of the 3.5.3 Anesthetized Dog Studies...... 31
Mitral Valve . . . . . . . . . . . . . . . . . . . 16 3.5.4 Conclusion . . . . . . . . . . . . . . . . . . . . 36
3.2.1 Introduction . . . . . . . . . . . . . . . . . . . 16
3.2.2 Theories of Valve Closure . . . . . 17
3.2.3 Computer Experiments . . . . . . . . 17
3.2.4 Animal Experiments . . . . . . . . . . . 18 4 Turbulence . . . . . . . . . . . . . . . . . . . . 37
3.2.5 Results and Discussion . . . . . . . . . 18 4.1 Turbulence in the Aorta . . . . . . . 37
3.2.6 Summary...................... 21 4.1.1 Introduction . . . . . . . . . . . . . . . . . . . 37
VIII Table of Contents
4.1.2 Turbulence Intensity Measured 5 Relation of Aortic Blood Flow to
in the Canine Ascending Cardiac Performance: Principle
Aorta ........................ . 37 of a Noninvasive Method of
4.1.2.1 Procedure of Animal Measuring Max (dP/dt) . . . . . . . . . 63
Experiments ................. . 37 5.1 Introduction . . . . . . . . . . . . . . . . . . . 63
4.1.2.2 Methods of Analysis (Ensemble 5.2 Water Hammer Formula . . . . . . . 63
Average Method) ............ . 38 5.3 Relation of Max ( dP/dt) to Max
4.1.2.3 Results ....................... . 39 (du!dt) and the Pulse Wave
4.1.3 Spectral Analysis of Turbulence Velocity . . . . . . . . . . . . . . . . . . . . . . . 64
in the Aorta .................. . 41 5.4 Animal Experiments . . . . . . . . . . . 64
4.1.3.1 Spectral Analysis by the 5.5 Clinical Application . . . . . . . . . . . 66
Conventional Method ........ . 41
4.1.3.2 Unsteady Spectral Analysis
Using the Quasi-steady Short 6 Blood Flow in Coronary Vessels . 69
Segment Method ............. . 43 6.1 Anatomical and Functional
4.1.3.3 Reexamination of the Characteristics of Coronary
Application of Taylor's Circulation . . . . . . . . . . . . . . . . . . . . 69
Hypothesis to Unsteady 6.1.1 Anatomy of the Coronary
Convective Velocity .......... . 44 Vasculature ................... 69
4.1.4 Multipoint Measurements in the 6.1.2 Myocardial Oxygen
Ascending and Descending Consumption and Coronary
Aortas of Dogs ............... . 48 Blood Flow . . . . . . . . . . . . . . . . . . . . 70
4.2 Turbulence Measured by 6.1.3 Autoregulation and Reactive
Ultrasonic Doppler Hyperemia . . . . . . . . . . . . . . . . . . . . 71
Velocimetry .................. . 49 6.1.4 Control of Coronary Vasomotor
4.2.1 Introduction .................. . 49 Tone . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4.2.2 Doppler Evaluation of 6.2 Methods of Measurements of
Turbulence ................... . 49 Phasic Coronary Blood Flow . . . 74
4.2.3 Aortic Turbulence Index ...... . 50 6.2.1 Historical Perspective . . . . . . . . . . 74
4.2.4 Aortic Turbulence As a Cause 6.2.2 Laser Doppler Velocimeter
of Murmurs .................. . 52 Using an Optical Fiber . . . . . . . . . 75
4.2.5 Determinants of Aortic Flow 6.2.3 Pulsed Doppler Velocimeter
Disturbances ................. . 53 with Zero-Cross and Fourier
4.3 Phenomena Related to Transform Methods . . . . . . . . . . . 76
Turbulence ................... . 54 6.3 Coronary Artery Flow and
4.3.1 Development of Anacrotic Pressure-Flow Relationship . . . . 77
Notch in the Pressure Wave in 6.3.1 Coronary Artery Flow in the
Patients with Semilunar Valve Proximal and Distal Coronary
Stenosis ...................... . 54 Arteries . . . . . . . . . . . . . . . . . . . . . . . 77
4.3.2 Shear Stress Imposed upon the 6.3.2 Dynamic Characteristics of
Arteries During Heart-Lung Diastolic Coronary Artery
Bypass and Its Clinical Pressure-Flow Relationship . . . . 81
Implications .................. . 57 6.4 Coronary Vein Flow and
4.3.2.1 Method of Heart-Lung Bypass .. 58 Functional Property of
4.3.2.2 Shear Stress Imposed upon the Intramyocardial Capacitance
Arteriallntima ............... . 58 Vessels........................ 84
4.3.2.3 Study on Shear Stress in Clinical 6.4.1 Phasic Characteristics of
Cases ........................ . 59 Coronary Venous Flow . . . . . . . . 84
4.3.2.4 Autopsy Findings of Aortic 6.4.2 Functional Property of
Dissection and Estimated Shear Intramyocardial Capacitance
Stress ........................ . 60 Vessels........................ 85
4.3.2.5 Discussion ................... . 61 6.5 Blood Flow and Pressure in
Intramyocardial Small Vessels 88
6.5.1 Red Cell Velocity in
Intramyocardial Microvessels. . 88
Table of Contents IX
60502 Pressure Measurement of 8.4 Idiopathic Hypertrophic
Intramyocardial Microvessels 89 Subaortic Stenosis: Analysis
0 0
606 Flow Dynamics in Coronary Using a Multisensor Catheter 120
Stenosis 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 8.401 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120
60601 Major Determinants of Stenosis 8.402 Blood Flow Velocity and
Severity 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91 Pressure in the Ascending Aorta
60602 Dynamic Nature of Coronary and Left Ventricle 00 0 0 0 0 0 0 0 0 0 0 0 121
Stenosis 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92 805 Mitral Stenosis 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 124
6o6o3 Intraoperative Assessment of 80501 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 124
Stenotic Coronary Flow 00 0 0 0 0 0 0 93 80502 Transmitral Flow Dynamics 00 0 0 124
80503 Clinical Application of Doppler
Echocardiography for
7 Stenosis: Theoretical Quantitative Evaluation of
Background 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97 Mitral Stenosis 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 125
701 Pressure Loss 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97 8050301 Estimation of Transmitral
701.1 Flow Separation 00 0 0 0 0 0 0 0 0 0 0 0 0 0 97 Pressure Gradient 00 0 0 0 0 0 0 0 0 0 0 0 125
702 Pressure-Loss Coefficient 00 0 0 0 0 98 8050302 Quantitating the Stenotic Orifice
70201 Pressure-Loss Coefficient for a Area 00 0 o 0 0 o o0 o o0 0 0 o 0 0 0 o 0 0 0 0 0 0 0 127
Stenosis 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99 806 Supravalvular Aortic Stenosis:
70201.1 Sudden Enlargement of Area 99 Model Experiments 00 0 0 0 0 0 0 0 0 0 0 128
0 0
70201.2 Orifice 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 80601 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 128
70201.3 Venturi Tube 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102 80602 Model Experiments 00 0 0 0 0 0 0 0 0 0 0 128
703 Methods of Estimating Pressure 80603 Fluid Dynamic Differences
Loss from Measured Velocities 102 Between Hourglass and
7.4 The Gorlin Formula 00 0 0 0 0 0 0 0 0 0 103 Hypoplastic Types 00 0 0 0 0 0 0 0 0 0 0 0 130
705 Measurement of Static and Total
Pressures 00 oooooo 000 000 000 0000 0 104
9 Regurgitation 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 133
901 Aortic Regurgitation:
8 Stenosis: Clinical Measurements 105 Measurement with a
801 Application of Pressure-Loss Multisensor Catheter 00 0 0 0 0 0 0 0 0 133
Coefficient 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 105 901.1 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 133
8ol.1 Calculating the Pressure-Loss 901.2 Quantification of Aortic
Coefficient Under Clinical Regurgitation Using a
Conditions 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 105 Multisensor Catheter 00 0 0 0 0 0 0 0 0 133
801.2 Clinical Significance of the 902 Pulmonary Regurgitation 00 0 0 0 0 138
Pressure-Loss Coefficient 00 0 0 0 0 107 90201 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 138
801.3 Selection of Patients for 90202 Quantitative Assessment of
Operation and Evaluation of the Pulmonary Valvular
Effects of Operation Based on Regurgitation Using a
the Pressure-Loss Coefficient 00 0 110 Multisensor Catheter 00 0 0 0 0 0 0 0 0 138
8o2 Estimation of the Valve Area 90203 Relationship Between the
Using the Equation of Con- Simple Regurgitation Ratio and
tinuity 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 114 Clinical Findings 00 0 0 0 0 0 0 0 0 0 0 0 0 0 141
80201 Calculation of Valve Area 903 Dynamics of Mitral
Based on Godin's Formula 00 0 0 0 114 Regurgitation 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 142
80202 Calculation of Valve Area Using 90301 Introduction 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 142
the Equation of Continuity 00 0 0 0 114 90302 Methods 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 142
80203 Mapping the Changes of Cross 90303 Discussion of Illustrative
Sectional Area Using the Results 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143
Equation of Continuity 00 0 0 0 0 0 0 118 9030301 Changes in Regurgitant Orifice
803 Aortic Stenosis: Blood Flow in Area 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 143
the Aorta Measured with a 9030302 Time Variation of Regurgitant
Multisensor Catheter 00 0 0 0 0 0 0 0 0 119 Flow 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 144
X Table of Contents
9.3.3.3 Effect of Prolonged PR Interval 145 10.5.3 Results . . . . . . . . . . . . . . . . . . . . . . . . 167
9.3.4 Summary . . . . . . . . . . . . . . . . . . . . . . 145 10.5.4 Discussion . . . . . . . . . . . . . . . . . . . . 168
10 Shunt ......................... 147 11 Fluid Dynamics of Free Jets:
10.1 Evaluation ofthe Shunt ........ 147 Quantification of Regurgitations,
10.1.1 Fick's Method ................. 147 Shunts, and Stenosed Flows . . . . 173
10.1.1.1 Principle . . . . . . . . . . . . . . . . . . . . . . 147 11.1 Introduction . . . . . . . . . . . . . . . . . . . 173
10.1.1.2 Shunt Ratio . . . . . . . . . . . . . . . . . . . 148 11.2 Turbulent Free Jets ............ 173
10.1.1.3 Pulmonary to Systemic Flow 11.2.1 Characteristics of a Turbulent
Ratio ......................... 148 Free Jet ....................... 173
10.1.2 Pulsed Doppler 11.2.2 Grading Systems for
Echocardiography ............. 148 Regurgitation Based on
10.2 Atrial Septal Defect . . . . . . . . . . . 149 Turbulent Free Jet Theory . . . . . 175
10.2.1 Flow Dynamics of Atrial Septal 11.2.3 Method of Estimating the
Defect ........................ 149 Issuing Flow-Rate of a
10.2.2 Problems in Calculating Shunt Turbulent Free Jet . . . . . . . . . . . . . 176
Flow in Atrial Septal Defect . . . . 151 11.2.4 Model Experiments:
10.3 Ventricular Septal Defect . . . . . . 153 Measurements with a Color
10.3.1 Anatomical Location of the Doppler Flow Imaging System . 176
Defect and Flow Dynamics . . . . . 153
10.3.2 Aortic Regurgitation Associated
with Infundibular Ventricular 12 Pulmonary Hypertension . . . . . . . 179
Septal Defect and Its Flow 12.1 Pressure-Flow Relationship . . . . 179
Dynamics . . . . . . . . . . . . . . . . . . . . . 157 12.1.1 Resistance . . . . . . . . . . . . . . . . . . . . 179
10.3.3 Interventricular Pressure 12.1.2 Impedance . . . . . . . . . . . . . . . . . . . . 179
Gradient and the Flow 12.2 Noninvasive Estimation of
Dynamics of Ventricular Septal Pulmonary Artery Pressure . . . . 180
Defect ........................ 158
10.3.3.1 Ventricular Septal Defect with
Normal or Slightly Elevated 13 Methods of Measuring Blood
Right Ventricular Pressure . . . . . 159 Velocity . . . . . . . . . . . . . . . . . . . . . . . 187
10.3.3.2 Ventricular Septal Defect with a 13.1 Blood Flow Measurement with
15-30 mmHg of Systolic the Hot-Film Anemometer . . . . . 187
Interventricular Pressure 13.1.1 The Hot-Film Anemometer . . . . 187
Difference . . . . . . . . . . . . . . . . . . . . . 159 13.1.2 Static and Dynamic Calibration . 188
10.3.3.3 Ventricular Septal Defect with 13.2 The Multisensor Catheter . . . . . . 189
Equal Ventricular Pressures and 13.2.1 Introduction . . . . . . . . . . . . . . . . . . . 189
Increased Pulmonary Flow . . . . . 160 13.2.2 Catheter-Tip Electromagnetic
10.3.3.4 So-called Eisenmenger Velocity Probe and
Syndrome with Equal Micromanometer (Multisensor
Ventricular Pressures . . . . . . . . . . 161 Catheter) . . . . . . . . . . . . . . . . . . . . . 189
10.4 Patent Ductus Arteriosus . . . . . . 162 13.2.3 Calibration of the Catheter-Tip
10.4.1 Continuous Aorta-to- Velocity Sensor................ 189
Pulmonary Artery Shunt ....... 162 13.2.4 Relationship Between Flow
10.4.2 bidirectional Shunt . . . . . . . . . . . . 163 Meter Output and Temperature 192
10.4.3 PDA in Case of Aortic Atresia. 164 13.2.5 Relationship Between Flow
10.5 Blood Flow Pattern of the Meter Output and Hematocrit . . 193
Interatrial Communication in 13.2.6 Zero Flow Level . . . . . . . . . . . . . . . 193
Patients with Complete 13.2.7 Safety ......................... 194
Transposition of the Great 13.3 Ultrasonic Doppler
Arteries . . . . . . . . . . . . . . . . . . . . . . . 166 Velocimetry ................... 195
10.5.1 Introduction . . . . . . . . . . . . . . . . . . . 166 13.3.1 Introduction . . . . . . . . . . . . . . . . . . . 195
10.5.2 Methods . . . . . . . . . . . . . . . . . . . . . . 166 13.3.2 Principle and Device . . . . . . . . . . . 195
Table of Contents XI
13.3.2.1 Continuous Wave Doppler 13.4.2.1 Analytical Solution . . . . . . . . . . . . 202
Method ....................... 195 13.4.2.2 Geometrical Analysis . . . . . . . . . . 205
13.3.2.2 Pulsed Doppler Method . . . . . . . 196 13.4.3 Blood Flow in the Ascending
13.3.2.3 Detection of the Flow Aorta ......................... 205
Direction . . . . . . . . . . . . . . . . . . . . . . 197 13.4.4 Conclusion . . . . . . . . . . . . . . . . . . . . 206
13.3.2.4 Frequency Analysis . . . . . . . . . . . . 197
13.3.3 Measurement Method . . . . . . . . . 200 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
13.3.4 Color Doppler Imaging System . 201
13.4 A Problem in Measurements of Author Index 221
Unsteady Flow with Ultrasonic
Doppler V elocimeters . . . . . . . . . 202 Subject Index 224
13.4.1 Introduction . . . . . . . . . . . . . . . . . . . 202
13.4.2 Backscattering from an
Acceleration Particle . . . . . . . . . . 202
List of Contributors
CHIHARA, KuNIHIRO Department of Control Engineering
Faculty of Engineering Science
Osaka University
Toyonaka, 553 Japan
Fum, KENSHI The First Department of Medicine
Osaka University School of Medicine
Osaka, 553 Japan
GOTO, MASAMI Department of Medical Engineering
Kawasaki Medical School
Kurashiki, 701-01 Japan
HANYA, SHIZUO Department of Thoracic and Cardiovascular Surgery
Kitasato University School of Medicine
Sagamihara, 228 Japan
HARADA, YORIKAZU Department of Pediatric Cardiovascular Surgery
The Heart Institute of Japan
Tokyo Women's Medical College
Tokyo, 162 Japan
HoNGo, HIRONOBU Medical Engineering Laboratory
Toshiba Corporation
Ohtawara, 329-26 Japan
KAJIYA, FuMIHIKO Department of Medical Engineering
Kawasaki Medical School
Kurashiki, 701-01 Japan
KAMADA, TAKENOBU The First Department of Medicine
Osaka University School of Medicine
Osaka, 553 Japan
KrrABATAKE, AKIRA The First Department of Medicine
Osaka University School of Medicine
Osaka, 553 Japan
KIKKAWA, SHO Department of Information Science
Faculty of Science
Toho University
Funabashi, 274 Japan
KoYAMA, Yun Department of Cardiovascular Surgery
Tokyo Women's Medical College Second Hospital
Tokyo, 116 Japan
MASUYAMA, TOHRU The First Department of Medicine
Osaka University School of Medicine
Osaka, 553 Japan