An understanding of the basic concepts of the physics of blood flow is of vital importance to the cardiologist as he or she attempts to utilize new blood flow imaging modalities, such as Doppler ultrasound and nuclear magnetic resonance imaging. Concepts such as the Bernoulli equation and its limitations, the continuity equation and volume flow calculations and the theory of free and confined jets have applications in cardiac blood flow-related problems. For example, mitral regurgitant flow may be treated with the free jet theory. Aortic stenosis results in confined jet flow. It is important that the cardiologist understand the basic principles behind these hydrodynamic concepts so that he or she can use them in appropriate applications. The limitations of the simplification of complex hydrodynamic relations that are used clinically need to be clearly understood so that these simplified principles are not used improperly or used to draw oversimplified conclusions.
Small changes in AoSA produce important changes in septal shear stress. The levels of stress increase are consistent with cellular flow studies showing stimulation of growth factors and cellular proliferation. Steepened AoSA may be a risk factor for the development of SAS. Evidence exists for all four stages of the proposed etiology of SAS.
The extracardiac conduit procedure provides superior hemodynamics compared with the intra-atrial lateral tunnel and extracardiac tunnel techniques. This hydrodynamic advantage is markedly enhanced by the use of conduit-superior vena cava offset, particularly at high physiologic flows that are representative of exercise. These data suggest additional rationale for the use of extracardiac conduit procedures for final-stage completion of the Fontan circulation.
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