Pressure and Flow Relations in the Systemic Arterial Tree Throughout Development From Newborn to Adult.

Berend E Westerhof,Jeroen P Van Den Wijngaard,Martin J C Van Gemert

doi:10.3389/fped.2020.00251

Abstract

Objective: Distributed models of the arterial tree allow studying the effect of physiological and pathophysiological changes in the vasculature on hemodynamics. For the adult, several models exist; however, a model encompassing the full age range from newborn to adult was until now lacking. Our goal is to describe a complete distributed hemodynamic model for normal development from newborn to adult.Methods: The arterial system was modeled by 121 segments characterized by length, radius, wall thickness, wall stiffness, and wall viscosity. The final segments ended in three-element Windkessels. All parameters were adapted based on body height and weight as a function of age as described in the literature.Results: Pressures and flows are calculated as a function of age at sites along the arterial tree. Central to peripheral transfer functions are given. Our results indicate that peripheral pressure in younger children resembles central pressure. Furthermore, total arterial compliance, inertance and impedance are calculated. Findings indicate that the arterial tree can be simulated by using a three-element Windkessel system. Pulse wave velocity in the aorta was found to increase during development.Conclusions: The arterial system, modeled from newborn to adult bears clinical significance, both for the interpretation of peripheral measured pressure in younger and older children, and for using a Windkessel model to determine flow from pressure measurements.

Highlights

Arterial models help in understanding of hemodynamics and allow simulated experimental interventions that may not be performed in the human [1]
Our general aim was to develop a full-scale distributed model of the systemic arterial tree, consisting of realistic segments derived from physiological measurements, throughout development from newborn to adult
We investigated pressure-flow relations in the model, with as a first aim to determine the central to peripheral pressure transfer functions

Summary

Introduction

Arterial models help in understanding of hemodynamics and allow simulated experimental interventions that may not be performed in the human [1]. Descriptions of fetal [9, 10], neonatal [11], and infant [12] circulations do exist, usually with simplified arterial networks The second aim was to derive and determine the applicability of Windkessel models, based on characteristic impedance and the lumped parameters, as found by network analysis, describing total arterial resistance, compliance, and inertance. The second aim gives insight in the applicability of 3- or 4-element Windkessels for realistic modeling of the input impedance of systemic arterial tree [13]. Combined, these aims may aid in calculating cardiac output from peripherally measured pressures

Methods

Results

Conclusion