Y. Sun et al., A COMPREHENSIVE MODEL FOR RIGHT-LEFT HEART INTERACTION UNDER THE INFLUENCE OF PERICARDIUM AND BAROREFLEX, American journal of physiology. Heart and circulatory physiology, 41(3), 1997, pp. 1499-1515
A phenomenological model of the cardiopulmonary circulation is develop
ed with a focus on the interaction between the right heart and the lef
t heart. The model predicts the hemodynamic consequences of changing c
irculatory parameters in terms of a broad spectrum of pressure and flo
w waveforms. Hemodynamics are characterized by use of an electrical an
alog incorporating mechanisms for transseptal pressure coupling, peric
ardial volume coupling, intrathoracic pressure, and baroreflex control
of heart rate. Computer simulations are accomplished by numerically i
ntegrating 28 differential equations that contain nonlinear and time-v
arying coefficients. Validity of the model is supported by its accurat
e fit to clinical pressure and Doppler echocardiographic recordings. T
he model characterizes the hemodynamic waveforms for mitral stenosis,
mitral regurgitation, left heart failure, right heart failure, cardiac
tamponade, pulsus paradoxus, and the Valsalva maneuver. The wave shap
es of pulmonary capillary wedge pressure under the above conditions ar
e also accurately represented. Sensitivity analysis reveals that simul
ated hemodynamics are insensitive to most individual model parameters
with the exception of afterload resistance, preload capacitances, intr
athoracic pressure, contractility, and pericardial fluid volume. Basel
ine hemodynamics are minimally affected by transseptal coupling (up to
2%) and significantly affected by pericardial coupling (up to 20%). T
he model should be useful for quantitative studies of cardiopulmonary
dynamics related to the right-left heart interaction under normal and
disease conditions.