Handbook of Cardiac Anatomy, Physiology, and Devices

Foreword
Preface
Contents
Part I: Introduction
	1: General Features of the Cardiovascular System
		1.1	 Introduction
		1.2	 Components of the Cardiovascular System
			1.2.1	 Blood
			1.2.2	 Blood Vessels
			1.2.3	 Blood Flow
			1.2.4	 The Heart
			1.2.5	 Regulation of Cardiovascular Function
			1.2.6	 The Coronary Circulation
			1.2.7	 The Lymphatic System
		1.3	 Summary
		Sources
	2: Attitudinally Correct Cardiac Anatomy
		2.1	 Introduction
		2.2	 The Problem: Cardiac Anatomy Does Not Play by the Rules
		2.3	 The Attitudinally Correct Position of the Human Heart
		2.4	 Commonly Used Incorrect Terms
		2.5	 Comparative Aspects of Attitudinally Correct Cardiac Anatomy
		2.6	 Summary
		References
Part II: Cardiac Anatomy and Physiology
	3: Anatomy of the Thoracic Wall, Pulmonary Cavities, and Mediastinum
		3.1	 Introduction
		3.2	 Overview of the Thorax
		3.3	 Bones of the Thoracic Wall
			3.3.1	 The Thoracic Cage
			3.3.2	 The Pectoral Girdle
		3.4	 Muscles of the Thoracic Wall
			3.4.1	 The Pectoral Muscles
			3.4.2	 The Intercostal Muscles
			3.4.3	 The Respiratory Diaphragm
			3.4.4	 Other Muscles of Respiration
		3.5	 Nerves of the Thoracic Wall
		3.6	 Vessels of the Thoracic Wall
		3.7	 The Superior Mediastinum
			3.7.1	 Arteries in the Superior Mediastinum
			3.7.2	 Brachiocephalic Veins
			3.7.3	 The Trachea and the Esophagus
			3.7.4	 Nerves of the Superior Mediastinum
			3.7.5	 The Thymus
		3.8	 The Middle Mediastinum
			3.8.1	 The Pericardium
			3.8.2	 The Great Vessels
		3.9	 The Anterior Mediastinum
		3.10	 The Posterior Mediastinum
			3.10.1	 The Esophagus and the Esophageal Plexus
			3.10.2	 The Azygos System of Veins
			3.10.3	 The Thoracic Duct and Lymphatics
			3.10.4	 The Descending Thoracic Aorta
			3.10.5	 The Thoracic Sympathetic Nerves
		3.11	 The Pleura and Lungs
			3.11.1	 The Pleura
			3.11.2	 The Lungs
			3.11.3	 The Mechanics of Respiration
		3.12	 Surface Anatomy
			3.12.1	 Landmarks of the Thoracic Wall
			3.12.2	 The Lungs and the Pleura
			3.12.3	 The Heart
			3.12.4	 Vascular Access
		3.13	 Summary
	4: Anatomy of the Human Heart
		4.1	 Introduction
		4.2	 Position of the Heart in the Thorax
		4.3	 The Pericardium
		4.4	 Internal Anatomy of the Heart
			4.4.1	 Cardiopulmonary Circulation
			4.4.2	 The Right Atrium
			4.4.3	 The Right Ventricle
				4.4.3.1	 The Tricuspid Valve
				4.4.3.2	 The Pulmonary Semilunar Valve
			4.4.4	 The Left Atrium
			4.4.5	 The Left Ventricle
				4.4.5.1	 The Bicuspid (Mitral) Valve
				4.4.5.2	 The Aortic Semilunar Valve
		4.5	 The Cardiac Skeleton
		4.6	 The Fetal Heart
		4.7	 Other Fetal Remnants: The Chiari Network
		4.8	 Other Fetal Remnants: Atrial Septal Defect
		4.9	 Other Fetal Remnants: Ventricular Atrial Septal Defect
		4.10	 Vasculature of the Heart
			4.10.1	 The Right Coronary Artery
			4.10.2	 The Left Coronary Artery
			4.10.3	 The Cardiac Veins
			4.10.4	 Myocardial Bridges
		4.11	 Autonomic Innervation of the Heart
		4.12	 Summary
		References
			Further Reading
	5: Cardiac Development
		5.1	 An Overview of Human Heart Embryology and Development
		5.2	 First Heart Field Contribution to the Linear Heart Tube, Left Ventricle, and Atria
		5.3	 Second Heart Field Contribution to the Outflow Tract, Right Ventricle, and Atria
		5.4	 Cardiac Neural Crest Contribution and Septation of the Outflow Tract and Ventricles
		5.5	 Proepicardial Organ and Coronary Artery Development
		5.6	 Cardiac Maturation
		5.7	 Summary of Embryonic Contributions to Heart Development
		References
	6: Cellular Myocytes
		6.1	 General Cellular Morphology
		6.2	 Cardiac Muscle Cell Morphology
		6.3	 Cardiac Cell Membranes
		6.4	 Intercalated Disks
		6.5	 Gap Junctions
		6.6	 The Myofibrillar Structure
		6.7	 Thin Filaments
		6.8	 Thick Filaments
		6.9	 Energy Metabolism
		6.10	 Force Production: The Crossbridge Cycle
		6.11	 The Length–Tension Relationship
			6.11.1	 Practical Applications of the Length–Tension Relationship
		6.12	 Force and Velocity
		6.13	 Myocyte Hypertrophy
		6.14	 Cardiac Cell Action Potentials
		6.15	 Pacemaker Cells
		6.16	 Summary
		References
			Other Resources
	7: Fueling Normal and Diseased Hearts: Myocardial Bioenergetics
		7.1	 Introduction
		7.2	 Myocardial Blood Flow: Carbon Substrate and Oxygen Delivery to the Heart
			7.2.1	 Regulation of Myocardial Blood Flow
			7.2.2	 Signaling Pathways Regulating the Coronary Circulation
			7.2.3	 Blood Flow in the Diseased Heart
		7.3	 Intermediary Metabolism and Bioenergetics in the Normal Heart
			7.3.1	 Glucose Metabolism
			7.3.2	 Fatty Acid Metabolism
			7.3.3	 The Tricarboxylic Acid (TCA) Cycle
			7.3.4	 The Mitochondrion
			7.3.5	 The Electron Transport Chain and Oxidative Phosphorylation
			7.3.6	 Regulation of Carbon Substrate Metabolic Pathways
			7.3.7	 Myocardial Carbon Substrate Selection
			7.3.8	 Regulation of the TCA Cycle, Electron Transport Chain, and Oxidative Phosphorylation
			7.3.9	 Toxic By-products Generated by Mitochondria and Other Cellular Moieties That Impact Energy Generation and Contraction
		7.4	 Metabolism in the Diseased Myocardium
			7.4.1	 The Ischemic Myocardium
			7.4.2	 Metabolism in the Hypertrophied and Failing Hearts
			7.4.3	 Primary (Genetic) Myocardial Metabolic Abnormalities
		7.5	 Summary
		References
			References for Regulation of Myocardial Blood Flow
			General Biochemistry Text
			References for Glucose and Fatty Acid Metabolism and Regulation of Glycolysis and Fatty Acid Metabolism
			References for Myocardial Substrate Selection
			References for the TCA Cycle, Electron Transport Chain, and Oxidative Phosphorylation and Their Regulation
			References for Toxic Metabolic By-products; Reactive Species
			References for Metabolism During Ischemia
			References for Metabolism in Hypertrophied and Failing Myocardium
			References for Inherited Defects in Myocardial Metabolism
	8: Cardiac and Vascular Receptors and Signal Transduction
		8.1	 Introduction
		8.2	 Definition
		8.3	 G Protein-Coupled Receptor (Seven-Transmembrane-Spanning Receptors) and Signal Transduction
			8.3.1	 Overview
			8.3.2	 Receptor Structure
			8.3.3	 Receptor Coupling
			8.3.4	 Receptor Function and Regulation
		8.4	 Beta-Adrenergic Receptors (β-ARs)
			8.4.1	 Classification of β-Adrenergic Receptors
			8.4.2	 β-AR Activation and Cardiovascular Function
				8.4.2.1	 Effects of β-Receptor Activation on the Heart
				8.4.2.2	 Positive Chronotropic Effects
				8.4.2.3	 Positive Inotropic Effects
				8.4.2.4	 The Second Messenger Concept
				8.4.2.5	 Positive Lusitropic Effects
				8.4.2.6	 Dromotropic Effects
				8.4.2.7	 Metabolic Effects
				8.4.2.8	 Effects of β-Receptor Activation in the Vasculature
			8.4.3	 β-AR Regulation
				8.4.3.1	 β-Adrenergic Receptor Desensitization and Downregulation
		8.5	 The Association Between β-ARs and Cardiac Disease
			8.5.1	 Beta-Adrenergic Signaling and Heart Failure
		8.6	 Alpha-Adrenergic
			8.6.1	 The Physiology of Alpha-Adrenergics
			8.6.2	 Role in Disease States
		8.7	 Role of Adrenergic and Other Receptors in Myocardial Hypertrophy
		8.8	 Muscarinic Receptors
			8.8.1	 The Physiology of Muscarinic Receptors
		8.9	 Other G Protein-Coupled Cardiovascular Receptors
		8.10	 Receptor Cross Talk
		8.11	 Guanylyl Cyclase-Linked Receptors
			8.11.1	 Soluble Guanylyl Cyclase (Receptor for Nitric Oxide)
			8.11.2	 Membrane Guanylyl Cyclase-A (Receptors for Natriuretic Peptides)
			8.11.3	 The Physiology of Receptors for Natriuretic Peptides
			8.11.4	 Roles in Cardiac Disease
		8.12	 Vascular Response to Drug Eluting Stents (DES): Inflammation, Neointimal Formation, and Endothelial Function
			8.12.1	 The History of Angioplasty/Stenting
			8.12.2	 The Vascular Biology of Restenosis
				8.12.2.1	 Overview
				8.12.2.2	 Biology of Smooth Muscle Cells
				8.12.2.3	 Extracellular Matrix Accumulation
				8.12.2.4	 SMC Cycle and Proliferation
				8.12.2.5	 Drugs for DES
				8.12.2.6	 Endothelial Cells
				8.12.2.7	 Effect of Shear Stress on Endothelial Cells and the Link to Restenosis
			8.12.3	 The Role of Inflammation in Restenosis
				8.12.3.1	 Leukocyte Recruitment
				8.12.3.2	 Chemokines and Proinflammatory Cytokines
				8.12.3.3	 Systemic Markers of Inflammation and ISR
				8.12.3.4	 The Cross Talk Between Inflammation and Thrombosis
				8.12.3.5	 The Molecular Signaling Leading to Inflammation Due to Vascular Interventions
		8.13	 Drug-Eluting Versus Bare-Metal Stents for Coronary Artery Disease
		8.14	 Summary
		References
	9: Detailed Anatomical and Functional Features of the Cardiac Valves
		9.1	 Introduction
		9.2	 The Cardiac Skeleton
		9.3	 The Atrioventricular Valves
			9.3.1	 Atrioventricular Valve Function
		9.4	 The Semilunar Valves
			9.4.1	 The Functioning of the Semilunar Valves
		9.5	 Valve Histologies
		9.6	 The Mitral Valve
		9.7	 The Tricuspid Valve
		9.8	 The Aortic Valve
			9.8.1	 The Aortic Root
			9.8.2	 The Aortic Leaflets
		9.9	 The Pulmonary Valve
		9.10	 Valve Co-location with Other Cardiac Structures
		9.11	 Common Clinical Imaging of the Cardiac Valves
		9.12	 Summary
		References
	10: The Coronary Vascular System and Associated Anatomical Features
		10.1	 Introduction
		10.2	 Coronary Arteries
			10.2.1 Coronary Arteries: Anatomical Description
			10.2.2 The Left Coronary Artery and Its Branches
				10.2.2.1 Left Anterior Descending Artery and Its Branches
				10.2.2.2 Circumflex Artery and Its Branches
			10.2.3 The Right Coronary Artery and Its Branches
			10.2.4 Abnormal Coronary Artery Anatomy
			10.2.5 Coronary Arteries: Disease
		10.3	 Cardiac Capillaries
		10.4	 Coronary Veins
			10.4.1 Coronary Veins: Anatomical Description
				10.4.1.1 The Greater Cardiac Venous System
					10.4.1.1.1 Coronary Sinus
					10.4.1.1.2 Anterior Interventricular Vein and Great Cardiac Vein
					10.4.1.1.3 Lateral Veins
					10.4.1.1.4 Inferior Veins
					10.4.1.1.5 Middle Cardiac Vein
					10.4.1.1.6 Small Cardiac Vein
					10.4.1.1.7 Oblique Vein of the Left Atrium
					10.4.1.1.8 Right Marginal Vein
					10.4.1.1.9 Anterior Cardiac Veins
					10.4.1.1.10 Atrial Veins
				10.4.1.2 The Smaller Cardiac Venous System
				10.4.1.3 Coronary Veins: Valves
					10.4.1.3.1 Abnormal Venous Anatomy
			10.4.2 Coronary Veins: Disease
		10.5	 Microanatomy of Coronary Arteries and Veins
		10.6	 Anastomoses and Collaterals
		10.7	 Assessment and Visualization of the Coronary System
		10.8	 Medical Devices and the Coronary System
			10.8.1 Devices and the Coronary Arteries
			10.8.2 Devices and the Coronary Veins
		10.9	 Notable Engineering Parameters and Design Criteria Associated with the Coronary System
			10.9.1 Diameter
			10.9.2 Cross-Sectional Profile
			10.9.3 Ostial Anatomy
			10.9.4 Vessel Length
			10.9.5 Tortuosity
			10.9.6 Branch Angle
			10.9.7 Wall Thickness
			10.9.8 Motion Characteristics
			10.9.9 Relationship to Myocardium and Epicardial Fat
			10.9.10 Nearby Clinically Relevant Anatomy
				10.9.10.1 Associations Between the Veins and Arteries
				10.9.10.2 Mitral Isthmus
				10.9.10.3 Cavotricuspid Isthmus
				10.9.10.4 Phrenic Nerve
			10.9.11 Assessment of Anatomical Parameters
		10.10	 Summary
		References
	11: The Cardiac Conduction System
		11.1	 Introduction
		11.2	 Overview of Cardiac Conduction
		11.3	 Cardiac Rate Control
		11.4	 Cardiac Action Potentials
		11.5	 Gap Junctions (Cell-to-Cell Conduction)
		11.6	 The Atrioventricular Node and Bundle of His: Specific Features
		11.7	 Comparative Anatomy
		11.8	 The Recording of Action Potentials and/or the Spread of Excitation through the Myocardium
		11.9	 Future Research
		11.10	 Summary
		References
			Further Reading
	12: Autonomic Nervous System
		12.1	 Introduction
		12.2	 Sympathetic Anatomy
		12.3	 Adrenal Medulla
		12.4	 Parasympathetic Anatomy
		12.5	 Baroreceptors
		12.6	 Homeostasis
		12.7	 Hypothalamic Control
		12.8	 Effector Pathways to the Heart
		12.9	 Specific Sympathetic and Parasympathetic Cardiac Controls
			12.9.1 Heart Rate
			12.9.2 Stroke Volume and Contractility
			12.9.3 Baroreceptor Pressure Regulation
			12.9.4 Arteriolar Pressure Regulation
		12.10	 Cardiac Denervation
			12.10.1 Effects of Denervation on Basal Cardiac Function
			12.10.2 Effects of Denervation on Exercise Hemodynamics
			12.10.3 Reinnervation
		12.11	 Summary
		References
	13: The Pericardium
		13.1	 Introduction
		13.2	 Pericardial Anatomy
		13.3	 Physiology of the Normal Pericardium
			13.3.1	 Pericardial Fluid
			13.3.2	 Mechanical Effects of the Pericardium
		13.4	 Pericardial Disorders: Congenital, Pathological, and Iatrogenic
		13.5	 Comparative Anatomy and Biomechanics of Pericardium
			13.5.1	 Comparative Anatomy of the Pericardium
			13.5.2	 Comparative Biomechanics of Human and Porcine Pericardium
		13.6	 Surgical Uses of the Pericardium
		13.7	 Intrapericardial Therapeutics
			13.7.1	 Clinical Pericardial Access
			13.7.2	 Intrapericardial Therapies
			13.7.3	 Pericardial Pharmacokinetics
		13.8	 Summary
		References
	14: Comparative Cardiac Anatomy
		14.1	 Historical Perspective of Anatomy and Animal Research
		14.2	 Importance of Anatomy and Preclinical Animal Research
		14.3	 Literature Review of Large Mammalian Comparative Cardiac Anatomy
			14.3.1	 The Atria
			14.3.2	 The Ventricles
			14.3.3	 The Cardiac Valves
			14.3.4	 The Coronary System
			14.3.5	 The Lymphatic System
			14.3.6	 The Conduction System
		14.4	 Qualitative and Quantitative Comparisons of Cardiac Anatomy in Commonly Used Large Mammalian Cardiovascular Research Models
			14.4.1	 Importance for Comparing the Anatomy of Various Animal Models
			14.4.2	 Methods and Materials
				14.4.2.1	 Heart Preservation
				14.4.2.2	 Qualitative Anatomical Assessment of Perfusion-Fixed Hearts
				14.4.2.3	 Quantitative Anatomical Assessments of Perfusion-Fixed Hearts
			14.4.3	 Results
				14.4.3.1	 Qualitative Comparisons
				14.4.3.2	 Quantitative Comparisons
			14.4.4	 Discussion and Consideration of Previous Studies on Comparative Anatomy
		14.5	 Summary
		References
	15: Congenital Cardiac Anatomy and Operative Correction
		15.1	 Introduction
		15.2	 Cardiopulmonary Bypass
		15.3	 Systemic Venous Anomalies
		15.4	 Atrial Septal Defects
		15.5	 Anomalies of the Tricuspid Valve
		15.6	 Ventricular Septal Defects
		15.7	 Atrioventricular Septal Defect
		15.8	 Anomalies of the Great Arteries
			15.8.1	 Transposition of the Great Arteries
			15.8.2	 Persistent Truncus Arteriosus
			15.8.3	 Aortopulmonary Window
			15.8.4	 Coarctation of Aorta
			15.8.5	 Interrupted Aortic Arch
		15.9	 Pulmonary Atresia
		15.10	 Tetralogy of Fallot/Double Outlet Right Ventricle
		15.11	 Pulmonary Venous Anomalies
		15.12	 Obstructive Left Heart Lesions
			15.12.1	 Mitral Valve Anomalies
			15.12.2	 Hypoplastic Left Ventricle
			15.12.3	 Subaortic Ridge
			15.12.4	 Bicuspid Aortic Valve
		15.13	 Coronary Artery Anomalies
		15.14	 Summary
		References
Part III: Cardiac Assessment
	16: Blood Pressure, Heart Tones, and Diagnoses
		16.1	 A Brief History of Cardiovascular Assessment
			16.1.1	 Physiology of Blood Pressure
		16.2	 Methods of Measuring Blood Pressure
			16.2.1	 Noninvasive Methods
				16.2.1.1	 Palpation
				16.2.1.2	 Doppler Method
				16.2.1.3	 Auscultation (Riva-Rocci Method)
				16.2.1.4	 Oscillometry
				16.2.1.5	 Arterial Tonometry
				16.2.1.6	 Plethysmography
				16.2.1.7	 Pulse Propagation: Pulse Wave Velocity and Pulse Transit Time
			16.2.2	 Invasive Methods of Blood Pressure Measurement
				16.2.2.1	 Indications
				16.2.2.2	 Cannulation Sites
				16.2.2.3	 Techniques
				16.2.2.4	 Devices and the Physics of Transduction Systems
				16.2.2.5	 Arterial Waveform Analysis
				16.2.2.6	 Complications
		16.3	 Diagnoses
			16.3.1	 Pulsus Paradoxus
			16.3.2	 Pulsus Alternans
			16.3.3	 Bigeminal Pulse
			16.3.4	 Pulse Deficit
			16.3.5	 Wide Pulse Pressure
			16.3.6	 Pulsus Parvus Et Tardus
			16.3.7	 Bisferiens Pulse
			16.3.8	 Dicrotic Pulse
		16.4	 Heart Tones
			16.4.1	 Physiology and Normal Heart Sounds
			16.4.2	 Auscultatory Areas
			16.4.3	 Abnormal Heart Sounds
				16.4.3.1	 Splitting of S2
				16.4.3.2	 Murmurs
			16.4.4	 Dynamic Auscultation
			16.4.5	 Specific Murmurs
				16.4.5.1	 Aortic Stenosis
				16.4.5.2	 Pulmonic Stenosis Pulmonary
				16.4.5.3	 Aortic Insufficiency
				16.4.5.4	 Pulmonic Regurgitation
				16.4.5.5	 Mitral Stenosis
				16.4.5.6	 Tricuspid Stenosis
				16.4.5.7	 Mitral Regurgitation
				16.4.5.8	 Tricuspid Regurgitation
				16.4.5.9	 Atrial Septal Defect
				16.4.5.10	 Patent Ductus Arteriosus
				16.4.5.11	 Ventricular Septal Defect
		16.5	 Recent Developments
			16.5.1	 Summary
		Bibliography
	17: Basic ECG Theory, 12-Lead Recordings and Their Interpretation
		17.1	 The Basics of the Electrocardiogram
		17.2	 ECG Recording Devices
		17.3	 History of the ECG
		17.4	 The Basics of Recording the ECG Waveform
		17.5	 Details of the 12-Lead EKG
			17.5.1	 Frontal Plane Leads
			17.5.2	 Horizontal Plane Leads
		17.6	 The ECG Recording Equipment and Paper Traces
		17.7	 The Basic Interpretation of a Non-Pathologic 12-Lead ECG
			17.7.1	 An Adequately Acquired Standard 12-Lead ECG
			17.7.2	 Rhythm: How to Know If It Is a Sinus Rhythm?
			17.7.3	 The Functional Electrical Heart Rate
			17.7.4	 The Electrical Frontal QRS Axis of the Heart
			17.7.5	 The ECG Waveform, Segments and Intervals
		17.8	 Computer ECG Analyses
		17.9	 Long-Term ECG Recording Devices
		17.10	 Summary
	18: Introduction to Echocardiography
		18.1	 Introduction
		18.2	 Echo Probes
		18.3	 The Basics of Ultrasound Imaging
			18.3.1	 Ultrasound Physics
			18.3.2	 Doppler Physics
		18.4	 The Basic Echocardiographic Clinical Exam
		18.5	 Assessing the Cardiac Chambers
			18.5.1	 Left Ventricle
			18.5.2	 Right Ventricle
			18.5.3	 Left Atrium
			18.5.4	 Right Atrium
		18.6	 Assessing the Cardiac Valves
			18.6.1	 Aortic Valve
			18.6.2	 Mitral Valve
			18.6.3	 Tricuspid Valve
			18.6.4	 Pulmonic Valve
		18.7	 Devices and Echocardiography
			18.7.1	 LVADs
			18.7.2	 Transatrial Septal Puncture
			18.7.3	 Valvular Interventions
			18.7.4	 Extracorporeal Mechanical Circulatory Support
				18.7.4.1	 Other Structural Heart Interventions
		18.8	 Summary
		References
	19: Mechanical Aspects of Cardiac Performance
		19.1	 Introduction
		19.2	 Cardiac Cycle
		19.3	 Cardiac Pressure-Volume Curves
			19.3.1	 Preload
			19.3.2	 Contractility
			19.3.3	 Afterload
			19.3.4	 Sonomicrometry Crystals
			19.3.5	 Conductance Catheters
		19.4	 Blood Pressure Monitoring
			19.4.1	 Noninvasive Arterial Blood Pressure Monitoring
			19.4.2	 Invasive Arterial Blood Pressure Monitoring
			19.4.3	 Pressure Transducer System
			19.4.4	 Transducer Catheters
		19.5	 Central Venous Pressure Monitoring
		19.6	 Pulmonary Artery and Right Ventricular Pressure Monitoring
		19.7	 Intraosseous Pressure
		19.8	 Cardiac Output/Cardiac Index Monitoring
		19.9	 Mixed Venous Saturation Monitoring (SvO2)
		19.10	 Flow Monitoring
		19.11	 Implantable Monitoring
		19.12	 Summary
		References
	20: The Effects of Anesthetic Agents on Cardiac Function
		20.1	 Introduction
		20.2	 The Anesthesia Induction Sequence
		20.3	 Inhalational Anesthetics
			20.3.1 Blood Pressure and Systemic Vascular Resistance
			20.3.2 The Cardiac Conduction System and the Control of Heart Rate
			20.3.3 Coronary Blood Flow
			20.3.4 Contractility and Cardiac Output
			20.3.5 Pulmonary Blood Flow
			20.3.6 Cardioprotection/Preconditioning
			20.3.7 The Development of New Inhalational Anesthetics
		20.4	 Intravenous Anesthetics
			20.4.1 Barbiturates
			20.4.2 Benzodiazepines
			20.4.3 Opioids
			20.4.4 Ketamine
			20.4.5 Propofol
			20.4.6 Etomidate
			20.4.7 Nondepolarizing Muscle Relaxants
			20.4.8 Depolarizing Muscle Relaxant
			20.4.9 Dexmedetomidine
			20.4.10 Acupuncture
			20.4.11 Anesthesia and Temperature Regulation
			20.4.12 Myocardial Preconditioning with Inhalational and Intravenous Anesthetics
			20.4.13 Heart Transplant
		20.5	 Summary
		References
	21: Insertable Cardiac Monitoring
		21.1	 Introduction
		21.2	 Clinical Problems Addressed by ICMs
			21.2.1	 Tools for Monitoring Arrhythmias
			21.2.2	 Indicated Uses of ICMs
			21.2.3	 ICM Use in Patients with Syncope
			21.2.4	 ICM Monitoring of AF
			21.2.5	 Advanced Uses of ICMs
		21.3	 A Brief History of ICMs
			21.3.1	 The Invention of ICMs
			21.3.2	 Early Commercial Models
		21.4	 Technical Operation of ICMs
			21.4.1	 ECG Collection
			21.4.2	 ECG Rhythm Analysis
			21.4.3	 ECG Data Transmission
		21.5	 Clinical Management of ICM’s
			21.5.1	 Inserting an ICM
			21.5.2	 Data Review
			21.5.3	 Patient Assistant-Captured Events
			21.5.4	 ICM Removal
		21.6	 Future Directions
			21.6.1	 Enhancements from Utilizing Artificial Intelligence with ICMs
			21.6.2	 New ICMs for Other Disease States
			21.6.3	 ICM Uses in Pre-clinical Animal Research or in Wildlife Management
		21.7	 Conclusion
		References
	22: Cardiac Mapping Technologies
		22.1	 Introduction and Background
			22.1.1	 Basics of Mapping and Navigation
			22.1.2	 Cardiac Navigation Theory of Operation
				22.1.2.1	 Electropotential Navigation
				22.1.2.2	 Electromagnetic Navigation
			22.1.3	 Navigation Performance
			22.1.4	 Comparison of Methods
			22.1.5	 Combining Modalities
			22.1.6	 Industry Overview
		22.2	 Clinical Implementation
			22.2.1	 Types of Maps
				22.2.1.1	 Voltage Mapping
				22.2.1.2	 Activation Mapping
		22.3	 Commercially Available Invasive Mapping Systems
			22.3.1	 LocaLisa® Technologies
			22.3.2	 The Carto Mapping Platform
			22.3.3	 EnSite X
			22.3.4	 The Rhythmia Mapping System
			22.3.5	 The Affera Prism-1 Mapping System
			22.3.6	 Additional Technologies
		22.4	 Continuous Mapping Systems
		22.5	 Summary
		References
	23: Multimodality Imaging in Congenital Heart Disease
		23.1	 Introduction
		23.2	 Imaging Modalities
			23.2.1	 Basic Cardiac Anatomy
			23.2.2	 Anatomical and Physiological Significance by View
			23.2.3	 The Importance of Echocardiography in Managing CHD and Acquired Heart Disease
		23.3	 Transthoracic Echocardiography (TTE)
		23.4	 The Fetal Echocardiogram
		23.5	 Transesophageal Echocardiography (TEE)
		23.6	 The Epicardial Echocardiogram
		23.7	 Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CT)
			23.7.1	 Cardiovascular Magnetic Resonance (CMR): Clinical Factors
			23.7.2	 Computed Tomography (CT): Clinical Factors
			23.7.3	 CMR and CT Uses
		23.8	 High-Resolution 3D Computational Heart Models and Printing
			23.8.1	 Digital Segmentation
			23.8.2	 Various 3D Printing Techniques
			23.8.3	 Applications of 3D Printing in Cardiology
			23.8.4	 Advantages and Future Implications in 3D Printing for CHD
			23.8.5	 High-Resolution 3D Computational Heart Models Viewed in Virtual Reality
		23.9	 Various Types of CHD and Employed Imaging Modalities: Case Studies
		23.10	 Summary
		References
	24: Monitoring and Managing the Critically Ill Patient in the Intensive Care Unit
		24.1	 Brief History of Advances in Critical Care
		24.2	 Goals of Monitoring
			24.2.1	 The Diagnosis of Shock
			24.2.2	 Evaluations of Cardiac Function
			24.2.3	 Titration of Vasoactive Therapy
		24.3	 Monitors: Do They Help?
			24.3.1	 What About Telemedicine?
		24.4	 Invasive Monitoring Techniques in the ICU
			24.4.1	 Central Venous Pressure (CVP) Monitoring
			24.4.2	 Arterial Blood Pressure Monitoring
			24.4.3	 Pulmonary Artery Catheters
			24.4.4	 Complications of Invasive Monitors
		24.5	 Less Invasive Monitoring Techniques
			24.5.1	 Cardiac Hemodynamics
				24.5.1.1 Pulse Contour Wave Processing
				24.5.1.2 Ultrasonography/Echocardiography
				24.5.1.3 CO2 Partial Rebreathing Technique
			24.5.2	 Perfusion Monitors
				24.5.2.1 Reflectance Near-Infrared Spectroscopy
				24.5.2.2 Capnometry
				24.5.2.3 Central Venous O2 Saturation Monitors
			24.5.3	 Subcutaneous Continuous Glucose Monitoring
			24.5.4	 Artificial Intelligence
			24.5.5	 Conclusions
		References
	25: Cardiovascular Magnetic Resonance Imaging and MR-Conditional Cardiac Devices
		25.1	 Introduction
		25.2	 Overview of MRI
			25.2.1	 Resonance
			25.2.2	 The Echo
			25.2.3	 Image Contrast
		25.3	 Cardiac MR Techniques and Applications
			25.3.1	 Cardiac Morphology
			25.3.2	 Global Cardiac Function
			25.3.3	 Regional Myocardial Function
			25.3.4	 Myocardial Perfusion
			25.3.5	 Myocardial Viability
			25.3.6	 Blood Flow Velocity
			25.3.7	 Fiber Structure
				25.3.7.1	 Importance of Myofiber Orientation
				25.3.7.2	 Quantifying Fiber Structure with Diffusion Tensor MRI
				25.3.7.3	 Pathological Changes in Fiber Structure
			25.3.8	 Mapping
		25.4	 MRI and Biomedical Devices
			25.4.1	 Real-Time Imaging and Cardiovascular Interventions
			25.4.2	 MR-Conditional Implantable Devices and Nomenclature
		25.5	 Quantitative Analyses of Cardiac MR
			25.5.1	 Ventricular Function
			25.5.2	 Analyses of Wall Motions and Regional Myocardial Strains
				25.5.2.1	 Analyses of Relative Wall Motions
				25.5.2.2	 Analyses of Regional Myocardial Strain
			25.5.3	 Perfusion Analyses
			25.5.4	 Myocardial Scar Size
		25.6	 Summary
		References
	26: Reversible and Irreversible Damage of the Myocardium: Ischemia/Reperfusion Injury and Cardioprotection
		26.1	 Introduction
		26.2	 Basic Cardiac Metabolism
		26.3	 Myocardial Ischemia
		26.4	 Ischemic Syndromes
			26.4.1 Myocardial Stunning
			26.4.2 Hibernating Myocardium
			26.4.3 Maimed Myocardium
			26.4.4 Ischemic Preconditioning
			26.4.5 Silent Ischemia
			26.4.6 How Can the Heart Be Protected from Ischemia?
		26.5	 Reperfusion Injury
			26.5.1 Aspects of Reperfusion Injury
				26.5.1.1	 Myocardial Stunning
				26.5.1.2	 Accelerated Cell Death
				26.5.1.3	 Other Forms of Cellular Death
				26.5.1.4	 Arrhythmias
				26.5.1.5	 Microvascular Damage and No-Reflow
				26.5.1.6	 Post-pump Syndrome
		26.6	 Examples of Current Pharmacological Cardioprotective Therapies
			26.6.1 Na + /H + Exchange Blockers
			26.6.2 Antioxidants
			26.6.3 Calcium Channel Antagonists
			26.6.4 Glucose–Insulin–Potassium
			26.6.5 Growth Factors
			26.6.6 Glutamate/Aspartate
			26.6.7 Nitric Oxide (NO)
			26.6.8 Hibernation-Specific Proteins
			26.6.9 Assessment of Pharmaceutical Agents via Target Pericardial Delivery
			26.6.10 Acute and Global Assessments of the Potential Benefits of Protective Agents Administered to In Vitro to Isolated Large Mammalian Hearts
		26.7	 Conclusions
		References
Part IV: Devices and Therapies
	27: Historical Perspective of Cardiovascular Devices and Techniques Associated with the University of Minnesota
		27.1	 Introduction
		27.2	 Cross-Circulation
		27.3	 Lillehei-DeWall Bubble Oxygenator
		27.4	 Heart Block and the Development of the Pacemaker
		27.5	 Heart Valves
		27.6	 Other University-Affiliated Medical Devices
		27.7	 Medical Device Regulation
		27.8	 LifeScience Alley
		27.9	 The Institute for Engineering in Medicine
		27.10	 Medical Devices Center
		27.11	 Design of Medical Device Conference
		27.12	 Cardiovascular Physiology at the University of Minnesota
		27.13	 Summary
		References
			Additional Resources
	28: Medical Device Innovation
		28.1	 Introduction
		28.2	 Common Steps Today to Develop a Medical Device
		28.3	 How to Evaluate Your Idea
		28.4	 Moving Your Idea Forward
			28.4.1	 User Research
			28.4.2	 Testing Your Idea
			28.4.3	 Regulatory Requirements
			28.4.4	 Reimbursement
		28.5	 Patent Basics
		28.6	 Financing Your Innovative Medical Device Idea
		28.7	 Summary
		Further Reading
	29: Animal Models for Cardiac Research
		29.1	 Protocol Development
		29.2	 Spontaneously Occurring Animal Models of Congenital Cardiac Disease
		29.3	 Alternatives to Whole Animal Models
			29.3.1	 Isolated Cardiomyocytes
			29.3.2	 Isolated Perfused Hearts
			29.3.3	 Additional Problems with Isolated Perfused Heart Models
		29.4	 Animal Models Used to Test Devices for Treatment of Valvular Disease
			29.4.1	 Animal Models of Atrial Fibrillation for Preclinical Valve Testing
			29.4.2	 Pacing-Induced Atrial Fibrillation
			29.4.3	 Pharmacologic-Induced Atrial Fibrillation
			29.4.4	 Other Potential Atrial Fibrillation Models
		29.5	 Animal Models in Myocardial Ischemia
			29.5.1	 Experimental Methods for Creating Ischemia
			29.5.2	 Localizing and Quantifying Myocardial Ischemia
			29.5.3	 Specific Animal Models for Ischemia Investigations
		29.6	 Animal Models in Heart Failure and Transplantation
			29.6.1	 Methods in Transplantation Research
			29.6.2	 Specific Animal Models for Transplantation Research
				29.6.2.1 The Rodent Transplantation Model
				29.6.2.2 The Canine Transplantation Model
				29.6.2.3 The Swine Transplantation Model
				29.6.2.4 The Nonhuman Primate Transplantation Model
		29.7	 Animal Models for the Testing of Mechanical Devices
			29.7.1	 Animal Model Selection for Device Testing
			29.7.2	 Federal Guidelines for Device Testing
			29.7.3	 Explant Analysis
				29.7.3.1 Background
				29.7.3.2 Pathology in Context of the Study
				29.7.3.3 Process of Using Pathology
		29.8	 Cellular Cardiomyoplasty
			29.8.1	 The Ideal Cell Population for Cardiomyoplasty
			29.8.2	 Animal Models for Stem Cell Research
			29.8.3	 Stem Cell Delivery Methods
			29.8.4	 Stem Cell Engraftment Issues
			29.8.5	 Functional Assessment of Stem Cell Therapies
		29.9	 Summary
		References
	30: The Use of Reanimated Human and Other Large Mammalian Hearts as Means to Enhance the Design and Testing of Cardiac Devices
		30.1	 Introduction
		30.2	 Anatomical Models in Medical Device Development
		30.3	 The Isolated Beating Heart Model
		30.4	 The Visible Heart® Laboratories Methodologies
		30.5	 Translation Research with the Visible Heart®
			30.5.1	 Pacemakers and Pulse Generators
			30.5.2	 Ablation and Electrophysiology Mapping
			30.5.3	 Intracardiac Defibrillator
			30.5.4	 Valve Replacements
			30.5.5	 Left Ventricular Assist Devices
			30.5.6	 Stenting
			30.5.7	 Uses of Myocardial Pre- and Post-conditioning Agents to Aid in Treating Ischemic Events
		30.6	 The Visible Heart® Mobile Apparatus
		30.7	 Unique Educational Capabilities Offered by the Visible Heart® Laboratories
		30.8	 Limitations of the Visible Heart®
		30.9	 Conclusion
		References
	31: Cardiac Ablative Technologies
		31.1	 Introduction
		31.2	 Radiofrequency (RF) Ablation: Utility
			31.2.1	 Mechanism of Tissue Ablation
			31.2.2	 The RF Generator
			31.2.3	 Additional RF Clinical Generator Information
			31.2.4	 RF Catheter: Standard Features
			31.2.5	 Multielectrode Catheter
			31.2.6	 Irrigated Tip RF Catheters
			31.2.7	 Additional Sensors and Modifications of RF Catheters and Technologies: MicroFidelity Technologies
			31.2.8	 Tissue Contact Force
		31.3	 Cryothermal Cardiac Ablation
			31.3.1	 Mechanism of Cryo-Ablation
			31.3.2	 Available Tools for the Application of Cryotherapies
			31.3.3	 Complications and Clinical Outcomes with Cryo Therapies
		31.4	 Utility of Ultrasound Technology
			31.4.1	 Mechanisms of Ultrasound Ablation
			31.4.2	 High-Intensity-Focused Ultrasound Balloon Catheter Systems
			31.4.3	 Complications and Clinical Outcomes Employing HIFU Ablations
			31.4.4	 Low-Intensity Collimated Ultrasound System
		31.5	 Microwave Energy
			31.5.1	 Mechanisms of Cardiac Microwave Ablation
			31.5.2	 Current Microwave Generators
			31.5.3	 Microwave Ablation Catheters
			31.5.4	 Complications and Clinical Applications
		31.6	 Balloon Laser Catheter: Endoscopic Ablation System (EAS)
			31.6.1	 The Endoscopic Laser Ablation System
			31.6.2	 Laser Energy and Cardiac Ablations
			31.6.3	 Clinical Use and Safety Aspects of Laser Cardiac Ablation
		31.7	 Pulse Field Ablation (PFA)
			31.7.1	 Pulse Field Ablation System
			31.7.2	 Lesion Maturation and Thermal Effect on PFA
		31.8	 Summary
		References
	32: Catheter Ablation of Cardiac Arrhythmias
		32.1	 Introduction
		32.2	 Mechanisms of Cardiac Arrhythmias
		32.3	 Clinical Presentations and Diagnoses in the Patient Presenting with an Arrhythmia
		32.4	 Treatment Considerations
		32.5	 Tachyarrhythmias and Associated Treatment Strategies Including Electrophysiological Studies (EPS) and Catheter Ablations
			32.5.1 Premature Beat Complexes
				32.5.1.1	 Premature Atrial Complexes (PACs)
				32.5.1.2	 Premature Ventricular Complexes (PVCs)
			32.5.2 Atrial Tachycardia (AT)
			32.5.3 Multifocal Atrial Tachycardia
			32.5.4 AV Junctional Premature Complexes
			32.5.5 Sinus Tachycardia
				32.5.5.1	 Physiological Sinus Tachycardia
				32.5.5.2	 Inappropriate Sinus Tachycardia (IST)
			32.5.6 Paroxysmal Supraventricular Tachycardia (PSVT)
				32.5.6.1	 Sinus Nodal Reentry Tachycardia
				32.5.6.2	 AV Nodal Reentry Tachycardia (AVNRT)
				32.5.6.3	 AV Reentry Tachycardia (AVRT) Due to an Accessory Pathway
				32.5.6.4	 Wolff-Parkinson-White (WPW) Syndrome and Related Preexcitation Syndromes
			32.5.7 Atrial Flutter
			32.5.8 Atrial Fibrillation (AFib)
			32.5.9 Ablations of Atrial Fibrillation
				32.5.9.1	 Focal AFib Ablation
				32.5.9.2	 Segmental Ostial Isolations of Pulmonary Veins
				32.5.9.3	 Circumferential Isolations of Pulmonary Veins
				32.5.9.4	 Substrate Ablation
				32.5.9.5	 Ablation of Autonomic Targets
				32.5.9.6	 Cryoballoon Ablation of AFib
				32.5.9.7	 AV Nodal Ablations for Rate Control
				32.5.9.8	 Catheter-Based Maze Procedure
			32.5.10 Ventricular Tachycardia (VT)
			32.5.11 Ventricular Flutter and Ventricular Fibrillation
			32.5.12 Accelerated Idioventricular Rhythm
			32.5.13 Torsades de Pointes (TdP)
			32.5.14 Nonparoxysmal Junctional Tachycardias
		32.6	 Summary
		References
	33: Pacing and Defibrillation
		33.1	 Introduction
		33.2	 Cardiac Rhythms and Arrhythmias
			33.2.1	 Cardiac Function and Rhythm
			33.2.2	 Conditions of the Sinoatrial Node
			33.2.3	 Conditions of the Atrioventricular Node
			33.2.4	 Arrhythmias
		33.3	 Introduction to Implantable Pacing and Defibrillation Systems
		33.4	 Cardiac Pacing
			33.4.1	 History
			33.4.2	 Artificial Electrical Stimulation
			33.4.3	 Indications for Pacing
			33.4.4	 HRS/BPEG Codes
			33.4.5	 Implantable Pulse Generators (IPGs)
			33.4.6	 Sensing Algorithms
			33.4.7	 Drug Interactions with Pacing Systems
			33.4.8	 New Indications/Recent Clinical Trials
		33.5	 Cardiac Defibrillation
			33.5.1	 History
			33.5.2	 Tachyarrhythmias
			33.5.3	 ICD Indications
			33.5.4	 External Cardiac Defibrillators
			33.5.5	 Implantable Cardioverter Defibrillators
			33.5.6	 Sensing and Detection
			33.5.7	 ICD Therapies
			33.5.8	 Pharmacologic Considerations in the Management of Tachyarrhythmias
			33.5.9	 Indications/Clinical Trials
			33.5.10	 Pacing and Defibrillation Leads
			33.5.11	 Leadless Pacing
			33.5.12	 New ICD Technologies
		33.6	 Summary
		References
			Additional Text Sources
	34: Cardiac Resynchronization Therapy
		34.1	 Introduction
		34.2	 Development of CRT
		34.3	 Mechanisms of CRT
			34.3.1	 Impact of LBBB and HF on Ventricular Electrical and Mechanical Function
			34.3.2	 Improvement of Cardiac Function with CRT
		34.4	 Implantation of CRT
			34.4.1	 Left Ventricular Leads
			34.4.2	 ComplicationsAssociated with CRT
		34.5	 Clinical Trials in CRT
			34.5.1	 Moderate to Severe HF
			34.5.2	 Mild HF
			34.5.3	 Mechanical Dyssynchrony, Narrow QRS duration, and AV Block
		34.6	 Factors Influencing CRT Response
			34.6.1	 QRS Duration, Morphology, and QRS to LV EGM onset (QLV)
			34.6.2	 Patient Sex and Height
			34.6.3	 LV Lead Positions, Myocardial Scar, and Mechanical Dyssynchrony
			34.6.4	 Role of Baseline Mechanical Dyssynchrony, Scar, and Implications for LV Lead Positioning
			34.6.5	 AV and VV Optimization
			34.6.6	 Atrial Arrhythmias, Atrial Fibrillation, and Percentage of Biventricular Pacing
			34.6.7	 Effective CRT
			34.6.8	 Reappraisal of CRT Response
		34.7	 Future Directions
			34.7.1	 Multisite LV Pacing
			34.7.2	 Conduction System Pacing
			34.7.3	 LV Endocardial Pacing
			34.7.4	 Image Guidance and Navigation
		34.8	 Summary
		References
	35: Cardiopulmonary Bypass and Cardioplegia
		35.1	 History of Cardiopulmonary Bypass
		35.2	 Cardiopulmonary Bypass Machine Basics
		35.3	 Physiology of Cardiopulmonary Bypass
			35.3.1	 Anticoagulation
			35.3.2	 Cardiopulmonary Bypass-Related Systemic Inflammatory Response
			35.3.3	 Hemodilution
		35.4	 Intraoperative Management of Cardiopulmonary Bypass
			35.4.1	 Heart Lung Machine Priming
			35.4.2	 Cannulation
				35.4.2.1	 Venous Drainage
				35.4.2.2	 Arterial Return
			35.4.3	 Perfusion Pressures and Hemodynamics
			35.4.4	 Perfusion Temperatures
			35.4.5	 Circulatory Arrest and Cerebral Perfusion Strategies
		35.5	 Cardioplegia
			35.5.1	 Cardioplegia Administration
			35.5.2	 Type of Cardioplegia Solutions
				35.5.2.1	 Crystalloid Cardioplegia
				35.5.2.2	 Blood-Based Cardioplegia
			35.5.3	 Adjunct Topical Hypothermia
		35.6	 Weaning and Decannulation
		35.7	 Summary
		References
	36: Mechanical Circulatory Support Devices for Pediatric Patients
		36.1	 Introduction
		36.2	 Historical Notes
		36.3	 Heart Failure in Pediatric Patients
		36.4	 Types of Circulatory Support Pumps/Devices
		36.5	 Short-Term Support
		36.6	 Long-Term Support
		36.7	 Challenges of Designing Pediatric Ventricular Assist Devices
		36.8	 Future Pediatric Devices
		36.9	 VAD Management and Complications
		36.10	 Summary
		References
	37: Valvular Heart Disease
		37.1	 Introduction
		37.2	 A New Frontier: Valve Replacement
			37.2.1	 Mechanical Prosthetic Valves
			37.2.2	 Biological Prosthetic Valves
			37.2.3	 Biological Versus Mechanical Valves
			37.2.4	 Prosthetic Heart Valve Endocarditis and Performance Tracking
		37.3	 Specific Valvular Diseases: Etiologies and Treatments
			37.3.1	 Aortic Valve Disease
				37.3.1.1	 Aortic Stenosis
				37.3.1.2	 Aortic Sclerosis
				37.3.1.3	 Aortic Regurgitation
				37.3.1.4	 Chronic Aortic Regurgitation
				37.3.1.5	 Acute Aortic Regurgitation
				37.3.1.6	 Aortic Valve Disease Associated with Disease of the Ascending Aorta
				37.3.1.7	 Treatment of Aortic Regurgitation
			37.3.2	 Diseases of the Mitral Valve
				37.3.2.1	 Mitral Stenosis
				37.3.2.2	 Mitral Regurgitation
			37.3.3	 Tricuspid Valve Disease
		37.4	 Summary
		References
	38: Minimally Invasive Cardiac Surgery
		38.1	 Introduction
		38.2	 Impacts of Incision Size
		38.3	 Side-Effects of Cardiopulmonary Bypass
		38.4	 Effects of Manipulating the Aorta
		38.5	 Technological Innovations
			38.5.1	 Sternum Sparing Surgery: Partial Sternotomy, Minithoracotomy, and Thoracoscopy
				38.5.1.1	 Upper Partial Sternotomy or Minithoracotomy Approaches for Aortic Valve Replacement
			38.5.2	 OPCABG Improvement
			38.5.3	 Aortic Non-Touch Techniques
			38.5.4	 Endoscopic Robotics
		38.6	 Future Directions
		References
	39: Transcatheter Valve Repair and Replacement
		39.1	 Introduction
		39.2	 Pulmonic Valve
		39.3	 Aortic Valve
		39.4	 Mitral Valve
		39.5	 Tricuspid Valve
		39.6	 Imaging
		39.7	 Training Systems
		39.8	 Summary
		References
	40: Percutaneous Coronary Intervention: Devices, Research, and Clinical Implications
		40.1	 Introduction
		40.2	 Procedural Process of PCI
		40.3	 Coronary Angioplasty and Stenting
			40.3.1	 Balloon Angioplasty
			40.3.2	 Bare Metal Stents
			40.3.3	 Drug-Eluting Stents
			40.3.4	 Bifurcation Stenting Techniques
			40.3.5	 Provisional Stenting Technique
			40.3.6	 Two-Stent T or T with a Small Protrusion (TAP) Techniques
			40.3.7	 Two-Stent Culotte Techniques
			40.3.8	 Two-Stent Crush Techniques
			40.3.9	 Dedicated Bifurcation Stents
			40.3.10	 Covered Stents
			40.3.11 Biodegradable Stents
			40.3.12 Drug-Coated Balloons
		40.4	 Post-procedure Stent Assessment
			40.4.1	 Dissection
			40.4.2	 Lumen Diameter and Cross-Sectional Area
			40.4.3	 Malapposition
			40.4.4	 Neo-Carina Positioning
		40.5	 Lesion Preparation
			40.5.1	 Specialty Balloons
			40.5.2	 Rotational and Orbital Atherectomy
			40.5.3	 Laser Atherectomy
			40.5.4	 Lithotripsy
		40.6	 Chronic Total Occlusion (CTO)
			40.6.1	 Diagnosis of CTO
			40.6.2	 Techniques for Treating CTOs
			40.6.3	 Devices Employed for CTO Procedures
		40.7	 Imaging and Assessment
			40.7.1	 Invasive Coronary Angiography (ICA) and Fluoroscopy
			40.7.2	 Intravascular Ultrasound (IVUS)
			40.7.3	 Optical Coherence Tomography (OCT)
			40.7.4	 Fractional Flow Reserve
			40.7.5	 Computed Tomography
		40.8	 Training, Education, and Preclinical Research
		40.9	 Summary
		References
	41: Cardiac Septal Defects: Treatment via the Amplatzer® Family of Devices
		41.1	 Introduction
		41.2	 Amplatzer Devices
			41.2.1	 Safety
		41.3	 Preclinical Animal Models Mimicking Congenital Defects
		41.4	 Atrial Septal Defects
			41.4.1	 History
		41.5	 Amplatzer Device Designs
			41.5.1	 Preclinical Animal Testing of the Amplatzer Device Designs
			41.5.2	 Required Testing for FDA Approval
			41.5.3	 Continued Animal Research and Translation to Humans
			41.5.4	 Improved Delivery System: Trevisio™ Intravascular Delivery System
			41.5.5	 Other Family of Atrial Septal Occluders: The Gore Occluders
		41.6	 The Patent Ductus Arteriosus
			41.6.1	 Preclinical Animal Testing of the Amplatzer Ductal Occluder and Translation to Human Procedures
			41.6.2	 Preclinical Animal Trials Designed to Test Prototype Angled Amplatzer Ductal Occluder Devices
			41.6.3	 Redesign of a Ductal Occluder Device Without Fabric and a Flexible Retention Disc Orientation
			41.6.4	 Preemie PDA Closure: The Amplatzer Piccolo Device
		41.7	 Muscular Ventricular Septal Defects
			41.7.1	 Preclinical Animal Trials Designed to Test Ventricular Closure Devices
		41.8	 Perimembranous Ventricular Septal Defects
			41.8.1	 Preclinical Animal Trials Designed to Test Perimembranous Ventricular Septal Occluders
		41.9	 Summary
		References
	42: Left Atrial Appendage Closure and Exclusion Devices for Stroke Risk Reduction in Patients with Atrial Fibrillation
		42.1	 Introduction
			42.1.1	 LAA and Impact on Stroke
		42.2	 Surgical Left Atrial Appendage Exclusion
			42.2.1	 LAA Therapeutic Devices
			42.2.2	 AtriClip
				42.2.2.1	 Clinical Evidence for AtriClip Outcomes
			42.2.3	 Medtronic Penditure LAA Surgical Closure System
				42.2.3.1	 Clinical Evidence for Penditure Outcomes
			42.2.4	 The LARIAT LAA Exclusion System
				42.2.4.1	 Clinical Evidence for LARIAT Outcomes
			42.2.5	 Surgical LAAE Device Complications
		42.3	 Endocardial Transcatheter Left Atrial Appendage Closure
			42.3.1	 Procedure Steps in Percutaneous LAAC
			42.3.2	 Devices
				42.3.2.1	 Design Features of the LAAC—WATCHMAN Device
				42.3.2.2	 The Amulet LAAC Device
					42.3.2.2.1 Clinical Evidence for the AMPLATZER LAAC Device
				42.3.2.3	 Other Devices in Clinical Trials or with EU Approvals
					42.3.2.3.1 LAAC Procedural Complications
			42.3.3	 Post-Procedural Complications with LAAC
		42.3.4	 Summary
		References
	43: Advancing Field of Neurocardiology: Physiologic Mechanisms and Devices
		43.1	 Introduction
		43.2	 The Physiological Link Between the Cardiac and Autonomic System
			43.2.1	 The Sympathetic System Innervating the Heart
			43.2.2	 Parasympathetic System Innervating the Heart
		43.3	 Therapeutic Interventions Targeting the Autonomic Nervous System
			43.3.1	 Vagal Stimulation
				43.3.1.1	 Vagal Stimulation in HF and AF Patients
				43.3.1.2	 Challenges in Optimizing a Patient’s Programming for Vagal Stimulation
				43.3.1.3	 Stimulating a Vagal Branch: Auricular Stimulation
				43.3.1.4	 Auricular Stimulation of Vagal Branch (tVNS) to Treat Heart Failure
				43.3.1.5	 Auricular Stimulation of Vagal Branch to Prevent Atrial Arrhythmias
				43.3.1.6	 Auricular Stimulation of Vagal Branch (tVNS) to Prevent Ischemia-Reperfusion Injury After MI
				43.3.1.7	 AV-Node Stimulation for Shock Reduction and Anti-inflammatory Benefits
				43.3.1.8	 Future Perspectives for Clinical Uses of Vagal Stimulation Therapies
			43.3.2	 Spinal Cord Stimulation
				43.3.2.1	 Spinal Cord Stimulation to Treat HFrEF
				43.3.2.2	 Spinal Cord Stimulation for the Prevention of Arrhythmias
				43.3.2.3	 Future Perspectives on SCS
			43.3.3	 Baroreceptor Activation Therapy
				43.3.3.1	 Hypertension
				43.3.3.2	 Baroreceptors
				43.3.3.3	 Baroreceptor Activation Therapy for Hypertension
				43.3.3.4	 BAT for HFrEF Patients
				43.3.3.5	 Carotid Artery Stents to Modify Baroreflex Responses
				43.3.3.6	 Future Perspectives for Baroreflex Therapy
			43.3.4	 Dorsal Root Ganglion Stimulation to Promote Diuresis in HF Patients
				43.3.4.1	 The Potential for Dorsal Root Ganglion Stimulation to Lower Blood Pressure
			43.3.5	 Cardiac Nerve Stimulation for Modulating Autonomics
				43.3.5.1	 Future Perspectives on Cardiac Nerve Stimulation
			43.3.6	 Skin Sympathetic Nerve Activity
		43.4	 Ablation Techniques for Autonomic Modulation
			43.4.1	 Splanchnic Bed Denervation
			43.4.2	 Renal Denervation to Reduce Blood Pressure
			43.4.3	 Renal Denervation to Treat the HF Patient
			43.4.4	 Renal Denervation and the Kidney Responses
			43.4.5	 Stellate Ganglion Ablation-Cardiac Sympathetic Denervation to Reduce Ventricular Arrhythmias
		43.5	 Summary
		Abbreviations/Terms
		References
	44: New Device Technologies for Treating and Monitoring Acute Decompensated and Chronic Heart Failure Patients
		44.1	 Introduction
		44.2	 Mechanisms of Heart Failure and Diagnostic Applications for Detection, Monitoring, and Therapeutic Management
		44.3	 Historical Concepts of Impedance Monitoring
			44.3.1	 Impedance Theory
		44.4	 Bioimpedance Monitoring
		44.5	 Bioreactance Monitoring
		44.6	 Other Novel Implantable Impedance Devices for HF Management
		44.7	 Impedance Multi-Sensor Diagnostic Solution for HF Management
		44.8	 Other Devices in Development as Therapies for the Heart Failure Patient
			44.8.1	 Devices Solution via Induced Structural Changes
			44.8.2	 Carillon Mitral Contour System
			44.8.3	 V-Sling System
			44.8.4	 AccuCinch System
		44.9	 Devices to Provide Electrophysiologic Therapies to Enhance Function
		44.10	 Device-Based Acute Decompensated Heart Failure Therapies
		44.11	 Summary
		References
	45: Harnessing Cardiopulmonary Interactions to Improve Circulation and Outcomes After Cardiac Arrest and Other States of Low Blood Pressure
		45.1	 Introduction
		45.2	 Sudden Cardiac Arrest
		45.3	 The Impedance Threshold Device for Cardiac Arrest
		45.4	 Effects of Incomplete Chest Wall Recoil and Hyperventilation on the Quality of Standard CPR
		45.5	 Optimizing Outcomes with Standard CPR and the Impedance Threshold Device
		45.6	 Active Compression-Decompression CPR
		45.7	 Treatment of Life-Threatening Hypotension with ITD in Spontaneously Breathing Patients
		45.8	 ITPR Therapy: A Potential Novel Treatment of Severe Hypotension in Severely Ill Patients
		45.9	 Summary
		References
	46: End-Stage Congestive Heart Failure in the Adult Population: Ventricular Assist Devices
		46.1	 Introduction
		46.2	 A Brief History of Pump Design—Classification of VADs
		46.3	 VADs Defined by Mechanics and Clinical Applications
			46.3.1	 Volume Displacement Pumps (Pulsatile Pumps)
			46.3.2	 Continuous Flow Pumps: Axial Designs
			46.3.3	 Continuous Flow Pumps: Centrifugal Design
		46.4	 VAD Implantation Techniques
		46.5	 Device Management
		46.6	 University of Minnesota VAD Experience
			46.6.1	 University of Minnesota VAD Experience: Computational Modeling and 3D Printing
		46.7	 Summary
		References
	47: Clinical Trial Requirements for Cardiac Devices
		47.1	 Introduction
		47.2	 Clinical Trial Regulations
			47.2.1	 Regulatory Bodies
				47.2.1.1	 The United States Food and Drug Administration (FDA)
				47.2.1.2	 European Union
				47.2.1.3	 Other Regulatory Bodies
				47.2.1.4	 International Organization for Standardization
				47.2.1.5	 Good Clinical Practice
		47.3	 Overview of the Clinical Trial Process
		47.4	 Clinical Trial Design and Protocol Development
		47.5	 Statistical Considerations
		47.6	 Clinical Trial Setup and Initiation
		47.7	 Clinical Trial Execution
			47.7.1	 Data Collection
			47.7.2	 Complications and Reported Complication Rates
		47.8	 Clinical Trial Follow-Up and Closeout
		47.9	 Regulatory Submissions
		47.10	 Reimbursement and Payer Information
		47.11	 Summary
		References
	48: Virtual and Augmented Realities for Cardiac Education and Device Training
		48.1	 Introduction
		48.2	 Mixed Reality (MR) Application Creation Process
			48.2.1	 Needed Collaborations
			48.2.2	 Software Development: High-Level Considerations
			48.2.3	 Software Development: Low-Level Parameters
		48.3	 Current Applications
			48.3.1	 Virtual Reality
				48.3.1.1	 Heart Education Tool (Fig. 48.1)
				48.3.1.2	 Stenting Simulator (Fig. 48.2)
				48.3.1.3	 Amplatzer Placement Simulator (Fig. 48.3)
				48.3.1.4	 Seldinger Technique Guidewire Simulator (Fig. 48.4)
				48.3.1.5	 Left Bundle Branch Pacing Simulator (Fig. 48.5)
				48.3.1.6	 TEE Simulator (Fig. 48.6)
				48.3.1.7	 TTE Simulator (Fig. 48.7)
			48.3.2	 Augmented Reality
				48.3.2.1	 Heart to Learn (Fig. 48.8)
				48.3.2.2	 UMN CHDs (Fig. 48.9)
				48.3.2.3	 UMN Stents (Fig. 48.10)
				48.3.2.4	 AR TTE (Fig. 48.11)
		48.4	 Utilizing Mixed Reality Training at the University of Minnesota Medical Center to Improve Transesophageal Echocardiography (TEE) Skill Acquisition
			48.4.1	 Uses of Mixed Reality Teaching within the Adult Cardiothoracic Anesthesiology (ACTA) Fellowship
			48.4.2	 The Required Clinical Skills for Performing a TEE
			48.4.3	 Details of Developed VR TEE Simulator
			48.4.4	 Standardized TEE Views Represented within 3D-Printed Heart Models
		48.5	 Summary
		References
	49: Cardiac Devices and Technologies: Continued Rapid Rates of Development
		49.1	 Introduction
		49.2	 Resuscitation Systems and Devices
		49.3	 Implantable Therapies
			49.3.1	 Left Atrial Appendage/Atrial Fibrillation Therapy
			49.3.2	 Cardiac Remodeling
		49.4	 Catheter-Delivered Devices
			49.4.1	 Stents
			49.4.2	 Catheter-Delivered Leads or Pacemakers
		49.5	 Implantable Sensors
		49.6	 Procedural Improvements
		49.7	 Training Systems
		49.8	 Summary
		References
			Website Sources
Index