Daniel Burkhoff, MD, PhD, is Director of Heart Failure, Hemodynamics and Mechanical Circulatory Support Research at the Cardiovascular Research Foundation and an Adjunct Associate Professor of Medicine at Columbia University in the City of New York. He holds degrees in Applied and Engineering Physics (BS, Cornell University), a medical degree (The Johns Hopkins Medical School) and a doctorate degree in Biomedical Engineering (The Johns Hopkins University). He has published over 230 peer reviewed articles in the fields of ventricular mechanics, heart failure, medical devices and cardiovascular modeling.

Marc L Dickstein MD is a Professor of Anesthesiology at Columbia University Medical Center and a member of the Division of Cardiothoracic Anesthesia at New York Presbyterian Hospital. He manages patients on cardiopulmonary bypass, ECMO, LVADs, and other types of Mechanical Circulatory Support (MCS) as part of his clinical practice. His research interests include ventricular physiology, RV failure, and MCS. He has a passion for teaching and has received numerous teaching awards including the Columbia University Presidential Award for Outstanding Teaching.

One unique aspect of this Textbook is the incorporation of a relatively sophisticated, real-time model of the cardiovascular system that is used to explain the dynamic interactions between heart and vasculature. Elements of the model pop up during Try it Now options in which specific parameter values can be varied and effects observed. Use of the model is required to complete many of the Tutorials. In addition, the entire simulation can be called by returning to the Main Menu and tapping the simulation icon. So, exactly how is the model constructed?

Hydraulic networks (like the circulatory system) can be represented by electronic circuits because of the analogies between flow of fluids through pipes and flow of electrical currents through conducting wires, between pressure and voltage, between hydraulic and electrical resistance, and between hydraulic and electrical capacitance. One electrical representation of the cardiovascular system is depicted in the following Figure.

The atria and ventricles are represented by time-varying capacitances (shown by capacitors with the arrows through them). Each vascular system is represented by a series of resistances and capacitors. The heart valves are represented by diodes that permit flow in only one direction.

Using this model as a guide, a set of time varying, simultaneous differential equations can be derived to represent the circulatory system. These equations are solved in real-time and the results yield real time pressure, volume and flow tracings that form the basis of the simulations used in this textbook. More complex models of the cardiovascular system are available. However, it is remarkable how much circulatory physiology and pathophysiology this simple model explains. Of course, it is not necessary to have any understanding of electronic circuitry or differential equations to understand the remainder of this text; all explanations are based on descriptions of physiological principles without detailed reference to this model.

In addition to the basic model shown above, more complex situations can be modeled. Two examples are shunts between the atria (atrial septal defect) and between the ventricles (ventricular septal defects). The corresponding models are shown in the figures below.

Other examples of advanced model features include the ability to introduce mechanical circulatory support devices (whose inlet and outlet sites can be selected) and the ability to simulate regurgitant and stenotic lesions into any one of the cardiac valves.

In addition to these types of model enhancements, other advanced features are incorporated into the model, such as heart cycle-dependent contractility, a pericardium, coronary vasculature, myocardial work-oxygen consumption relations and effects of simple cardiovascular drugs. These features are described in detail in various textbook chapters.

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Harvi-Student Translation Editors

Chinese: Yuhui Sun, MD, Kunlun He, MD, and Hanyu Zhang, MD
German: Karl-Philip Rommel, MD y Philipp Lurz, MD
Portuguese: Livia Melro, MD e Vinícius Zofoli, MD
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Chinese: Yuhui Sun, MD, Kunlun He, MD, and Hanyu Zhang, MD
German: Karl-Philip Rommel, MD and Philipp Lurz, MD
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