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Restore effective atrial contribution to ventricular filling during AF…
Restore effective atrial contribution to ventricular filling during AF (
Physiologic
)
Right Atria
:Fire: HMW Utilize RA contraction to augment LA contraciton
Buttress the Atrial septum to improve LA contractile force
Right Ventricle
HMW Utilize elevated PA pressure during diastole :fire:
HMW- Use the RV contraction to augment LV diastolic filling? :fire:
Change ventricular septal shape so under RV contraction creates more LV suction
PA/ Aorta
HMW- Utilize Aortic recoil during diastole
HMW- use elevated PA pressure to empty the LA
Left Atria
HMW- Maximize passive atrial elastic contraciton (NOT active contraction- think equivalent of Titin protein vs actin/myosin)
Anchor the LA to the pericardium
HMW- Increase the reservoir function of the left atrium
:fire: HMW- Directly assist atrial contraction
Ballon based pneumatic pump
Spring implanted into the atria that expands and then contracts
External pump
Trans mechanical pump
External LAAD
HMW- Utilize the LAA
Spring inside and outiside the appendage
Spring tethered from the apex of the LAA to the ventricular wall
:fire: HMW- Minimize energy/ flow not directed to fill the LV
:fire: HMW- Transform the LA and LV into a single pump (Inspired by cor-triatriatum sinister)
Move the MV plane proximally so that you give some of the LA to the LV
HMW- Prevent LAE
Tack the LA to the pericardium
Mitral Valve/ Inflow
HMW Increase transmitral pressure gradient :fire:
Mitral valve pump
Delayed mitral valve closing to increase pressure gradient
HMW Optimize transmitral flow patterns :fire:
Create something analagous to the Eustacean valve
HMW Utilize mitral valve apical displacement during systole
HMW entrain flow to go into LV
Jet pump from pA
Left Ventricle
HMW Improve LV compliance
Device to break up the fibrosis
Add something to the LV wall to make it softer
Dynamic horizontally translatable valve. Valve on train tracks that moves outward during diastole and in during systole
HMW Improve LV relaxation time/rate/amount :fire:
V-sling like coil but spring out LV
HMW Maximize passive ventricular filling
Augment the suction of the LV during early diastole
Pin the LV apex down?
Shunting to the middle cardiac vein
HMW convert ventricular systolic energy to atrial emptying
Directly connect the LA posterior wall to the LV via a delayed mechanical device
Fill a balloon that is next to the LA to squeeze the LA
Use 3 balloons one of which is elastic
HMW Decrease ESV to prepare it for diastolic filling :fire:
Balloon in the ventricle that inflates during systole and decreases in diastole- Increases CO, decreases ESV and creates suction during diastole
Extracardiac
HMW- Utilize diaphagm contraction to assist with LA emptying
Increase relaxation of LV with diaphram pacing
HMW- Optimize sympathetic signal to augment contraction/ relaxation
Coronary Sinus
Coronary Arteries
SA Node
AV Node
Atrial Septum
Pulmonary Veins
Ventricular Septum
Pericardium
HMW- Utilize the interventricular dependence
Vagus Nerve/ Parasympathetics
Stellate Ganglia/ Sympathetics
Reverse Brainstorm
HMW- Prevent any blood from getting into the LV from the LA
HMW- decrease the LV's capacity to accept blood
HMW- Limit the ability for the LA to contract
HMW- Fill the LA faster than it can empty
HMW- Increase the end diastolic pressure in the aorta to maximize LVESV
HMW- Incompletely empty the LV
Restore effective atrial contribution to ventricular filling during AF (
Solution
)
Mechanical
HMW- Utilize a pump
Continuous
Pneumatic
HMW- Utilize a new valve location
HMW- utilize a vaccuum
Utilize a balloon
HMW- Utilize a self-expanding cage
HMW- Utilize a self-collapsing cage/ Spring
HMW- Utilize vibration
Digital
Pharmacologically
Electrical
HMW- Use electrical stimulation
HMW- Sense LV contraction
Non-Invasive
HMW- Stimulate atrial contraction non-invasively?