Ulrich Kertzscher

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (81)108.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Drivelines for ventricular assist devices and catheters for peritoneal dialysis are percutaneous implants which are designed for a dwell time of at least one year. The testing of such percutaneous devices in animal experiments should represent this long period, since infection episodes can occur a long time after implantation. Usually, these animal experiments are the final step in the previous development of the implant and represent a high monetary value. However, a single malfunction is already sufficient to end the experiment. As part of a research project preclinical testing of percutaneous implants was performed in goats. Although the percutaneous devices do not cause pain, the animals will bite and pull at them and endanger the experiment. Therefore, protection of the implant is required. Standard wound dressing is not sufficient and appropriate protective garments for goats are not commercially available. Therefore, custom fit protective waistcoats were designed and manufactured. To this end the size of the goats was measured and a pattern for sewing was created. A polyester mesh fabric provides the necessary resistance and good breathability. The waistcoats were reinforced with polyethylene foam to prevent biting through the garment. Side-release buckles were chosen as fasteners. A total of six waistcoats were manufactured. They fit the goats tightly, while preserving the full range of motion. The goats tolerate them well. They are durable, secure and effectively protected the implants for a period of over one year.
    BMT 2014 - 48. Jahrestagung der DGBMT; 10/2014
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    ABSTRACT: Pressure drop associated with coarctation of the aorta (CoA) can be successfully treated surgically or by stent placement. However, a decreased life expectancy associated with altered aortic hemodynamics was found in long-term studies. Image-based computational fluid dynamics (CFD) is intended to support particular diagnoses, to help in choosing between treatment options, and to improve performance of treatment procedures. This study aimed to prove the ability of CFD to improve aortic hemodynamics in CoA patients. In 13 patients (6 males, 7 females; mean age 25 ± 14 years), we compared pre- and post-treatment peak systole hemodynamics [pressure drops and wall shear stress (WSS)] vs. virtual treatment as proposed by biomedical engineers. Anatomy and flow data for CFD were based on MRI and angiography. Segmentation, geometry reconstruction and virtual treatment geometry were performed using the software ZIBAmira, whereas peak systole flow conditions were simulated with the software ANSYS(®) Fluent(®). Virtual treatment significantly reduced pressure drop compared to post-treatment values by a mean of 2.8 ± 3.15 mmHg, which significantly reduced mean WSS by 3.8 Pa. Thus, CFD has the potential to improve post-treatment hemodynamics associated with poor long-term prognosis of patients with coarctation of the aorta. MRI-based CFD has a huge potential to allow the slight reduction of post-treatment pressure drop, which causes significant improvement (reduction) of the WSS at the stenosis segment.
    Annals of biomedical engineering. 09/2014;
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    ABSTRACT: Coils and flow diverters or stents are devices successfully used to treat cerebral aneurysms. Treatment aims to reduce intra-aneurysmal flow, thereby separating the aneurysmal sac from the blood circulation. The focus and this manuscript combining literature review and our original research is an analysis of changes in aneurysmal hemodynamics caused by endovascular treatment devices. Knowledge of post-treatment hemodynamics is a path to successful long-term treatment. Summarizing findings on hemodynamic impact of treatment devices, we conclude: coiling and stenting do not affect post-treatment intra-aneurysmal pressure, but significantly alter aneurysmal hemodynamics through flow reduction and a change in flow structure. The impact of treatment devices on aneurysmal flow depends, however, on a set of parameters including device geometry, course of placement, parent vessel and aneurysm geometry.
    Expert Review of Medical Devices 06/2014; 11(4). · 2.43 Impact Factor
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    ABSTRACT: Hunterian ligation affecting hemodynamics in vessels was proposed to avoid rebleeding in a case of a fenestrated basilar artery aneurysm after incomplete coil occlusion. We studied the hemodynamics in vitro to predict the hemodynamic changes near the aneurysm remnant caused by Hunterian ligation. A transparent model was fabricated based on three-dimensional rotational angiography imaging. Arteries were segmented and reconstructed. Pulsatile flow in the artery segments near the partially occluded (coiled) aneurysm was investigated by means of particle image velocimetry. The hemodynamic situation was investigated before and after Hunterian ligation of either the left or the right vertebral artery (LVA/RVA). Since post-ligation flow rate in the basilar artery was unknown, reduced and retained flow rates were simulated for both ligation options. Flow in the RVA and in the corresponding fenestra vessel is characterized by a vortex at the vertebrobasilar junction, whereas the LVA exhibits undisturbed laminar flow. Both options (RVA or LVA ligation) cause a significant flow reduction near the aneurysm remnant with a retained flow rate. The impact of RVA ligation is, however, significantly higher. This in vitro case study shows that flow reduction near the aneurysm remnant can be achieved by Hunterian ligation and that this effect depends largely on the selection of the ligated vessel. Thus the ability of the proposed in vitro pipe-line to improve hemodynamic impact of the proposed therapy was successfully proved.
    The International journal of artificial organs 05/2014; 37(4):325-35. · 1.76 Impact Factor
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    ABSTRACT: PurposeTo reduce the need for diagnostic catheterization and optimize treatment in a variety of congenital heart diseases, magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) is proposed. However, data about the accuracy of CFD in a clinical context are still sparse. To fill this gap, this study compares MRI-based CFD to catheterization in the coarctation of aorta (CoA) setting.Materials and Methods Thirteen patients with CoA were investigated by routine MRI prior to catheterization. 3D whole-heart MRI was used to reconstruct geometries and 4D flow-sensitive phase-contrast MRI was used to acquire flows. Peak systolic flows were simulated using the program FLUENT.ResultsPeak systolic pressure drops in CoA measured by catheterization and CFD correlated significantly for both pre- and posttreatment measurements (pre: r = 0.98, p = 0.00; post: r = 0.87, p = 0.00). The pretreatment bias was −0.5 ± 3.33 mmHg (95% confidence interval −2.55 to 1.47 mmHg). CFD predicted a reduction of the peak systolic pressure drop after treatment that ranged from 17.6 ± 5.56 mmHg to 6.7 ± 5.58 mmHg. The posttreatment bias was 3.0 ± 2.91 mmHg (95% CI −1.74 to 5.43 mmHg).Conclusion Peak systolic pressure drops can be reliably calculated using MRI-based CFD in a clinical setting. Therefore, CFD might be an attractive noninvasive alternative to diagnostic catheterization.J. Magn. Reson. Imaging 2014. © 2014 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 04/2014; · 2.57 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 09/2013; · 1.16 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 09/2013; · 1.16 Impact Factor
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    ABSTRACT: Aortic coarctation (CoA) accounting for 3-11% of congenital heart disease can be successfully treated. Long-term results, however, have revealed decreased life expectancy associated with abnormal hemodynamics. Accordingly, an assessment of hemodynamics is the key factor in treatment decisions and successful long-term results. In this study, 3D angiography whole heart (3DWH) and 4D phase-contrast magnetic resonance imaging (MRI) data were acquired. Geometries of the thoracic aorta with CoAs were reconstructed using ZIB-Amira software. X-ray angiograms were used to evaluate the post-treatment geometry. Computational fluid dynamics models in three patients were created to simulate pre- and post-treatment situations using the FLUENT program. The aim of the study was to investigate the impact of the inlet velocity profile (plug vs. MRI-based) with a focus on the peak systole pressure gradient and wall shear stress (WSS). Results show that helical flow at the aorta inlet can significantly affect the assessment of pressure drop and WSS. Simplified plug inlet velocity profiles significantly (p < 0.05) overestimate the pressure drop in pre- and post-treatment geometries and significantly (p < 0.05) underestimate surface-averaged WSS. We conclude that the use of the physiologically correct but time-expensive 4D MRI-based in vivo velocity profile in CFD studies may be an important step towards a patient-specific analysis of CoA hemodynamics.
    Annals of Biomedical Engineering 08/2013; · 3.23 Impact Factor
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    ABSTRACT: Background and Study Aims Image-based computational fluid dynamics (CFD) provides a means for analysis of biofluid mechanical parameters of cerebral aneurysms. This may enable patient-specific rupture risk analysis and facilitate treatment decisions. Application of different imaging methods may, however, alter the geometrical basis of these studies. The present study compares geometry and hemodynamics of an aneurysm phantom model acquired by means of magnetic resonance imaging (MRI), computed tomography (CT), and rotational angiography (3DRA).Materials and Methods The phantom model of a basilaris artery aneurysm was fabricated based on data generated by CT angiography. This model underwent imaging by means of CT, MRI, and 3DRA. We compared the geometrical reconstructions using the original dataset with those obtained from CT, MRI, and 3DRA. Similarly, CFD analyses were performed using the four reconstructions (3DRA, MRI, CT, and original dataset).Results MRI and the 3DRA-based reconstructions yield mean reconstruction errors of 0.097 mm and 0.1 mm, which are by a factor of 2.5 better than the CT reconstruction. The maximal error for the aneurysm radius (7.11 mm) measurement was found in the 3DRA reconstruction and was 3.8% (0.28 mm). A comparison of calculated time-averaged wall shear stress (WSS) shows good correlations for the entire surface and, separately, for the surface of the aneurysmal sack. The maximal error of 8% of the mean WSS calculation of the whole surface was found for the CT reconstruction. The calculations of the aneurysmal sack mean WSS from the MRI reconstruction were estimated to have a maximal error of 7%.Conclusion All three imaging techniques (CT, MRI, 3DRA) adequately reproduce aneurysm geometry and allow meaningful CFD analyses.
    Journal of neurological surgery. Part A, Central European neurosurgery. 05/2013;
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    ABSTRACT: In the course of pulmonary research, understanding alveolar tissue dynamics plays a critical role in the treatment of patients suffering from acute lung diseases. As a gold standard technique for monitoring micro scale changes of lung tissue, real-time intra-vital microscopy (IVM) has been established to evaluate the behavior of the alveolar tissue. To allow profound qualitative and quantitative conclusions, characteristic features of the obtained images have to be thoroughly understood. These factors are strongly influenced by the imaging setup and physiological condition of the lung. To circumvent misinterpretations, a ray-tracing approach has been applied in this study using an idealized geometry of the mouse lung parenchyma deduced from optical coherence tomography (OCT) as a complementary imaging technique. Basic features of IVM images are double ring structures and disappearing of alveoli related to liquid infiltration. Ray propagation analysis reveals the formation of these features by two major reflection processes: partial reflection and total internal reflection. The results give rise to quantification errors of the alveolar area related to reflexes misinterpreted as alveolar borders and should further be used to yield a correction factor for future IVM lung tissue studies.
    European Conference on Biomedical Optics; 05/2013
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    ABSTRACT: The suggested concept of rhinorespiratory homeostasis is a new theoretical model for the discussion of physiologic and physical principles of nasal breathing. This model is based on a comprehensive view of nasal functions that takes comparative animal physiology into account. Consequently, it has a universal cross-species character and emphasizes the central role of nasal secretion. In contrast to the established view, the focus is transferred from the inspired air to the nasal wall. This concept considers the parietal effect of airflow represented by wall shear stress with special regard to the epithelial lining fluid. It delivers one possible mechanism of an inherent triggering of the nasal cycle. Furthermore, the issue of biological fluid-structure interaction is introduced. This article presents a rethinking of nasal breathing that was inspired by clinical experience and results of flow field investigations through computational fluid dynamics. Full text under: https://www.thieme-connect.com/ejournals/pdf/10.1055/s-0033-1341590.pdf
    Facial Plastic Surgery 04/2013; 29(2):085-092. · 0.92 Impact Factor
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    ABSTRACT: Platelet deposition to collagen-coated surface under low shear conditions was investigated using an experimental model. The flow chamber was created by combining a stationary and a rotational glass plates spaced 50μm apart. Blood filled into this space was subjected to a simple Couette flow. Both glass plates were covered with albumin to render them anti-thrombogenic. However, one spot 1×1mm in size was covered with collagen. This spot was where the platelets deposited. The device was mounted on an inverted microscope and the platelet deposition was recorded. Platelets were dyed to render them fluorescent. The blood used was human blood from healthy volunteers. It was subjected to a range of low shear rates (below 7001/s) to find out how they act on platelet deposition. The results show a characteristic curve with elevated platelet deposition in the range of 1501/s. For the interpretation of these results a numerical model was developed. It applies the Monte Carlo method to model a random walk of platelets. This diffusive motion was superimposed on the convective motion by the Couette flow. A satisfactory match to the experimental data was achieved.
    Journal of biomechanics 11/2012; · 2.66 Impact Factor
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    ABSTRACT: Percutaneous devices enable the transfer of mass, energy and forces through the skin. There is a wide clinical need for this, which is not likely to decrease or disappear. The emerging new artificial organs, such as wearable kidneys or lungs, will be in increased demand in the future. Any application lasting longer than days or weeks is endangered by infections entering the body via the exit site. The only carefree solution that has been found is for an exit site placed on the skull, where it can be securely immobilized. For the majority of the locations on the abdomen or chest, no solution for an infection-free device has been found. A solution may be possible with a better understanding of the physiology of keratinocytes as a barrier for microbes.
    Expert Review of Medical Devices 07/2012; 9(4):389-99. · 2.43 Impact Factor
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    ABSTRACT: Flow fields are one of the key factors associated with the life threatening formation of thrombi in artificial organs. Therefore, knowledge of flow field is crucial for the design and optimization of a long-term blood pump performance. The blood chamber flow of a novel counterpulsation heart assist device (CPD) has been investigated using laser Doppler velocimetry (LDV), particle image velocimetry (PIV), and near-wall PIV (wall-PIV). The wall-PIV is an in-house developed technique assessing wall shear rates (WSR). These experimental techniques analyzed complex transient three-dimensional (3D) flow fields including major and secondary structures during the whole CPD cycle (ejection, filling, and hold time). PIV measurements in the central plane investigated an evolution (development and destruction) of the blood chamber fully filling vortex as the major CPD flow structure. The wall-PIV measurements identified areas of blood stagnation (vortex center and jet impingements) and quantified WSR at the front housing. Maximal mean WSR of 2,045 ± 605 s(-1) were found at the end of the filling. The LDV, which identified helical flow structure at the outer region of the pump, was used to complete 3D flow analysis and to combine PIV and wall-PIV results. The results suggest good washing behavior of the CPD regarding thrombus formation.
    Annals of Biomedical Engineering 04/2012; 40(9):1982-95. · 3.23 Impact Factor
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    ABSTRACT: Cerebral arterial vasospasm leads to delayed cerebral ischemia and constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage. Cerebral vasospasm can be reduced by increased blood clearance from the subarachnoid space. Clinical pilot studies allow the hypothesis that the clearance of subarachnoid blood is facilitated by means of head shaking. A major obstacle for meaningful clinical studies is the lack of data on appropriate parameters of head shaking. Our in vitro study aims to provide these essential parameters. A model of the basal cerebral cistern was derived from human magnetic resonance imaging data. Subarachnoid hemorrhage was simulated by addition of dyed experimental blood to transparent experimental cerebrospinal fluid (CSF) filling the model of the basal cerebral cistern. Effects of various head positions and head motion settings (shaking angle amplitudes and shaking frequencies) on blood clearance were investigated using the quantitative dye washout method. Blood washout can be divided into two phases: Blood/CSF mixing and clearance. The major effect of shaking consists in better mixing of blood and CSF thereby increasing clearance rate. Without shaking, blood/CSF mixing and blood clearance in the basal cerebral cistern are hampered by differences in density and viscosity of blood and CSF. Blood clearance increases with decreased shaking frequency and with increased shaking angle amplitude. Head shaking facilitates clearance by varying the direction of gravitational force. From this in vitro study can be inferred that patient or head shaking with large shaking angles at low frequency is a promising therapeutic strategy to increase blood clearance from the subarachnoid space.
    PLoS ONE 01/2012; 7(8):e41677. · 3.53 Impact Factor
  • tm - Technisches Messen 01/2012; 79(6). · 0.26 Impact Factor
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    ABSTRACT: Haemodynamics and morphology play an important role in the genesis, growth and rupture of cerebral aneurysms. The goal of this study was to generate and analyse statistical wall shear stress (WSS) distributions and shapes in middle cerebral artery (MCA) saccular aneurysms. Unsteady flow was simulated in seven ruptured and 15 unruptured MCA aneurysms. In order to compare these results, all geometries must be brought in a uniform coordinate system. For this, aneurysms with corresponding WSS data were transformed into a uniform spherical shape; then, all geometries were uniformly aligned in three-dimensional space. Subsequently, we compared statistical WSS maps and surfaces of ruptured and unruptured aneurysms. No significant (p > 0.05) differences exist between ruptured and unruptured aneurysms regarding radius and mean WSS. In unruptured aneurysms, statistical WSS map relates regions with high (greater than 3 Pa) WSS to the neck region. In ruptured aneurysms, additional areas with high WSS contiguous to regions of low (less than 1 Pa) WSS are found in the dome region. In ruptured aneurysms, we found significantly lower WSS. The averaged aneurysm surface of unruptured aneurysms is round shaped, whereas the averaged surface of ruptured cases is multi-lobular. Our results confirm the hypothesis of low WSS and irregular shape as the essential rupture risk parameters.
    Journal of The Royal Society Interface 09/2011; 9(69):677-88. · 4.91 Impact Factor
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    ABSTRACT: The objective of this study is to assess the effect of a purge flow on valves of pulsatile heart-assist devices. Clinical applications of these devices are still limited because of frequent thromboembolic complications. These complications often originate at the valves and the unavoidable flow separation regions that are found behind the leaflets. The flow separations cause a long residence time of blood that is considered particularly detrimental. To solve this problem, a valve with a purge flow is proposed. A purge flow is a jet, which is separated from the main blood flow and directed behind the leaflets into the sinus to flush it. Even though the purge flow does not prevent a flow separation, it shortens the residence time of the blood in the sinus. Thus, the purge flow improves the periodic washout of the blood in the region of flow separation. The complex purge flow was investigated in a tri-leaflet valve. The geometrical parameters of the valve were varied systematically. A statistical technique--the Taguchi method--was used to reduce the number of investigated models to 12. The flows through the resulting valve models were numerically simulated and analyzed. The evaluated models with the best results were subsequently investigated experimentally using different methods: hemodynamic tests in a valve tester and flow visualization using the dye washout method. It was shown that the purge flow can effectively wash out the sinus. Therefore, the purge flow valve reduces the potential of a thrombus formation normally associated with the valve.
    Artificial Organs 09/2011; 36(1):42-8. · 1.96 Impact Factor
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    ABSTRACT: Clinical records show ever increasing functional times of rotary blood pumps implanted in patients. With longer functional time, the problem of driveline infection is becoming more urgent. No material or scaffold has been found, which allows a permanent and stable ingrowth of skin cells that would prevent (pathogenic) germs entering the body. Usually, the epithelial cells die at the exit site and new cells form a sulcus around the driveline, which grows deeper and finally becomes infected. The purpose of this project is to present a solution to this problem by elaborating a new mechanism, the active skin-penetrating device. The device is composed of a tube with a 5-mm diameter, a protective sleeve that surrounds the catheter exit site, and an active traction device. The protective sleeve is made of thin polyurethane covered with polyethylenterephtalat (PET, i.e. Dacron) fibers to permit the attachment of keratinocytes, similar to the standard driveline. The active traction device exerts a constant pull on the protective sleeve. The ingrown keratinocytes slowly give way and the protective sleeve gradually moves out of the body at a rate of a few millimeters per week. Meanwhile, the keratinocytes transform into horny cells and are then shed as in natural skin. Therefore, the formation of a sulcus is avoided, and the protective sleeve remains infection-free. In a first proof of the concept, four of the new devices and 10 control devices were implanted in goats. The devices remained infection-free for a period of 420 days, whereas four of the 10 control devices became infected. On the basis of these experiments, the active skin-penetrating device has been further developed and is being tested again in goats in a refined version. The results so far indicate that with the active-skin penetrating device an infection-resistant percutaneous energy transfer can be achieved for a prolonged period of time.
    Artificial Organs 08/2011; 35(8):800-6. · 1.96 Impact Factor
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    ABSTRACT: Depending on the applied ventilation strategy, mechanical ventilation leads to alveolar epithelial and capillary endothelial damage. Protective ventilatory approaches try to minimize this biotrauma while still ensuring sufficient gas exchange. However, the optimization of ventilation strategies is hampered by the lack of insights into the cellular and molecular mechanisms underlying ventilator-induced lung injury, and by the lack of morphological and biomechanical information pertinent to the development of suitable computational and experimental models for ventilation-dependent biofluid mechanics [13, 15, 30].
    04/2011: pages 49-65;