Lindbergh perfusion pump in Putnam Gallery, 2009-11-24

Perfusion is the passage of fluid through the

circulatory system The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

lymphatic system The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid o ...

to an

organ Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...

or a tissue, usually referring to the delivery of

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...

to a

capillary A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

bed in tissue. Perfusion is measured as the rate at which blood is delivered to tissue, or volume of blood per unit time (blood

flow Flow may refer to: Science and technology * Fluid flow, the motion of a gas or liquid * Flow (geomorphology), a type of mass wasting or slope movement in geomorphology * Flow (mathematics), a group action of the real numbers on a set * Flow (psych ...

) per unit tissue mass. The SI unit is m³/(s·kg), although for human organs perfusion is typically reported in ml/min/g. The word is derived from the French verb "perfuser" meaning to "pour over or through". All animal tissues require an adequate blood supply for

health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

and

life Life is a quality that distinguishes matter that has biological processes, such as signaling and self-sustaining processes, from that which does not, and is defined by the capacity for growth, reaction to stimuli, metabolism, energ ...

. Poor perfusion (malperfusion), that is,

ischemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...

, causes health problems, as seen in

cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...

, including

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...

, cerebrovascular disease, peripheral artery disease, and many other conditions. Tests verifying that adequate perfusion exists are a part of a patient's assessment process that are performed by medical or emergency personnel. The most common methods include evaluating a body's

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

color,

temperature Temperature is a physical quantity that expresses quantitatively the perceptions of hotness and coldness. Temperature is measured with a thermometer. Thermometers are calibrated in various temperature scales that historically have relied o ...

, condition (dry/soft/firm/swollen/sunken/etc), and

capillary refill Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. It can be measured by holding a hand higher than heart-level and pressing the soft pad of a f ...

. During major surgery, especially cardiothoracic surgery, perfusion must be maintained and managed by the

health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

s involved, rather than left to the body's

homeostasis In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...

alone. As the lead surgeons are often too busy to handle all

hemodynamic Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously mo ...

control by themselves, specialists called

perfusionist A cardiovascular perfusionist, clinical perfusionist or perfusiologist, and occasionally a cardiopulmonary bypass doctor or clinical perfusion scientist, is a healthcare professional who operates the cardiopulmonary bypass machine (heart–lung ma ...

s manage this aspect. There are more than one hundred thousand perfusion procedures annually.

Discovery

In 1920,

August Krogh Schack August Steenberg Krogh (15 November 1874 – 13 September 1949) was a Danish professor at the department of zoophysiology at the University of Copenhagen from 1916 to 1945. He contributed a number of fundamental discoveries within several ...

was awarded the

Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accord ...

for his discovering the mechanism of regulation of capillaries in

skeletal muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

. Krogh was the first to describe the adaptation of blood perfusion in muscle and other organs according to demands through the opening and closing of

arterioles An arteriole is a small-diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillaries. Arterioles have muscular walls (usually only one to two layers of smooth muscle cells) and are the primar ...

and capillaries.

Malperfusion

Malperfusion can refer to any type of incorrect perfusion though it usually refers to hypoperfusion. The meaning of the terms "overperfusion" and "underperfusion" is relative to the average level of perfusion that exists across all the tissues in an individual body. Perfusion levels also differ from person to person depending on metabolic demand. Examples follow: *

Heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

tissues are considered overperfused because they normally are receiving more blood than the rest of tissues in the organism; they need this blood because they are constantly working. * In the case of skin cells, extra blood flow in them is used for

thermoregulation Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...

of a body. In addition to delivering

oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...

, blood flow helps to

dissipate In thermodynamics, dissipation is the result of an irreversible process that takes place in homogeneous thermodynamic systems. In a dissipative process, energy (internal, bulk flow kinetic, or system potential) transforms from an initial form to a ...

heat in a physical body by redirecting warm blood closer to its surface where it can help to cool a body through

sweating Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distr ...

and

thermal dissipation All electronic devices and circuitry generate excess heat and thus require thermal management to improve reliability and prevent premature failure. The amount of heat output is equal to the power input, if there are no other energy int ...

. * Many types of

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s, and especially certain types, have been described as "hot and bloody" because of their overperfusion relative to the body overall. Overperfusion and underperfusion should not be confused with hypoperfusion and hyperperfusion, which relate to the perfusion level relative to a tissue's current need to meet its metabolic needs. For example, hypoperfusion can be caused when an

artery An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...

or arteriole that supplies blood to a volume of tissue becomes blocked by an embolus, causing either no blood or at least not enough blood to reach the tissue. Hyperperfusion can be caused by

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

, producing hyperemia of a body part. Malperfusion, also called poor perfusion, is any type of incorrect perfusion. There is no official or formal dividing line between hypoperfusion and

; sometimes the latter term refers to zero perfusion, but often it refers to any hypoperfusion that is bad enough to cause

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

Measurement

In equations, the symbol Q is sometimes used to represent perfusion when referring to

cardiac output In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: t ...

. However, this terminology can be a source of confusion since both cardiac output and the symbol Q refer to

(volume per unit time, for example, L/min), whereas perfusion is measured as flow per unit tissue mass (mL/(min·g)).

Microspheres

Microspheres Microparticles are particles between 0.1 and 100 μm in size. Commercially available microparticles are available in a wide variety of materials, including ceramics, glass, polymers, and metals. Microparticles encountered in daily life includ ...

that are labeled with radioactive isotopes have been widely used since the 1960s. Radioactively labeled particles are injected into the test subject and a radiation detector measures radioactivity in tissues of interest.Studies of the Circulation with Radioactive Microspheres., Wagner et al, Invest. Radiol., 1969. 4(6): p. 374-386. Application of this process is used to develop

radionuclide angiography Radionuclide angiography is an area of nuclear medicine which specialises in imaging to show the functionality of the right and left ventricles of the heart, thus allowing informed diagnostic intervention in heart failure. It involves use of a ...

, a method of diagnosing heart problems. In the 1990s, methods for using

fluorescent Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, tha ...

microspheres became a common substitute for radioactive particles.

Nuclear medicine

Perfusion of various tissues can be readily measured

in vivo Studies that are ''in vivo'' (Latin for "within the living"; often not italicized in English) are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and ...

with nuclear medicine methods which are mainly

positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including bl ...

(PET) and single photon emission computed tomography (SPECT). Various radiopharmaceuticals targeted at specific organs are also available, some of the most common are: * ^99mTc labelled HMPAO and ECD for brain perfusion ( rCBF) studied with SPECT * ^99mTc labelled

Tetrofosmin Technetium (99mTc) tetrofosmin is a drug used in nuclear medicine cardiac imaging. It is sold under the brand name Myoview (GE Healthcare). The radioisotope, technetium-99m, is chelated by two 1,2-''bis''i-(2-ethoxyethyl)phosphinothane ligands whi ...

and

Sestamibi Technetium (99mTc) sestamibi (INN) (commonly sestamibi; USP: technetium Tc 99m sestamibi; trade name Cardiolite) is a pharmaceutical agent used in nuclear medicine imaging. The drug is a coordination complex consisting of the radioisotope techn ...

for

myocardial perfusion imaging Myocardial perfusion imaging or scanning (also referred to as MPI or MPS) is a nuclear medicine procedure that illustrates the function of the heart muscle (myocardium). It evaluates many heart conditions, such as coronary artery disease (CAD), h ...

with SPECT * ¹³³Xe-gas for absolute quantification of brain perfusion ( rCBF) with SPECT * ¹⁵O-labeled water for brain perfusion ( rCBF) with PET (absolute quantification is possible when measuring arterial radioactivity concentration) * ⁸²Rb-chloride for measuring myocardial perfusion with PET (absolute quantification is possible)

MRI

Two main categories of

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

(MRI) techniques can be used to measure tissue perfusion

. * The first is based on the use of an injected contrast agent that changes the

magnetic susceptibility In electromagnetism, the magnetic susceptibility (Latin: , "receptive"; denoted ) is a measure of how much a material will become magnetized in an applied magnetic field. It is the ratio of magnetization (magnetic moment per unit volume) to the ap ...

of blood and thereby the MR signal which is repeatedly measured during

bolus Bolus may refer to: Geography * Bolus, Iran, a village in Ardabil Province, Iran * Bolus, or Baulus, an Anatolian village on the site of ancient Berissa Medicine * Bolus (digestion), a ball-shaped mass moving through the digestive tract * Bolus ...

passage. * The other category is based on

arterial spin labelling Arterial spin labeling (ASL), also known as arterial spin tagging, is a magnetic resonance imaging technique used to quantify cerebral blood perfusion by labelling blood water as it flows throughout the brain. ASL specifically refers to magnetic lab ...

(ASL), where arterial blood is

magnet A magnet is a material or object that produces a magnetic field. This magnetic field is invisible but is responsible for the most notable property of a magnet: a force that pulls on other ferromagnetic materials, such as iron, steel, nickel, ...

ically tagged before it enters into the tissue being examined and the amount of labelling that is measured and compared to a control recording obtained without spin labelling.

CT

Brain perfusion (more correctly transit times) can be estimated with contrast-enhanced computed tomography.

Thermal diffusion

Perfusion can be determined by measuring the total thermal diffusion and then separating it into

thermal conductivity The thermal conductivity of a material is a measure of its ability to conduct heat. It is commonly denoted by k, \lambda, or \kappa. Heat transfer occurs at a lower rate in materials of low thermal conductivity than in materials of high thermal ...

and perfusion components. rCBF is usually measured continuously in time. It is necessary to stop the measurement periodically to cool down and reassess the

References

External links

Cardiac Surgery Portal
{{authority control Respiratory physiology Cardiovascular physiology Underwater diving physiology