A new dual activation simulator of the left heart that reproduces physiological and pathological conditions.

Heart valve replacements are often associated with cardiac pathologies, but valvular prostheses are still tested in vitro under the same physiological conditions as for a healthy young man. Therefore a new mock circulatory system of the left heart, the dual activation simulator (DAS), has been built. The DAS allows atrial and ventricular dynamics to be controlled with pumps that activate anatomically shaped silicon models of the cavities. The mitral flow is a two-peak waveform. The E/A ratio can be changed, and the A-wave can be suppressed to simulate, for instance, atrial fibrillation. The cardiac rhythm and the mean flow-rate can be changed at will. The ability of the DAS to reproduce physiological flow is assessed by computation of the aortic input impedance and by harmonic analysis of left ventricular and atrial pressures. It allows the behaviour of valve prostheses to be studied in various conditions of concern to clinicians and can be a useful tool for engineers to improve valve prostheses or validate diagnostic tools such as 3D colour Doppler. The DAS and its capacities are described.