Overview
Pericardiocentesis and chest tube represent successful decompression of a selected pericardial or pleural obstruction. They rebuild the reference without that lesion and preserve unrelated pathology and user loading experiments.
The Experimental valve section represents successful later valve-treatment endpoints. “Experimental” describes the simulator implementation, not the clinical status of the procedure. Anatomy, selection, procedural steps and outcome probabilities are not simulated.
Partial coronary and pulmonary reperfusion
Coronary angioplasty is a selected partial PCI endpoint in Acute MI: nominal flow increases by 30%, versus 12% with fibrinolytics. The same infarct does not receive two additive recoveries when both controls are on. Left-sided filling pressure falls modestly. Regional ST injury amplitude remains 55% after PCI or 80% after lysis, preserving rhythm, QRS and reciprocal polarity. These are chosen teaching effects, not guideline targets or treatment success rates.
In Acute PE with severe RV failure, fibrinolysis increases nominal flow by 20%, lowers PVR by 30% and partially unloads RAP/RVEDP. Rising pulmonary flow can offset some of the PA-pressure fall. Pre-existing pulmonary vascular disease blunts the PVR reduction. Competing fixed obstruction, volume depletion or acute valve failure halves the flow recovery. Residual disease, weak perfusion and abnormal gas exchange remain.
Reperfusion acts before other medication, ventilation and support effects; downstream waveforms, PV loops and imaging consume the resulting circulation. The shared SVR/flow relation reconstructs systemic pressure. Coronary PCI has no PE benefit and neither control creates native flow during VF or standstill. Bleeding, time to reperfusion, coronary patency, recurrent embolism and procedural complications are not simulated. Fibrinolysis is not appropriate for every PE or ACS.
Pericardial and pleural decompression
Pericardiocentesis removes tamponade; chest tube removes the tension-pneumothorax component. Filling, forward flow, pressure, oxygenation and imaging then follow the remaining combined state. Selecting a procedure with no matching lesion does not create a generic hemodynamic benefit.
Drain placement, access, bleeding, recurrent accumulation, pleural air leak and time to recovery are omitted. The CXR illustration does not imply that treatment should wait for imaging.
Valve endpoints
Mitral/tricuspid clips address selected regurgitant lesions; prosthetic examples address the corresponding stenosis or regurgitation. TAVI requires the selected native AS model; isolated AR is not assumed to be suitable for that button. One treatment per valve is selected, while different valves can be treated together.
The engine removes the corrected native waveform contribution and retains incomplete filling/flow recovery, chronic cavity history, coexisting myocardial disease and pulmonary vascular load. An aortic tissue-prosthesis example retains a small flow-dependent LV–aortic gradient. It is not a mechanical valve simulation.
Incomplete recovery and adverse examples
The successful-endpoint model does not predict residual leak, prosthesis mismatch, anesthesia, afterload mismatch, conduction injury or procedural complications. Clip selection with coexisting inflow stenosis intentionally adds obstruction rather than assuming benefit. Read the selected intervention reference for clinical context.
References & further reading
