Abstract:
The present invention describes a device and system for simulating normal and disease state cardiac functioning, including an anatomically accurate left cardiac simulator for training and medical device testing. The system and device uses pneumatically pressurized chambers to generate ventricle and atrium contractions. In conjunction with the interaction of synthetic mitral and aortic valves, the system is designed to generate pumping action that produces accurate volume fractions and pressure gradients of pulsatile flow, duplicating that of a human heart. Through the use of a remote handheld electronic controller and manual adjustments from a main control panel, the air pressure level, fluidic pressure, and heart rate is controlled to induce contractions that simulate a wide variety of heart conditions ranging from normal heart function to severely diseased or injured heart conditions.

Description:
FIELD OF THE INVENTION 
       [0001]    This invention relates to a surgical simulation system; and more particularly, to a device and system for simulating normal and disease state cardiac functioning, including an anatomically accurate left cardiac simulator for training and medical device testing. 
       BACKGROUND OF THE INVENTION 
       [0002]    Cardiovascular disease, diseases affecting the heart and the vasculature, and vascular disease, diseases affecting the circulatory system, are prevalent conditions affecting millions of individuals across the globe. While vasculature disease may manifest in the hardening of arterial walls at a specific location, such disease state affects every organ in the human body. Several options exist to alleviate or minimize the risk associated with prolonged vasculature disease states. Depending on the severity, changes in life style, i.e. diet and increased exercise, or the use of drugs may be helpful. In situations where other options will not work or where the disease is severe, surgical intervention remains the primary treatment tool. Traditional surgical procedures have been steadily replaced with more minimally invasive endovascular techniques and such minimally invasive advances in endovascular technology are altering the way surgeons treat vascular diseases. 
         [0003]    While vascular surgical procedures are safer than ever, complex vascular surgical procedures can result in collateral damage to the patient. While no surgery is without risk, the level of skill of the surgeon and his/her team, as well as the ability to minimize unforeseen surprises when performing the surgical procedure is paramount to preventing complications and/or death to the patient. Experienced surgeons having performed numerous vascular disease procedures are much more likely to complete such surgical procedures with fewer complications than those surgeons having less experience. While such experience is gained by training and performing numerous procedures, the number of surgical procedures available is a limiting factor. Accordingly, not every surgeon will have the same opportunity to perform the number of surgical procedures needed to obtain a skill level that minimizes the risks of the procedures undertaken. Moreover, as new procedures are developed, senior surgeons may find it difficult to obtain the necessary experience needed. 
         [0004]    Training devices for practicing various surgical procedures have been used by surgeons to improve skills and are known in the art. For example, U.S. Pat. No. 8,016,598, U.S. Pat. No. 7,976,313, and U.S. Pat. No. 7,976,312 describe patient simulator systems for teaching patient care. U.S. Pat. No. 7,798,815 discloses an electromechanical pumping system for simulating the beating of a heart in a cardiac surgery training environment. U.S. Pat. No. 7,866,983 discloses a surgical simulator for teaching, practicing, and evaluating surgical techniques. The simulator is described as comprising a cassette of organs, blood vessels, and tissues that may be disposable. 
         [0005]    U.S. Pat. No. 7,083,418 discloses a model for teaching or illustrating surgical and/or medical technique. The system is described as having a base component representing tissue or an organ, and several components structured and arranged to be coupleable to and detachable from the base component and/or to each other, to illustrate different positions of the components with respect to one another representing different phases in surgical and/or medical techniques. 
         [0006]    U.S. Pat. No. 7,063,942 discloses a system for hemodynamic simulation. The system is described as comprising a vessel having properties of a blood vessel, a reservoir containing a quantity of fluid, tubing connecting the vessel and reservoir, and at least one pump for circulating the fluid within the system. 
         [0007]    U.S. Pat. No. 6,843,145 discloses a cardiac phantom for simulating a dynamic cardiac ventricle. The phantom is described as comprising two concentrically-disposed, fluid-tight, flexible membranes defining a closed space between the walls of the membranes. 
         [0008]    U.S. Pat. No. 6,685,481 discloses a training device for cardiac surgery and other similar procedures. The device is described as including an organ model such as a cardiac model, an animation network adapted to impart to the model a motion similar to the corresponding natural organ, and a control device used to control the operation of the animation network. The cardiac model is described as being made of two sections, an inner cast simulating the myocardium and an external shell simulating the pericardium. 
         [0009]    U.S. Pat. No. 5,052,934 discloses an apparatus to serve as a phantom for evaluation of prosthetic valves and cardiac ultrasound procedures, wherein a controlled pulsatile flow of a blood-mimicking fluid is passed through a multi-chambered region into which are mounted mitral and aortic valves and adjustably positionable ultrasound transducers. 
         [0010]    While such training devices are known in the art, the device and system for simulating normal and disease state cardiac functioning in accordance with the present invention provides a training tool that is more anatomically and physiologically correct than such prior art devices, thereby providing a mechanism to reduce collateral damage associated with cardiovasculature or vasculature procedures. 
       SUMMARY OF THE INVENTION 
       [0011]    The present invention describes a device and system for simulating normal and disease state cardiac and vascular functioning, including an anatomically accurate cardiac simulator for training and medical device testing. The system and device uses pneumatically pressurized chambers to generate ventricle and atrium contractions. In conjunction with the interaction of synthetic mitral and aortic valves, the system is designed to generate pumping action that produces accurate volume fractions and pressure gradients of pulsatile flow, duplicating that of a human heart. Through the use of a remote handheld electronic controller and manual adjustments from a main control panel, the air pressure level, fluid pressure, and heart rate is controlled to induce contractions that simulate a wide variety of heart conditions, ranging from normal heart function to severely diseased or injured heart conditions. 
         [0012]    The cardiovasculature training and evaluation simulator system and device suitable for training and testing medical devices is adapted to provide an anatomically and physiologically accurate representation of a cardiovasculature system in normal or diseased states. In an illustrative embodiment, the system comprises a support structure, a pneumatically driven cardiac system module for simulating cardiac functioning of a patient, a vasculature system module fluidly connected to the cardiac system module and adapted for simulating the vasculature of a patient, and a control module operatively coupled to the cardiac system module and the vasculature system module. The cardiac module comprises an atrium assembly for simulating an atrium of a heart and a ventricle assembly for simulating a ventricle of a heart. A control module comprises one or more sub-modules for controlling or modifying one or more operational parameters of the system, including heart rate, ejection fraction, systemic vascular resistance and compliance. By modifying the systems parameters, pathological hemodynamic states, including but not limited to sepsis, hyperdynamic therapy with vasopressor agents, or cardiac arrhythmias, such as atrial fibrillation or flutter can be recreated. 
         [0013]    The system and devices therefore provide a mechanism that can be used to reduce collateral damage to patients undergoing vascular surgeries resulting from surgeon inexperience or inexperience with complex procedures. By providing a device that replicates the heart and vasculature, the surgeon can perform endovascular procedures prior to having to perform such procedures on the actual patient. Device selection, placement, and optimization can therefore be determined prior to actual surgery, eliminating the risk associated with having to do such tasks during a live procedure. 
         [0014]    Accordingly, it is a primary objective of the instant invention to provide a device and system for simulating normal and disease state cardiac functioning. 
         [0015]    It is a further objective of the instant invention to provide a device and system for simulating normal and disease state cardiac functioning including an anatomically accurate cardiac simulator for training and medical device testing. 
         [0016]    It is yet another objective of the instant invention to provide a device and system for simulating normal and disease state cardiac functioning designed to generate pumping action that produces accurate volume fractions duplicating that of a heart. 
         [0017]    It is a further objective of the instant invention to provide a device and system for simulating normal and disease state cardiac functioning designed to provide pressure gradients of pulsatile flow that duplicates a heart. 
         [0018]    It is yet another objective of the instant invention to provide a device and system for simulating normal and disease state cardiac function which controls air pressure level, fluid pressure, and heart rate, thereby inducing contractions that simulate a wide variety of heart conditions. 
         [0019]    It is a still further objective of the invention to provide a device and system for simulating normal cardiac functioning which controls air pressure level, fluid pressure, and heart rate to induce contractions that simulate a wide variety of heart conditions having normal heart functions. 
         [0020]    It is a further objective of the instant invention to a provide a device and system for simulating disease state cardiac functioning which controls air pressure level, fluid pressure, and heart rate to induce contractions that simulate a wide variety of heart conditions having diseased or injured heart conditions. 
         [0021]    It is a further objective of the instant invention to provide a training and evaluation simulator system and device suitable for training and testing medical devices which is adapted to provide an anatomically and physiologically accurate representation of a cardiovasculature system in normal or diseased states. 
         [0022]    It is yet another objective of the instant invention to provide a training and evaluation simulator system and device having a control module adapted for controlling or modifying one or more operational parameters of the system, including heart rate, ejection fraction, systemic vascular resistance and compliance. 
         [0023]    It is a still further objective of the invention to provide a training and evaluation simulator system and device in which pathological hemodynamic states, including but not limited to sepsis, hyperdynamic therapy with vasopressor agents, or cardiac arrhythmias, such as atrial fibrillation or flutter can be recreated. 
         [0024]    It is a further objective of the instant invention to provide a training and evaluation simulator system and device which allows a surgeon to perform endovascular procedures prior to having to perform such procedures on the actual patient. 
         [0025]    It is yet another objective of the instant invention to provide a training and evaluation simulator system and device which allows a surgeon to determine device selection, placement, and optimization prior to actual surgery, eliminating the risk associated with having to do so during a live procedure. 
         [0026]    Other objectives and advantages of this invention will become apparent from the following description taken in conjunction with any accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention. Any drawings contained herein constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0027]      FIG. 1  is a block diagram of the simulator system in accordance with an illustrative example of the present invention; 
           [0028]      FIG. 2  is a perspective view of a controller module of the present invention; 
           [0029]      FIG. 3  is a side view of the controller module; 
           [0030]      FIG. 4  is a top view of the controller module; 
           [0031]      FIG. 5  is an exploded perspective view of the controller module; 
           [0032]      FIG. 6  is a perspective view of the pneumatic modular chassis of the present invention; 
           [0033]      FIG. 7  is a perspective view of an illustrative example of a pneumatic actuator assembly; 
           [0034]      FIG. 8  is an exploded perspective view of the pneumatic actuator assembly; 
           [0035]      FIG. 9  is an exploded perspective view of the pneumatic actuator assembly; 
           [0036]      FIG. 10  is a right side view of the pneumatic actuator assembly; 
           [0037]      FIG. 11  is a left side view of the pneumatic actuator assembly; 
           [0038]      FIG. 12  is a front view of the pneumatic actuator assembly; 
           [0039]      FIG. 13  is a rear view of the pneumatic actuator assembly; 
           [0040]      FIG. 14  is a top view of the pneumatic actuator assembly; 
           [0041]      FIG. 15  is a bottom view of the pneumatic actuator assembly; 
           [0042]      FIG. 16  is a cross-sectional view of the cylinder tube assembly taken along lines  16 A- 16 A of  FIG. 14 ; 
           [0043]      FIG. 17  is a perspective view of an illustrative example of a hydraulics module of the present invention; 
           [0044]      FIG. 18  is an exploded perspective view of the hydraulics module; 
           [0045]      FIG. 19  is a right side view of the hydraulics module; 
           [0046]      FIG. 20  is a front view of the hydraulics module chassis with the front side wall removed; 
           [0047]      FIG. 21  is a back view of the hydraulics module chassis with the back side wall removed; 
           [0048]      FIG. 22  is a view of the top panel of the hydraulics module chassis; 
           [0049]      FIG. 23  is a perspective view of an illustrated embodiment of a fluid storage module; 
           [0050]      FIG. 24  is a perspective view illustrating one embodiment of the vascular compliance module of the present invention; 
           [0051]      FIG. 25  is a top view of the vascular compliance module; 
           [0052]      FIG. 26  is a bottom view of the vascular compliance module; 
           [0053]      FIG. 27  is a front view of the vascular compliance chamber; 
           [0054]      FIG. 28  is a cross-sectional view taken along lines  28 A- 28 A of  FIG. 25 ; 
           [0055]      FIG. 29  is an exploded perspective view of the vascular compliance chamber; 
           [0056]      FIG. 30A  is a perspective view of the controller module with an illustrative embodiment of the electrical module; 
           [0057]      FIG. 30B  illustrates one embodiment of an electrical schematic suitable for use with the present invention; 
           [0058]      FIG. 30C  illustrates one embodiment of a handheld device suitable for use with the present invention; 
           [0059]      FIG. 31  is a perspective view of an illustrative embodiment of the anatomical module; 
           [0060]      FIG. 32  is a front side view of the anatomical module; 
           [0061]      FIG. 33  is a back side view of the anatomical module; 
           [0062]      FIG. 34  is a partial perspective view of the cardiac simulator module and ventricular module; 
           [0063]      FIG. 35  is a partial cross-sectional view taken along lines  35 A- 35 A of  FIG. 34 , showing an aortic valve and aortic arch; 
           [0064]      FIG. 36  is a partial cross-sectional view taken along lines  36 A- 36 A of  FIG. 34  showing the atrial compression mechanism, the atrial chamber, and the mitral valve; 
           [0065]      FIG. 37  is a back view of the cardiac simulator module illustrating the ventricular compression chamber, the aortic arch, and the atrial compression mechanism; 
           [0066]      FIG. 38  is an exploded view of the cardiac simulator module; 
           [0067]      FIG. 39  is a side view of one embodiment of the ventricle and ventricle compression chamber; 
           [0068]      FIG. 40  is an alternative embodiment of the ventricular chamber and ventricle compression chamber; 
           [0069]      FIG. 41  is a perspective view of an illustrative example of the head unit with cerebrovasculature. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0070]    Referring to  FIG. 1 , a schematic block diagram of the simulator system generally referred to as the cardiovascular simulator system  10  is illustrated. The simulator system  10  is illustrated and described as a cardiovascular system. However, the simulator system is not limited to the cardiovascular system and can be adapted to replicate other systems. The cardiovascular simulator system  10  comprises of one or more modules including a control module  1000  and an anatomical module  2000 . The control module  1000  and the anatomical module  2000  interact in a manner to provide a system which is an anatomically and functionally accurate replication of a body system, i.e. a cardiac and/or vasculature system. Providing such an anatomically correct system provides the user a unique tool to practice and train for various surgical procedures and/or techniques prior to having to perform such actions on a living system. While such system will be described using human anatomy and systems, the vascular simulator system in accordance with the instant invention can be adapted to replicate or model other organism systems, such as but not limited to domesticated animals such as dogs and cats, rodents such as mice and rats, livestock such as cattle, horses, sheep, swine/porcine, or wild animals such as lions or tigers. 
         [0071]    Each of the control module  1000  and the anatomical module  2000  further contains sub-modules. The sub-modules comprise individual components that drive the system and/or provide accurate structural and functional replication of a living system. As will be described in greater detail, the control module  1000  contains one or more sub-modules including a pneumatics module  1100 , a hydraulics module  1300 , a fluid storage module  1400 , a compliance module  1500 , and an electronics module  1600 . The anatomical module  2000 , illustrated herein as a cardiovasculature system, is primarily made up of three sub-modules, including a cardiac simulator module  2100 , a vasculature simulator module  2200 , and one or more peripheral organ/systems simulator module  2300 . 
         [0072]    Referring to  FIGS. 2-5 , an illustrated example of the control module  1000  is shown. As shown in the figures, each of the sub-modules, including the pneumatics module  1100 , the hydraulics module  1300 , the fluid reservoir module  1400 , the compliance module  1500 , and the electronics module  1600 , are stored within a control module chamber chassis  1002 . The control module chamber chassis  1002  contains a plurality of walls  1004 ,  1006 ,  1008 ,  1010  and a bottom wall  1012  to form an interior  1014  portion, see  FIG. 5 . The interior portion  1014  is sized and shaped to accommodate each of the plurality of sub-modules enclosed within. A top portion, illustrated herein as a cover  1016 , is sized and shaped to engage the lower portion  1012 . In a preferred embodiment although non-limiting embodiment, the control module chamber chassis cover  1016  is hingedly connected to the bottom portion  1012  through one or more hinges, not illustrated. Accordingly, alternative means of connection as known to one of skill in the art can be used. 
         [0073]    Enclosing the sub-modules in a removable case allows the user the ability to move the control module  1000  and its components easily. Alternatively, each of the sub-modules may be stored individually on a support structure, such as a board. Secured to the inner surface  1018  of the cover  1016  through fastening members, such as but not limited to screws  1020  and pins  1022 , is the electronics module  1500 . The cover  1016  may contain at least one opening  1023  adapted to fit a connecting device for connecting an external device to the electronics module  1600 . Although not illustrated, the cover  1016  and one or all of the walls may contain a locking mechanism for securable engagement. 
         [0074]    The interior portion  1014  preferably contains one or more horizontal fastening beams arranged along the interior surface of the side walls, such as a first fastening beam  1024  secured to the interior surface  1026  of the side wall  1010 . A second fastening beam  1028  is positioned between two side walls and secures to the interior surface  1030  (not shown) of side wall  1004  and the interior surface  1032  of side wall  1008 . The fastening beams  1024  and  1028  may contain notches  1030  and/or apertures  1032  adapted to receive fastening members, such as screws or tightening pins to allow each of the sub-modules to be securely placed within. At the top surface  1034  of the bottom wall  1012  is a bumper  1036 . The side walls  1004 ,  1006 ,  1008 , or  1010  may also contain vertically aligned beams  1038  and  1040  for added support or securing the modules within. Additionally, side wall  1008  may contain a recessed portion  1042  containing inlet/outlet conduits  1044  (fluid out to the anatomical module, representing venous input) and  1046  (fluid into the control module, representing the arterial output). Additional recessed portions  1048  and  1050  contain additional external pneumatic connectors  1052  (arterial pneumatics out),  1054  (ventricle pneumatics out), and  1056  and allow for air to travel to the anatomical module  2000 . 
         [0075]    Referring to  FIGS. 6-16 , an illustrative example of a pneumatics module  1100  is illustrated. The pneumatics module  1100  contains the necessary components to provide one or more modules of the cardiovascular simulator system  10  with compressed air. The compressed air generated allows one or more of the components of the cardiac simulator module  2100 , which is pneumatically connected to the pneumatics module  1100 , to compress and forcibly expel any substance, such as liquid contained therein, out, as will be described later. Accordingly, the pneumatics module  1100  acts to provide the cardiac simulator module  2100  with accurate simulation of cardio dynamic functions. 
         [0076]    Most of the components of the pneumatics module  1100  are enclosed within a pneumatic module chassis  1102 . Referring to  FIG. 6 , the pneumatic module chassis  1102  contains a plurality of side walls  1104 ,  1106 ,  1108  (not illustrated), and  1110  (not illustrated) and a bottom wall  1112  (not illustrated). Each of the walls are arranged to create an internal compartment which stores the working components of the pneumatics module  1100  within. A pneumatic module chassis cover  1114  encloses the internal compartment. A pair of handles  1116  is attached to the outer surface  1117  of the pneumatic module chassis cover  1114  to allow the user to easily and quickly remove the pneumatic module chassis  1102  from the control module chamber chassis  1002 . 
         [0077]    Referring to  FIGS. 7-16 , a pneumatic actuator assembly, referred to generally as  1118 , housed within the pneumatic module chassis  1102  is illustrated. The pneumatic actuator assembly  1118  provides the necessary pressurized pneumatic fluid flow (i.e. air or other gases) needed to drive other parts of the cardiovasculature simulator system  10 , particularly the cardiac simulator module  2100 . The components of the pneumatic actuator assembly  1118  are directly or indirectly coupled to a pneumatic actuator assembly support structure  1120 . The pneumatic actuator assembly  1118  is designed to drive air into a plurality of locations within the cardiac simulator module. To achieve such functionality, a motor  1122 , such as a standard DC motor is used to drive a first pulley assembly  1123 . While a standard DC motor is illustrated, other motors such as a stepper motor can be used as well. 
         [0078]    The motor  1122 , which is supported by a first support structure  1124 , rotates a first drive pulley  1126  through rotation of a first pulley shaft  1128 . The first pulley shaft  1128  is secured to a second support structure  1130 . Rotation of the first drive pulley  1126  causes rotation of a driven pulley  1132  through movement of a first belt  1134 . The belt may be, for example, a standard synchronous belt with teeth  1135  (see  FIG. 13 ), such as but not limited to trapezoidal teeth or curvilinear teeth. The driven pulley  1132  is supported by a second pulley shaft  1136  which is coupled to parallel arms  1138  and  1140  of a third support structure  1142 . Belt aligning members  1144  and  1146  are used to align or adjust the tension of the belt  1134 . 
         [0079]    The pneumatic actuator assembly  1118  includes a pneumatic compliance adjustment component which functions as a compressed air cylinder driver, illustrated herein as a cylinder tube assembly, referred to generally as  1147  on  FIG. 8 . The cylinder tube assembly  1147  is configured to provide pressurized air which is directed to the cardiac simulator module  2100  and functions to provide contraction of the cardiac components. The cylinder tube assembly  1147  contains a cylinder sleeve  1148  coaxially aligned with a cylinder  1150 . The back end  1151  of the cylinder  1150  is secured to a cylinder support structure  1152 . The cylinder support structure  1152  is secured to the third support structure  1142  at the top end  1154  through insertion into the opening  1156  within the protrusion member  1158 . The cylinder support structure  1152  is further secured to the third support structure  1142  through insertion of aligning member  1144  through the opening  1160 . The cylinder support structure  1152  secures to the pneumatic actuator assembly support structure  1120  at the bottom end  1162 . The base end  1164  of the cylinder  1150  is preferably secured within the opening  1166  of the cylinder support structure  1152 . A belt clamp  1168  couples the belt  1134  to the cylinder sleeve  1148  such that as the belt  1134  moves, the cylinder sleeve  1148  moves along the cylinder  1150  as well. The belt clamp  1168  contains two plates  1170 , see  FIG. 9 , secured together through securing members  1172 , such as screws or nuts, to allow for passage of the belt  1134  there through. 
         [0080]    Inside the cylinder  1150  is a rod  1174  with a piston  1176  attached, see  FIG. 16 . The rod is coupled to the cylinder sleeve  1148  so that, as the cylinder sleeve  1148  moves along the fixed cylinder  1150 , the piston  1176  moves bi-directionally through space  1177  to generate air flow in the form of pressurized air in both directions. For example, as the piston  1176  moves to the right, see arrow  1179 , pressurized fluid in the form of compressed air is generated and expelled out of the cylinder  1150  through fluid conduit  1178  (see  FIG. 9 ). The pressurized air is directed to the atrium side (to be described later) of the cardiac chamber  2100  through tubing (not illustrated). As the piston  1176  moves in the opposite direction, see arrow  1181 , a second pressurized air is generated and can be expelled out through a different air conduit  1180  (see  FIG. 9 ). The pressurized air through fluid conduit  1180  is directed to the ventricle side (to be described later) of the cardiac chamber  2100  through tubing (not illustrated). Prior to exiting to the cardiac chamber  2100  through the fluid conduit  1178 , pressurized air exits out the cylinder though tubing connector  1183  to a connector  1185 . Prior to exiting to the cardiac chamber  2100  through connectors  1180 , pressurized air exits out the cylinder though tubing connector  1187  to a connector  1389 . Bi-directional movement, therefore, allows the generation of pressurized air which can be directed to various parts of the cardiac simulator module  2100 , thereby simulating atrial and ventricular “beating” through the contraction of corresponding cardiac simulator module portions, thereby simulating the systolic compression of the cardiac chambers. 
         [0081]    The cylinder sleeve  1148  is coupled to the rod  1174  at one end  1182  through a plate  1184 . The plate  1184  is secured to the cylinder sleeve  1148  through fastening members  1183 , see  FIG. 11 . At the opposite end  1191  of the cylinder sleeve  1148  is a bushing  1188 . The co-axial alignment allows the cylinder sleeve  1148  to move along the cylinder in a bi-directional, i.e. forward/reverse linear manner. The cylinder sleeve  1148  may contain one or more slots  1186  to allow for movement without contacting other components, such as the pulley  1126  or fluid connector devices, such as elbow connectors and/or tube barbs that are used to fluidly connect the cylinder assembly to other components of the system. 
         [0082]    The cylinder tube assembly  1147  further contains a second pulley system, refereed to generally as  1192 , coupleable to the cylinder sleeve  1148 . The second pulley system  1192  provides for control and manipulation of the pneumatic actuator assembly  1123  stroke adjustment. This system controls the air volume, increasing or decreasing the heart chamber compression and thus the cardiac output, i.e. the amount of fluid expelled from the cardiac simulator module and the force of expelling the fluid into the cardiac simulation module  2100 . The second pulley system  1192  is supported by a second pulley support structure  1194 . An interposer bracket  1196  is used to provide a mechanism to trigger changes in the stroke of the pneumatic actuator assembly  1123  through the use of a first sensing plate (limit set point)  1198  and a second home sensing plate  1200 . Both the first sensing plates (limit set point)  1198  and the second home sensing plate  1200  are adapted so that interposer bracket  1196  can move through a portion there through. Each of the sensing plates  1198  and  1200  may contain a cut out portion  1201  and  1202  in which the interposer bracket  1196  moves through as the cylinder sleeve  1150  moves bi-directionally. Both sensing plates  1198  and  1200  each contain a sensor (not illustrated), such as a laser, configured to detect directional movement of the interposer bracket  1196 . 
         [0083]    As the cylinder sleeve  1148  moves, the attachment interposer bracket  1196  moves through a portion of the first sensing plate (limit set point)  1198  triggering the sensor. The first sensing plate sensor is electronically coupled to the electronic control module  1600 . The triggering event, the sensing of the interposer bracket  1196 , electrically communicates with the motor  1122  to reverse the polarity and drive the motor in the opposite direction. Such action results in the belt  1134  reversing direction, causing the cylindrical sleeve  1150  to reverse directions as well. The interposer bracket  1196  moves in the opposite direction towards second home sensing plate  1200 , triggering its sensor upon reaching its destination. Once the interposer bracket  1196  triggers the second sensor, which is electronically coupled to the electronic control module  1600  the motor  1122  reverses direction, causing the cylinder sleeve  1148  and the interposer bracket  1196  to move in the opposite direction, or back to the original direction of movement. As the cylinder sleeve  1148  is moving bi-directionally, the attached rod moves the piston  1176  as well, causing air to move out of the cylinder  1150  and into fluid outlets  1178  or  1180  depending on the movement of the piston  1176 . 
         [0084]    In this manner, the interposer bracket  1196  oscillates in a back and forth motion triggering changes in pneumatic events, i.e. expelling air into the atrium module or ventricle module, and vice versa on the movement in the opposite direction. The distance between the first sensing plate (limit set point)  1198  and the second home sensing plate  1200  is adjustable, thereby changing the rate at which the cylinder moves in each direction. Preferably, first sensing plate  1198  is adjustable with the second home sensing plate  1200  as it is fixed to the rail  1203 . A pneumatic compression adjustment knob  1204 , see  FIG. 6 , adjusts the positioning of the first sensing plate  1198  relative second sensing plate  1200 . Moving the sensors provides a mechanism to increase/decrease contractions of the atrium and ventricle. Engaging the pneumatic compression adjustment knob  1204  causes the shaft  1205  to rotate the drive pulley  1206  of the second pulley assembly  1192 , moving the second pulley assembly belt  1208  and the driven pulley  1209 . The first sensing plate  1198  is secured to the second pulley assembly belt  1208  thereby moving the first sensing plate  1198  directionally along the rail  1203 . Alternative mechanisms for controlling the bi-directional movement of the cylinder sleeve, including devices using feedback mechanisms such as servomechanism, can be used. 
         [0085]    Pneumatically coupled to the cylinder tube assembly  1147  are manifolds  1214  and  1216  and 24V solenoid valves  1218  and  1220 . The manifolds  1214  and  1216  and 24V solenoid valves  1218  and  1220  are supported by support structure  1219  which is securable to the pneumatic actuator assembly support structure  1120 . The solenoid valves  1218  and  1220  are configured to controllably open and close to provide a mechanism to allow air to enter into the cylinder  1150  through solenoid air-in connectors  1221 A and  1221 B. As the piston  1176  is moving in the direction of arrow  1179  in  FIG. 16 , one of the solenoids, for example  1218 , is open to allow air into the space  1225  within cylinder  1150 . The other solenoid,  1220 , is in the closed position so that air cannot be directed into the second space  1227 . The air within the second space  1227  gets compressed as the piston  1176  moves in the opposite direction, see arrow  1181 . During this movement, the solenoid  1218  opens to allow air into space  1225  and the solenoid  1220  is closed. A pressure regulator  1222 , fluidly connected to the manifold  1214 , prevents over pressure of the atrial actuation system. 
         [0086]      FIGS. 17-22  show an illustrative example of the hydraulic module  1300 . The hydraulic module  1300  is adapted to: 1) provide a mechanism for removal of air bubbles trapped within the fluid moving through the system, 2) provide fluid pressure (simulating blood pressure) control by controlling resistance to fluid flow that circulates into (simulating the arterial circuit) and out of the hydraulic module  1300 , and enters back into (simulating the pulmonary circuit of) the anatomical module  2000  and 3) provide a mechanism to initiate fluid flow through the system. Adjustment of the fluid pressure control is accomplished through adjusting capillary resistance, to be described later, and through vascular tonometry through the use of a compliance chamber module  1500 , as described later. 
         [0087]    Similar to the other modules, most of the components of the hydraulics module  1300  are enclosed within a hydraulic module chassis  1302 . Referring to  FIGS. 17 and 18 , the hydraulic module chassis  1302  contains a plurality of side walls  1304 ,  1306 ,  1308 ,  1310  and a bottom wall  1312 . The side wall  1306  contains a recessed portion  1314  having one or more fluid conduits or connectors attached thereto for connecting to external devices, such as tubes or other fluid connectors. The recessed portion  1314  contains flanged portions  1316 A,  1316 B,  1316 C, and  1316 D which secure to a portion of the side wall  1306  through fastening members such as screws  1318  or pins  1320 . As illustrated, one or more of the side walls may be removeably attached to one or more of the other side walls. A top panel  1319  is secured to the side walls  1304 ,  1306 ,  1308  and  1310  through insertion of the pin  1320 , screws  1322  and washers  1324  into openings  1325 ,  1326  respectively, thereby forming an interior portion  1328 . 
         [0088]    Fluids, such as liquids simulating blood, circulate through the system  10  through both the anatomical module  2000  as well as though the hydraulic module  1300 . The fluid hydraulics circuit of the anatomical module  2000  and hydraulics module  1600  is made up of the anatomical vasculature module  2200  ( FIG. 31 ) as well as an interconnected loop that passes from the arterial manifold  2224  ( FIG. 31 ) through the control module  1000  and hydraulics module  1300  and returns to the anatomical module  2000  through the pulmonary manifold  2236 . The liquid fluid flow through the system  10  can be outlined as follows. Fluid passing from the arterial manifold  2224  is hydraulically connected to a quick disconnect fluid connector  1044  on the recessed panel  1042  ( FIG. 3 ). Fluid passes from the quick disconnect fluid connector  1044  into a control module fluid in entry manifold  1329 , see  FIG. 4 . The control module fluid in entry manifold  1329  contains 2 exit ports on the arterial side, not shown. One of these ports is connected though a butterfly valve to the compliance chamber  1500 . The other connection allows flow to the hydraulics module  1300  through a quick disconnect fluid connector  1330  ( FIG. 18 ). Connection of tubing to the quick disconnect fluid connector  1330  allows fluid to enter the hydraulics module entry manifold  1332 . 
         [0089]    Fluid flows from the port  1334  of the hydraulics module entry manifold  1332  through the bubble trap  1336 . An illustrative example of the bubble trap  1336  may contain an entry tube and exit port in which the entry tube is higher than the exit port in order to cause air to propagate to an air venting valve. The entry tube and exit port of the bubble trap are contained within a chamber larger in volume than normal system piping in order to reduce flow velocity. Any air trapped in the liquid is separated out and back into a non-contiguous section of the hydraulics module entry manifold  1332  through the port  1338 . Fluid flow then continues to the hydraulics loop manifold  1340  via a clear PVC pipe  1342  where it then continues out port  1346  to the capillary restriction valve  1348 . The capillary restriction valve  1348  provides a means of adjusting flow conditions to the anatomical module  2000  through, for example, the arterial simulated and pulmonary simulated circuits. The capillary restriction valve  1348  provides the system the capability to replicate capillary resistance found normally in the human body. Adjustment of the restriction valve  1348  simulates the resistance normally provided by the capillary and arterial system of a human. Use of the capillary restriction valve  1348  works in conjunction with vascular compliance, simulated through compliance chamber  1500 , determines the resistance associated with the cardiac module  2100 , i.e. resistance the heart pumps, and consequentially the representation of the systolic and diastolic blood pressure. Manipulation of the flow rate through the capillary restriction valve  1348  by adjustment knob  1349  renders various flow conditions found in a live cardiac system. From the capillary restriction valve, flow passes to the hydraulics module exit manifold  1344  where fluid exits the hydraulics module through quick disconnect port  1356 . Fluid flows from the quick disconnect port  1356  to the control module fluid in entry manifold  1329  where it exits through port  1046 , see  FIG. 3 , as it returns to the anatomical module  2000  at the pulmonary manifold  2236 , see  FIG. 31 . 
         [0090]    The hydraulics module  1300  provides fill function for the anatomical and hydraulics flow circuit through a fluid connection  1358  to an in-line squeeze bulb pump  1359  (see FIG.  4 ) connecting to fluid reservoir  1400 . The squeeze bulb pump  1359  is actuated by hand to draw fluid from the fluid reservoir module  1400  to the hydraulics module  1300 . Alternatively, the fluid can be drawn into the hydraulics module  1300  through other means such as an electrical pump. Fluid entering the hydraulics module  1300  through the aforementioned fluid connector  1358  is connected to a three way ball valve  1360  and labeled as “ 1 ” “system fill”, having a side port A,  1360 A, a side port B,  1360 B, and a center diverting port  1360 C. The ball valve  1360  can be actuated to make connections from side port  1360 A to diverting center port  1360 C, to a closed position with no connecting ports, and to connecting side port  1360 B to diverting port  1360 C through control knob  1362 . Fluid from the  1358  connector enters the 3 way ball valve through  1360 A side port and exits though center diverting port  1360 C if the valve  1360  is actuated to this connection. Fluid flows from valve port  1360 C to the hydraulics module exit manifold  1344 . During the initial fill cycle, the capillary resistance valve  1348  is actuated to a closed position so that fluid being pumped into the hydraulics circuit from the squeeze bulb pump  1359  must propagate through the entire flow circuit before reaching de-bubbler  1336  and system rapid de-air vent  1364 , see  FIG. 18 . The system rapid de-air vent  1364  is located on the loop manifold  1340  port  1366  and provides venting functions for initial fill only. When fluid reaches a poppet float valve (not illustrated) enclosed within, the vent closes for the duration of pressurized system use. When a fill and a de-air cycle are complete, or the system fill bulb is not in use, the system fill ball valve  1360  is actuated to the closed position to maintain fluid pressure. 
         [0091]    After the initial fluid fill, the capillary resistance valve  1348  is opened and tubing representing the arterial supply line (the supply line for moving fluid away from the cardiac simulator module  2100 ) is disconnected. The cardiac simulator module  2100  is used to pump fluid through the anatomical module  2000  which can be directed to make fluid connections from the highest point on the anatomical circuit, such as to an accessory organ/system module  2300 , such as tubing which represents a point located on a Circle of Willis output if a head is used as the accessory organ/system module  2300 , to a quick disconnect coupling  1056 , see  FIG. 3 . The fluid is then directed to the hydraulics module  1300  though a quick disconnect fluid connector  1367 , see  FIG. 18 . Fluid entering through the quick disconnect fluid connector  1367  is hydraulically coupled to a ball valve illustrated herein as  1372  ( FIG. 21 ) and labeled as “3” “Model De-Air” on  FIG. 22 . The three way ball valve  1372  has a side port A,  1372 A, a side port B,  1372 B, and a center diverting port  1372 C. The ball valve  1372  can be actuated to make connections from side port  1372 A to diverting center port  1372 C, to a closed position with no connecting ports, and to connecting side port  1372 B to diverting port  1372 C. Fluid enters the ball valve  1372  through port  1372 C, and in use as model de-air, functioning is connected to port  1372 A when the valve  1372  is actuated to this position. Fluid containing air bubbles from the anatomical vascular model enters the hydraulics module entry manifold  1332  through a side port  1364  ( FIG. 18 ). Bubbles and fluid entering from side port  1374  on the hydraulics entry manifold  1332  pass through the de-bubbler  1336  where the air is separated and vented. The model de-air  1372  three way ball valve can also be used to propagate additional flow through the vasculature module  2200 , simulated as neuro-vessel vasculature, by selecting the  1372 B port on the valve  1372  using knob  1376 . The knob  1376  is hydraulically coupled to a side port on the hydraulics exit manifold  1344 . Such action can be used to set an appropriate amount of flow on the capillary resistance valve  1348 . 
         [0092]    The hydraulics system de-air circuit consists of the rapid de-air vent, a system pressure relief  1375 , and the de-bubbler unit  1336 . These units expel air and fluid to a common vent line (not illustrated) which is hydraulically coupled to a 3 way ball valve (not illustrated but represented generally by  1377  and labeled by the “2” “System De-Air” on  FIG. 22 ). The three way ball valve represent by  1377  has a side port A, a side port B, and a center diverting port C. The three way ball valve represent by  1377  can be actuated, through knob  1378  to make connections from its side port A to the diverting center port C to a closed position with no connecting ports, and to connecting side port B to diverting center port C. The common vent line is hydraulically coupled to the side port A of the  1377  ball valve. If the valve is actuated to connect A and C ports, then air or fluid will flow through the valve represent by  1377  to the fluid connector  1358  on recessed panel  1314 , see  FIG. 18 . Fluid passing through the connector  1358  is vented to a port on the reservoir module  1400 . The system De-Air valve  1377  can also be closed for system pressure retention. 
         [0093]    The hydraulics module can be drained for transport or maintenance by actuating the system fill and system de-air ball valves  1360  and  1377  to the drain position by actuating both valves to their B port. A drain connection is made to a tube  1380  ( FIG. 20 ) which connects to loop manifold  1340 . As the hydraulics module and connected circuits are drained, air is drawn in through drain vent  1382 , ( FIG. 18 ) and displaces water draining out of drain tube  1380 . The hydraulics module  1300  may contain a gauge  1384  fluidly connected to the hydraulics entry manifold  1332  through connector  1386 . The gauge  1384  may also be fluidly connected to the pressure relief valve  1375  through connector  1388 . The gauge  1384  therefore can be used to measure the incoming fluid pressure, represented as the arterial input before reaching the capillary valve  1348 . Excess pressure can be released to the fluid reservoir module  1400  so that the desired fluid pressure, such as 0-200 mm/Hg, can be achieved. 
         [0094]    Referring to  FIGS. 2 ,  4 , and  23 , the control module  1000  further contains a fluid reservoir module  1400 . The fluid reservoir module  1400  contains a fluid storage chamber  1402  adapted to hold a fluid, and may contain a check valve to control back flow of fluid. The fluid can be any liquid that simulates blood. In a preferred embodiment, the fluid is a clear blood analog having properties which duplicate the viscosity of human blood and mimics the friction coefficients as endovascular devices, wires, and catheters traverse the vasculature system. Alternatively, the fluid can be whole blood. Accordingly, any fluid can be used and modified to have the viscosity and/or flow rate that is the same as or approximates that of blood flow through veins or arteries. The fluid could be clear, or may include a dye so that the fluid flow can be visualized throughout the system. In any form, the fluid storage chamber  1402  contains a plurality of side walls,  1404 ,  1406 ,  1408 , and  1410 , and a bottom wall  1412  (not illustrated). A top cover  1414  provides an enclosed interior portion  1416  (not illustrated) for storage of the fluid. The top portion contains a ridge  1418  extending around the perimeter which is used to attach to the top end of the side wall  1006  of the control module chamber chassis at one end and to fastening beam  1028 . The top cover  1414  may contain indictors, such as a gauge  1420 . A window may be utilized to provide visual confirmation of flow level. 
         [0095]    A fluid connector  1422  may be used to fill and/or remove the liquid. The bottom section of side wall  1404  may contain openings  1424  and  1426  to provide for fluid connectors to other components of the system for fluid connection into the fluid storage chamber  1402 , or for attachment to a water drain system. Handles  1428  and  1430  attach to the fluid storage chamber  1402  to provide easy removal from and placement into the control module  1002 . As described previously, to start the fluid flow, the fluid storage chamber  1402  is fluidly connected to a pump, illustrated herein as a hand pump  1359 , see  FIG. 4 . Engaging the hand pump  1359  (see  FIG. 4 ) through squeezing or compression causes fluid to flow from fluid storage chamber  1402  into the hydraulics module  1300 . Electrical pumps connected to the electrical module or other mechanisms which can activate flow of the fluid can be used. 
         [0096]    Referring to  FIGS. 24-28 , an illustrative example of a compliance chamber module  1500  is shown. The compliance chamber module  1500  acts as a system fluid storage device and is adapted to functionally provide compensation for the fact that the entire vasculature system is not modeled. Accordingly, the compliance chamber provides an anatomically correct range of cardiac system compliance and compensation given that the system  10  does not replicate all vasculature vessels contained within the entire human cardiovasculature system. For example, vasculature to the lower extremities, particularly the legs, is generally not included as part of the vasculature module  2200 . To replicate accurate cardio dynamics with anatomically accurate cardiac physiology while pumping into an incomplete modeled vascular system, the compliance chamber is used. The compliance chamber simulates the vascular volume and tonometry of the non-molded parts of the system. The vascular tonometry simulates arterial tension and can be changed by adding or removing air from the compliance chamber  1500 . Depending on the amount of air, the conditions of hypertension or hypotension can be simulated. 
         [0097]    Preferably, the compliance chamber module  1500  is placed within the system in which fluid flow is returning from the vasculature simulator module  2200  on its way toward the hydraulics module  1300 , and can be fluidly attached to the control module fluid in entry manifold  1329 . Fluid enters into the compliance chamber module  1500  and can be controllably replaced back into the system. The compliance chamber module  1500  contains a top cover plate  1502 , a bottom plate  1504 , and a main body  1506  there between. The main body may be constructed of a clear plastic material to allow for visualization of the contents therein. Several chamber stud posts  1508 , attached to the top cover plate  1502  through a washer  1510  and wing nut  1512 , secure the top cover plate  1502  to the bottom plate  1504 . The chamber stud posts  1508  may contain a swivel nut or threaded nut  1514  at one end to secure to the bottom cover. The main body contains a screen  1516  and diaphragm  1518  positioned at the bottom plate  1504 . The diaphragm separates the main body  1506  into a top portion and a bottom portion, and is made of a material that prevents liquid or gas fluids from diffusing or crossing through. 
         [0098]    Fluid, such as the fluid circulating through the anatomical module  2000  and representing blood flow, enters into the main body  1506  through a first fluid inlet/outlet  1520 . A gas can be inserted into the space above the diaphragm  1508  through a second fluid inlet/outlet  1522  and provides back pressure acting against the diaphragm  1518 . Additional air or gas placed into the main body  1506  increases the back pressure while removal of the gas decreases the back pressure. Based on the amount of gas in the compliance chamber, the flow of liquid out of the chamber is controllably released back into the system  10 . A third fluid inlet/outlet  1524  may be used to bleed out any excessive pressure built up if needed. O-rings  1526  and  1528  are sealed against the top cover plate  1502  and the bottom plate  1504  respectively. The compliance chamber module  1500  rests on a compliance chamber module mount  1530  and secures to the control module chamber chassis  1002  through fastening devices, such as screws  1532  and set screws  1534 . The use of the diaphragm  1518  is illustrative only and may be replaced with other accumulators that use pistons, springs, or bladders as known in the art. 
         [0099]    Referring to  FIGS. 30A and 30B , an illustrative embodiment of the electronic control module  1600  is shown. The electronics module  1600  contains the main controlling aspects of the system  10 , including a plurality of logic chips that allow the system to function and/or to be modified based on the task to be undertaken. In the illustrated example, the electronic control module  1600  is located on the inner surface  1018  of the control module chamber chassis cover  1016  and has the main function of providing the power and circuitry for driving the interactions between the modules. 
         [0100]    Several of the components are secured to the control module chamber chassis cover  1016  and enclosed by an electronics module cover  1602 . Alternatively, the components may be housed in a removable electronics module chassis. A main power supply, illustrated herein as a 24V DC regulated AC to DC converter  1604 , provides power to the system  10  and is electrically coupled to an electronic controller circuit board  1606  at power connection  1608  through cable  1610 . Alternatively, the main power supply could be an external 24V DC battery. The electronic controller circuit board  1606  contains individual logic circuitry for various components of the system  10 . Each of the circuitry is connected at various connection points, including the pneumatic module motor logic connector  1612 , the first and second sensors logic connectors  1614  (home sensor) and  1618  (limit sensor), the atrium solenoid logic connector  1620 , the ventricle solenoid logic connector  1622 , the handheld device logic connector  1621 , and a fan logic connector  1623 , are electrically coupled to the motor  1122 , first and second sensors  1210  and  1212 , the atrium solenoid  1216 , the ventricle solenoid  1214 , a fan  1625  (to cool down the control system), or an 24V DC accessory  1627 . Additionally, the main power supply  1604  may also be coupled to a power entry  1629 . Electrical coupling can be accomplished by means known to one of skill in the art, and may include, for example the use of a series of cables  1624  and electrical wiring  1626  which connect through the use of electrical connectors such as  1628 ,  1630   1632 ,  1634 ,  1636 , and  1638 . Each of the connectors may contain electrical pins  1640 , electrical sockets  1642 , or male/male feed thru devices  1644 . Additionally, brackets  1646  may be used to support one or more of the connectors. 
         [0101]    A handheld device  1648  is electrically coupled to the electronics module  1600  through the circuit logic connector  1621  to allow the user the ability to control the functioning of the system and manipulate one or more of the modules. Any of the control mechanisms or operational parameter adjustments discussed throughout the application can be controlled using the handheld unit  1648 . Referring to  FIG. 30C , an illustrative example of the handheld device  1648  is shown. The handheld device  1648  is constructed to provide a mixture of command functions and visual indicators. For example, a cardiac rate control knob  1650  can be manipulated by the user to control the cardiac module  2100 , thereby affecting the heart rate (beats per minute) simulation. A run-stop switch  1652  acts to pause one or more aspects of the system, preferably the beating of the heart, while allowing other aspects of the system to function. Several indicator LEDs are used to indicate function of one or more aspects of the system, including, but not limited to, the power  1654 , the atrium assembly  1656 , the ventricle assembly  1658 , and the system run  1660 . 
         [0102]    The control module  1000  interacts with the anatomical module  2000  by delivering pressurized air flow and liquids to the cardiac simulator module  2100 . The action of the pressurized air allows the cardiac simulator module  2100  to function like a heart muscle of an individual or animal by contracting and expanding, forcing fluid representing blood flow to travel within the vasculature simulator module  2300 . The control module is designed to supply pulses of pressurized air to the cardiac module  2100 . Fluid pressures and fluid dynamics/flows are created by the pumping action of the cardiac module itself.  FIGS. 31-40  illustrate the components of the cardiac simulator module  2100 , as well as the vasculature module  2200 . The Figures additionally illustrate the attachment of an embodiment of the accessory organ/system module  2300 , illustrated herein as a head. 
         [0103]    The cardiac simulator module  2100  is secured to a support board  2102  through a cardiac simulator module support structure  2104  through fastening members, such as screws  2106 . The cardiac simulator module  2100  comprises several chambers representing the left side of the heart, and includes an atrial actuator, illustrated herein as a left atrium assembly  2108 , and a ventricle actuator, illustrated herein as a left ventricle assembly  2110 . The atrium and the ventricle may be molded using a standard size and shape. Preferably, the present invention uses an atrium and a ventricle that have been molded using Computer Tomography (CT Scan) imagery of a heart as well as its vasculature. The atrium and ventricle can be molded to represent the exact size and shape analogous to that of individual patients. 
         [0104]    The left atrium assembly  2108  pneumatically connects to the fluid connector  1178  through tubing, not illustrated. Pressurized air enters the left atrium assembly  2108  through the atrium pneumatic-in connector  2111  which is coupled to an elbow connection  2112  to tube barb  2114  for fitting to a tube. The left atrium assembly  2108  contains an outer air pneumatic support structure  2116  which is preferably fabricated from a hard, firm, clear cast plastic, such as urethane. Inside of the outer air pneumatic support structure  2116  is a flexible bellow assembly  2120 , see  FIG. 36 , which is pneumatically connected to elbow connection  2112  to tube barb  2114 . Pneumatic pressure generated from the pneumatic modules and pneumatically connected to the atrium pneumatic-in connector  2111  inflates the bellows. Additional injection ports may be included to provide a mechanism to inject dyes or representative medicine into various places within the system  10 . As the bellow assembly  2120  expands it compresses a left atrium chamber  2122 . The bottom ends  2124  and  2126  of the atrium outer air pneumatic support structure  2116  connect to plates  2228  and  2230 , see  FIG. 38 . 
         [0105]    The left atrium chamber  2122  is preferably made of a soft, flexible, clear silicone which is capable of contracting and expanding. To allow fluid flow into the left ventricle at the appropriate time, i.e. when the left atrium contracts, without fluid flowing back into the left atrium upon relaxation, the left atrium  2128  contains a one way valve, illustrated herein as a synthetic valve  2129 , see  FIG. 36 . The valve  2129  represents a mitral valve, and as an illustrative example could be a synthetic replication. Alternatively, the valve may be a transplant of an actual mammalian mitral valve, such as a swine, or a human mitral valve. 
         [0106]    The left ventricle module  2110  is composed of a left ventricle pneumatic chamber  2130  which surrounds the left ventricle chamber  2132 , see  FIGS. 34 ,  36 , and  38 . The left ventricle pneumatic chamber  2130  is preferably fabricated from a hard, firm, clear cast plastic, such as urethane. The left ventricle chamber  2132  is preferably made of a soft, flexible clear plastic, such as silicone. A first end  2134  of the left ventricle pneumatic chamber  2130  contains a flange  2136  for connection to the left atrium assembly  2108 , preferably to a cardiac support structure  2137 . The second end  2138  of the left ventricle pneumatic chamber  2130  contains a second flange  2140 . The second flange  2140  connects to a ring  2141  sized and shaped to encircle an apex  2142  of the left ventricle chamber  2132 . In this embodiment, apex  2142  does not contract with the rest of the left ventricle chamber  2132 . In an alternative embodiment, the apex  2142  is fully enclosed by the left ventricle pneumatic chamber  2130 , see  FIG. 40 . 
         [0107]    As illustrated in  FIG. 39 , the left ventricle chamber  2132  does not include any vasculature. In an alternative embodiment, the left ventricle chamber  2132  includes anatomically correct vasculature  2144 , such as the left coronary artery, the left circumflex artery, the left marginal artery, the left anterior descending artery, and the diagonal branch, of the left ventricle chamber  2132 . The vasculature can be “normal” vasculature, or can be that of disease state vasculature. In addition, the normal or the disease state vasculature can be adapted to represent the exact vasculature of individual patients (through use of CT scans, MR and/or rotational angiography) or can be designed to represent normal/disease states of non-patient specifically. Moreover, sections of the ventricle chamber  2132  may include thick sections  2146  (simulating ventricular hypertrophy) and/or thinner sections  2148  (simulating ventricular hypotrophy) to simulate differing resistance of the heart to contraction and expansion, see  FIG. 40 . While not illustrated, such features may apply to the atrium  2122  as well. The left ventricle module  2110  is fluidly connected to one or more parts of the vasculature module  2200  through various connectors. For example, fluid flows out of the left ventricle into the vasculature module  2200  through a valve, illustrated herein as a synthetic aortic valve  2150 , see  FIG. 35 . The synthetic aortic valve  2150  may be constructed from a synthetic plastic or may be an animal such as a swine/pig or human aortic valve. In either case, the valve  2150  is designed to allow fluid flow at the proper time in one direction, i.e. out of the left ventricle chamber and into the vasculature module  2200 . 
         [0108]    The vasculature module  2200  is made of a plurality of members, such as synthetic tubing, that provide fluid flow into and away from the cardiac simulator module  2100 . Similar to the atrium and ventricle, the vasculature module  2200  tubing can be made to replicate the size, shape, and tonometry of the vasculature of specific patients. Preferably, the tubing is made of clear medical grade plastics having flexural modules, or stiffness, which corresponds to a desired need. Referring to  FIGS. 1 ,  34  and  37 , fluid flows out of the left ventricle chamber  2132  and into tubing representing the aorta  2202  and aortic arch  2203 . One or more aorta connectors, such as but not limited to,  2204  (subclavian artery),  2206  (right common carotid artery), and  2208  (braciocephalic artery) are used to fluidly attach to other components of the vasculature module  2200 , such as tubing representing the vertebral arteries  2210 , and fluidly connect to the periphery organ/system module  2300  (illustrated on  FIG. 31 ), the left common carotid artery  2212  and connected to fluid connector  2310  (illustrated on  FIG. 31 ) and the right common carotid artery  2214  connected to fluid connector  2312  (illustrated on  FIG. 31 ), see block diagram  1 . Fluid further flows into the descending aorta  2216  and connects to the right Iliac artery  2218  and the left Iliac artery  2220 . Fluid flow out of the cardiac simulator module  2100  is directed through the tubing and eventually into an arterial manifold  2224  through one or more arterial manifold inlets  2226 ,  2228 ,  2230 ,  2231 , or  2232 , depending on which part of the system the fluid is traveling, see  FIG. 31 . Fluid then travels out the arterial manifold  2224  through the output connector  2234 , through tubing (not illustrated) back to the control module  1000 . 
         [0109]    Fluid typically enters the cardiac simulator module  2100 , and then flows into the vasculature module  2200  through a pulmonary manifold  2236 . Fluid flows into the pulmonary manifold  2236  through the pulmonary manifold inlet  2238  and out to tubing from the pulmonary manifold outlets  2240 ,  2242 ,  2244 , and  2246 . The outlets  2240 - 2246  connect tubing representing the two left pulmonary veins  2248  and  2250 , and two right pulmonary veins  2252  and  2254 , see block diagram  FIG. 1 . The two left pulmonary veins  2248  and  2250  and two right pulmonary veins  2252  and  2254  direct flow into the left atrium chamber  2132 . 
         [0110]    Each of the components of the vasculature module  2200  may be supported by adjustable elevation posts  2256  mounted to the support plate  2102  through support plate connecting elements  2258 . The adjustable elevation posts  2256  also contain tab elements  2260  that are adapted to prevent interference with the natural reactions of the anatomical elements to flow and pressure wave transmission within the anatomical module  2000 . The posts  2256  provide 360 degree access and visualization of the anatomical parts and/or surfaces of the cardiovasculature system  10  for observation and characterization. The posts  2256  can be adjustable in the Z-axis, and can be mounted in the X and Y coordinate movement bracket. The combined movements allow for the augmentation of the tortuosity or offsets to the anatomical relationships at various increments along the contiguous anatomy model. The posts  2256  may also provide light illumination to one or more tubing to illuminate pathways back to the interior of the anatomical module  2000  through the translucent or transparent components of the anatomical module  2000 . The posts  2256  also provide for quick disconnect from one or more parts of the anatomical module  2000  for either replacement of one or more of the components or for exchange with other anatomical profile preferences. 
         [0111]    Referring to  FIGS. 31-33  and  41 , the periphery organ/system module is shown as a head  2302 . The head  2302  contains a bottom portion  2304  connected to a board  2305  and/or a top portion  2306  through fastening members  2308 , such as screws or nuts. Such arrangement allows for the top portion  2306  to be removed and replaced. The bottom portion  2304  contains one or more fluid connectors  2310  and  2312  which are adapted to fluidly connect the head  2302  to one or more components of the vasculature module  2200 . Such fluid connection allows the user to evaluate the effects of surgical techniques or procedures with peripheral organs or systems. 
         [0112]      FIG. 41  illustrates an illustrative example of the head unit  2302  with a plurality of tubing,  2312  and  2314 , representing the cerebrovasculature. The cerebrovasculature is placed within a gel like material  2316  in order to mimic the compliance of the vessels in the subarachnoid space and surrounding brain. The vasculature system, from the carotid bifurcation to the intracranial circulation, as well as any pathology can be replicated. The head unit  2302  may also contain additional tubing  2318  connectable to other parts of the system  10 , such as to connector  1054 . 
         [0113]    Referring back to  FIG. 1 , the present invention can be further demonstrated through an illustrative example of the simulator system  10  cycle. Fluid, such as a liquid representing blood flow through the system, stored within the fluid reservoir module  1400 , is passed through the manual hand pump  1359  with integral check valve module  1432 . The fluid is passed through the primary de-bubbler and/or the rapid debubbler to remove any bubbles and/or gases that may have formed therein. Removal of the bubbles prevents fluid dynamics abnormalities which may negatively affect the precision and accuracy of the cardio dynamics of the system, thereby enhancing the overall system performance. Once de-bubbling is complete, the fluid enters the anatomical module  2000  through tubing which is fluidly connected to the pulmonary manifold  2236 . Fluid in the pulmonary manifold  2236  represents oxygenated blood returning from the lungs, not used in the presently described system, and flows into the left atrium assembly  2108  through the two left and two right pulmonary veins. 
         [0114]    The atrium chamber  2122  fills with fluid and the pressure of the fluid, measured at the systolic side of the circuit, is controlled by the control module  1000  to be in the minimal normal range for diastolic pressure of a human heart (50-80 mm HG). The actual blood pressure of 120/80 (systolic/diastolic) obtained by the system is a combination function of the fluid flow volume (simulated by manipulation of the control module in relationship to the cardiac simulator module), the cardiac simulated heart rate, arterial compression, ventricular compression (or ejection fraction, simulated as the amount of fluid ejected out of the atrium chamber or ventricle chamber), the capillary resistance (simulated effects by the manipulation of the compliance chamber) and the vascular tonometry or tension (simulated effects by the manipulation of the compliance chamber). 
         [0115]    While the system does not independently adjust for systolic and diastolic values, various combinations of these parameters affect the systolic and diastolic numbers to varying degrees. The value of the diastolic pressure can be manipulated to above or below the normal ranges to simulate various disease states. Initiated by the control module  1000 , the left atrium is contracted. The electronics module  1600  drives the motor  1122  directionally, clockwise or counter clockwise, moving the piston  1176  bi-directionally in the cylinder  1150  in a direction which creates pressurized air flow to be directed into the left atrium chamber  2128 . The pressurized air generated flows through tubing and enters the outer air pneumatic support structure  2116  of the left atrium  2128 . The air causes the atrium bellows  2126  to compress against the left atrium chamber  2122 , reducing the volume within the left atrium chamber  2122 . Reduction of the volume results in fluid being expelled through the mitral valve  2129  and into the left ventricle pneumatic chamber  2130 . 
         [0116]    At the proper timing, pressurized air generated from the return stroke of the piston moving within the cylinder is controlled by the interaction of the control module and the second pulley system. The pressurized air generated travels through the tubing of the vasculature module into the left ventricle pneumatic chamber  2130 . The pressurized fluid causes a reduction of volume within the left ventricle chamber  2132 , resulting in the expulsion of fluid through the synthetic aortic valve  2150  and into the aortic arch  2202 . The pressure of the fluid is set within the normal range of normal systolic pressure, 100-160 mm Hg. The flow rate, 2-6 L/min of flow at 70 beats per minute of the heart and the ejection fraction (50-65%) is set within the normal range of the human heart. However, such conditions can be manipulated by the electronic control module  1600  to change the corresponding pressure, volume flow rate, ejection fraction, or combinations thereof. The fluid ejected from the left ventricle chamber is under pressure and flows through various portions of the ventricle module, such as the vertebral arteries, the left common carotid artery, and the right common carotid artery. Fluid also flows down to the descending aorta and into the right iliac artery and the left iliac artery. Eventually all fluid is directed to the arterial manifold  2224  and directed back to the control module  1000  in which the flow rate is adjusted, and air bubbles are removed. Vascular tension can be simulated and adjusted through several mechanisms, such as through the combination of the capillary resistance setting, the compliance chamber back pressure adjustments, and through the molded vasculature simulator module representing the arteries having various durometer values. Fluid is then returned to the pulmonary manifold to start a new cycle. 
         [0117]    As described previously, abnormal heart conditions can be simulated by varying the force, duration, and frequency of the air burst generated by the atrium/ventricle air cylinder through commands sent from the control and adjustments within the fluid control system. 
         [0118]    All patents and publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference. 
         [0119]    It is to be understood that while a certain form of the invention is illustrated, it is not to be limited to the specific form or arrangement herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification and any drawings/figures included herein. 
         [0120]    One skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned, as well as those inherent therein. The embodiments, methods, procedures and techniques described herein are presently representative of the preferred embodiments, are intended to be exemplary and are not intended as limitations on the scope. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims.