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At least 451 records · Page 25Linked to original sources

PubMed1989

[Intra-aortic balloon counterpulsation. Percutaneous insertion at surgical units. Apropos of 170 cases].

From 1st January 1985 to 31st December 1987, an intra-aortic balloon counterpulsation device (IABCP) was inserted in 170 patients: 166 balloons were inserted percutaneously and 4 surgically after failure of the percutaneous route. The indications for insertion of IABCP are classified into 3 categories. Category 1 (N = 28) consists of non-operated patients, category 2 (N = 60) consists of patients in whom IABCP balloons were inserted by necessity before, during of after a surgical operation under cardiopulmonary bypass (CPB) and category 1 (N = 82) consists of patients in whom the IABCP balloons were inserted prophylactically prior to an operation under CPB in patients at high risk. Sixteen patients with a percutaneous IABCP balloon developed a major complication related to the balloon (9.6 +/- 2.3%). The early mortality for the entire population was 49.4 +/- 3.8% (84/170). The mortality was 89 +/- 6% (25/28), 65 +/- 6% (39/60) and 24 +/- 5% (20/80) respectively in categories 1, 2 and 3. In category 3, 56 IABCP balloons (68.3%) were retrospectively considered to be necessary (group A). Nineteen patients in group A died (34 +/- 6%). The mortality observed in the 30 patients in category 2 in whom an IABCP balloon was required during the intra- or post-operative period (group B) was 76.6 +/- 7.7% (23/30). It was significantly higher than that observed in group A (p less than 0.001). However, the retrospective nature of this study prevented any formal conclusions concerning the benefit provided by prophylactic IABCP.

Adult↗

PubMed1989

[Observation on the therapeutic effect of external counterpulsation in progressive muscular dystrophy].

Twelve cases of progressive muscular dystrophy were treated with external counterpulsation (ECP). The therapeutic results of ECP were shown as follows: markedly improved, 3 cases: improved 6 cases: slightly improved 2 cases and no effect 1 case after ECP Clinical, improvement in various degrees developed in all the cases. Dystrophy muscle enlarged in 11 of the 12 cases. Gastrocnemius muscles softened and lessened in 3 of 8 cases. CPK markedly decreased in 9 of 10 cases. In electron microscopic examination the ultrastructure of the diseased muscles was found to have obviously improved, the structure and form of most mitochondria returned to normal, and collection of glycogen was rarely seen.

Adolescent↗

PubMedDate not supplied

Effects of veno-arterial counterpulsation (VACP) on ischemic-injured myocardium. A hemodynamic, ultrastructural and cytochemical study.

An experimental study was performed in order to evaluate the effects of veno-arterial counterpulsation (VACP) on ischemic-injured myocardium. Following ischemic episodes in 9 dogs, reperfusion by VACP was performed under normal temperature for 45 min, while reperfusion by partial cardiopulmonary bypass (PCPB) was performed in another 9 dogs in order to observe cardiac function, myocardial ultrastructure and cytochemical changes. The results thus obtained can be summarized as follows: Cardiac output recovered to 100% of the pre-ischemic value 60 min after weaning from cardiopulmonary bypass in the VACP group; however, only 70% at most could be recovered in the PCPB group. Glycogen granules were favorably maintained during cardiopulmonary bypass or even after the weaning in the VACP group as compared to the PCPB group. Sarcomere length after removal of cardiopulmonary bypass was almost similar to the control value in the VACP group, although this was longer than the control value. Succinate dehydrogenase activity in mitochondria was better maintained in the VACP group than in the PCPB group. From the evidence mentioned above, it was suggested that VACP is useful for the recovery of aerobic metabolism and myocardial contractility in ischemic-injured myocardium.

Acid Phosphatase↗

PubMed1987

Haemodynamic and antiischaemic protective effects of intra-aortic balloon counterpulsation in high risk coronary heart patients undergoing percutaneous transluminal coronary angioplasty.

Sixteen critically ill atherosclerotic cardiac patients required intra-aortic balloon counterpulsation (IABP) for uncontrollable chest pain, hypotension or shock in connection with percutaneous transluminal coronary angioplasty (PTCA). 1.75 coronary artery angioplasty/patient were attempted. An angiographic and an immediate clinical success was achieved in 27 out of 28 attempts (96% primary success rate). All patients received heparin and antiplatelet agents. After PTCA, haemodynamic stabilization was achieved and IABP support was stopped in 14 to 96 hours. The percutaneous therapeutic procedures were well tolerated. Three patients died: one of cerebrovascular accident not related to cardiovascular problems, two other patients died suddenly 1 and 3 months later. Two patients required coronary bypass surgery, one a repeated angioplasty on a reoccluded left anterior descending saphenous vein bypass. 12 of the 13 survivors are asymptomatic after a 15-months follow-up period. IABP is a useful adjunct to PTCA in patients with severely damaged coronary circulation and compromised haemodynamics.

Adult↗

PubMedDate not supplied

Hemodynamic effects of a counterpulsation device implanted on the ascending aorta in severe cardiogenic shock.

A valveless, single orifice counterpulsation device (CD) with maximum stroke volume of 100 ml was implanted on the ascending aorta of nine dogs. Its pneumatic driver was gaited by the ECG to provide aortic diastolic augmentation, with a stroke volume of 60-70 ml. In the same animals a 20 ml intraaortic balloon (IAB) was placed into the descending aorta. An attempt was made to evaluate the effectiveness of the CD on severe cardiogenic shock and to compare its hemodynamic effects with those of the IABP. Severe cardiogenic shock was induced by coronary artery ligation, propranolol administration, and fluid infusion and was characterized by a LVEDP of 22.2 +/- 6.4 mmHg, ASP less than 70 mmHg and greater than or equal to 30 mmHg, and a reduction of CI by 71.7%. The CD had a significant beneficial effect in all measured parameters. The LVEDP decreased by a mean of 44.3% (P less than 0.001) below control value, and the AEDP by 60.2% (P less than 0.001). The PADA increased by 108.5% (P less than 0.001), and the CI by 155.8% (P less than 0.004). The IABP did not significantly change any of the hemodynamic variables. In conclusion, the CD has significant salutary hemodynamic effects in severe cardiogenic shock where IABP is ineffective.

Animals↗

PubMed1987

Intraaortic balloon counterpulsation.

The authors summarize their experience with intraaortic balloon counterpulsation (IABC) at the Institute for Clinical and Experimental Medicine between 1978-1984. A total of 756 cardiac surgery procedures were performed for ischaemic heart disease (IHD), and 266 procedures for rheumatic heart disease (RHD). Of patients operated on for IDH, IABC was used in 38 (5%) and, of those undergoing surgery for RHD, in 38 cases (14%). Overall, IABC was employed in 76 patients, i.e., 7%. Ventricular assistance using IABC was successful in 55% of patients. The technique was significantly more successful in IHD (68%) than in RHD (42%) patients. IABC was less successful in IHD patients suffering myocardial infarction intraoperatively. Moreover, the success of IABC depended on its early initiation. Eleven patients (14%) developed complications associated with IABC. The data do not differ from results reported by world's leading centres.

Adult↗

PubMed1987

[Effect of intra-aortic balloon counterpulsation on thrombocyte ultrastructure and functional properties].

Ultrastructure and function of blood platelets have been examined after intraaortic balloon counterpulsation in 9 dogs. Intraaortic balloons made of "polyurethane" (Experiment I) or "biomer" plastic (Experiment II) were used. An increase in the number of platelet microforms due to the fragmentation of the normal-sized platelets has been noted along with the ultrastructural signs of platelet activation, degranulation and alterations of plasma membrane structure. The above changes were less pronounced in experiment II.

Animals↗

PubMed1983

Pulmonary artery balloon counterpulsation for right ventricular failure. An experimental evaluation.

Right ventricular (RV) failure frequently occurs in patients undergoing correction of congenital cardiac defects, as well as in other clinical settings. RV hypertrophy was created in 10 neonatal lambs by pulmonary artery (PA) banding. Twelve months later RV hypertrophy was present (RV weight/body weight = 2.71 +/- 0.31 gm/kg); RV systolic pressures were elevated (65 +/- 9 mm Hg) and the average gradient across the PA band was 38 +/- 9 mm Hg. RV failure was produced in all animals by performing a right ventriculotomy. Four unassisted (control) animals died shortly after separation from bypass. Six experimental animals underwent pulmonary artery balloon counterpulsation (PABCP). A Dacron graft anastomosed to the proximal PA served as a reservoir for a 40 ml intra-aortic balloon pump system. PABCP effectively reversed RV failure, low cardiac output, and systemic arterial hypotension. Periods with PABCP on and off in each animal were compared. PABCP increased cardiac output from 1.45 +/- 0.16 to 2.03 +/- 0.13 L/min (p less than 0.0001) and increased aortic systolic pressure from 78 +/- 7 to 99 +/- 6 mm Hg (p less than 0.0004). PABCP produced a significant reduction in RV peak systolic pressure from 56 +/- 5 to 41 +/- 3 mm Hg (p less than 0.0001). PA peak pressure distal to the band increased from 31 +/- 2 to 40 +/- 1 mm Hg (p less than 0.0001). Right atrial pressure decreased from 14 +/- 1 to 11 +/- 1 mm Hg (p less than 0.0001) with PABCP, and RV end-diastolic pressure fell from 15 +/- 1 to 11 +/- 1 mm Hg (p less than 0.0001). RV stroke work index increased 49% from 0.081 +/- 0.011 to 0.121 +/- 0.017 gm X m/kg/beat (p less than 0.01), and RV systolic pressure time index decreased 38% from 1140 +/- 79 to 710 +/- 65 mm Hg sec/min (p less than 0.0001). Thus PABCP in the presence of RV dysfunction can produce substantial improvement in RV function and in overall cardiac function and may prove clinically useful in managing patients in refractory RV failure.

Animals↗

PubMed1978

An analytical approach to the determination of optimal phasing for external counterpulsation.

An inhomogeneous linear one-dimensional mathematical model is constructed as a conceptual approach to the study of the effects of External Counterpulsation (ECP) on the pressure and flow at the root of the aorta. The optimal operation of ECP is defined by two conditions: (1) minimization of the mean systolic pressure; and (b) maximization of the ratio of diastolic area over systolic area under the total pressure curve. The phase shift of the external pressure is determined so as to satisfy these two requirements. It is demonstrated within our approximation that with a given magnitude of external pressure, the phase shifts that satisfy these two requirements are the same. These phase shifts are linear functions of the systolic fraction of the total cardiac period, and depend on the time for the external wave to travel from the site of application up the vascular bed to the root of the aorta, plus the reflection contributions. Even though these results are derived from a simple model far from the complexity of the actual vasculature, the basic concepts would remain valid even if more complex mathematical treatments would have been used.

Aorta↗

PubMed1978

[Counterpulsation by means of a new device with a pulsatile blood flow in open heart operations (author's transl)].

A new counterpulsation method in operations on an open heart is described. Clinical experience in the use of the new device in 124 patients, which also makes it possible to produce a pulsatile flow of blood in the system of extracorporeal circulation, testifies to its effectiveness. The authors claim that the positive changes in cardiac output, diastolic and systolic pressure, and coronary circulation are among the factors which cause an improvement in the final result of the operation in patients with severe valvular diseases and ischemic heart disease.

Adult↗

PubMed1978

[Effect of intra-aortic balloon counterpulsation on regional blood circulation].

The effect of intra-aortic balloon counterpulsation (IABC) on the volume blood flow in the descending branch of the left coronary artery and in the vertebral, renal, and femoral arteries was studied in dog experiments by means of an electromagnetic flowmeter. Resistography was applied to appraise the regulatory changes in the resistance to the blood flow in the vascular regions mentioned during IABC. It is shown that the increase in the coronary and cerebral blood flow during IABC is not associated with the reflex dilation of the resistant vessels of the heart and brain and is mainly due to a rise of diastolic pressure in the aorta. The volume blood flow in the kidney and hind extremity is maintained during IABC at a level close to the initial level due to regulatory decrease of the resistance of the vessels of these organs.

Animals↗

PubMed1978

Myocardial contusion: effect of intra-aortic balloon counterpulsation on cardiac output.

Intra-aortic balloon counterpulsation (IABCP) improves impaired left ventricular (LV) performance associated with myocardial ischemia. We have evaluated the effect of IABCP on cardiac output (CO) after blunt trauma to the heart where LV performance is impaired by myocardial contusion but coronary blood flow is normal. Contusion of 20 to 40% of the LV in 13 dogs decreased CO by 41% +/- 6.4. A 30-minute period of IABCP was followed by 30 minutes without IABCP with three assist periods in each animal unless death occurred. Immediate IABCP after injury in six dogs increased CO 14% +/- 3.8 (p less than 0.01). Treatment was delayed for 30 minutes in seven dogs, and CO further decreased 0.7% +/- 3.2; initiation of IABCP then increased CO 9.2% +/- 6.5 (p less than 0.05). When CO was decreased less than 25% or greater than 50% after injury, IABCP had no effect on CO. In midrange when CO decreased 25 to 50%, IABCP increased CO 12.5% +/- 3.2 (p less than 0.001 initially, 9.3% +/- 1.3 (p less than 0.005) with second assist, and third assist 5.6% +/- 2(NS). It is concluded that IABCP improves LV performance following myocardial contusion, especially when applied early after injury.

Animals↗

PubMed1982

Long-term follow-up of limbs after use of intra-aortic balloon counterpulsation device.

There has been concern for the viability and function of the limb distal to the femoral artery access site after use of the intra-aortic balloon counterpulsation device (IABCD). We have studied the long-term (6 to 50 months) hemodynamic status in the lower limbs of 31 patients who received circulatory support with the IABCD. Since both limbs were classified according to the pressure changes induced by treadmill walking, comparisons with the unoperated leg could be affected. Nine of ten patients with insertion problems had satisfactory results at follow-up. One limb was lost as a result of the use of IABCD. Two patients had required femorofemoral bypass, three required use of the opposite leg because of gross femoral disease, one required thrombectomy, three lost distal pulses, and one developed groin phlebitis. All these patients (except the one requiring amputation) had satisfactory hemodynamics at follow-up. Of the 21 patients with no insertion problems, all had satisfactory hemodynamics at follow-up, and 16 of the 21 were normal. Three patients had better hemodynamic data in the balloon-access limb than in the contralateral limb at follow-up, suggesting that the surgery may have been salutary. We conclude that placement of the IABCD via the common femoral artery does not alter the long-term function of the ipsilateral limb if perioperative problems are avoided or handled appropriately.

Assisted Circulation↗

PubMed1982

Isosorbide dinitrate alone and in association with intra-aortic balloon counterpulsation in acute myocardial infarction. A clinical study by precordial ECG mapping.

The effects of the association of Isosorbide Dinitrate (ISDN) and Intra-Aortic Balloon Counterpulsation (IABCP) on ECGphic signs (in 24-lead precordial maps) of myocardial damage were studied in 7 patients (pts) with anterior acute myocardial infarction (AMI) without cardiogenic shock and/or pulmonary congestion, admitted to the CCU within 6 hours (hrs) since the chest pain. Matched control group consisted of 7 pts treated with ISDN alone. Analysis of variance showed that the association of IABCP and ISDN influenced favourably (p less than 0.01) the trend of the sigma ST (in all leads and in those with ST segment elevation greater than 0.2 mV), of the ST and of NST. The trend of sigma R was similar in the two groups. sigma Q was influenced either by time and by therapy; NQ was significantly lower (p less than 0.01) in pts treated with ISDN and IABCP. These findings seem to give evidence that the association of ISDN and IABCP may really be effective in reducing and stabilizing the ECG extent of ischemic myocardial injury in pts with transmural AMI without left ventricular failure; however this aggressive therapy cannot have a widespread indication until more reliable criteria for evaluating infarct size are available and larger randomized clinical trials performed.

Assisted Circulation↗

PubMed1981

Intra-aortic balloon counterpulsation in septic shock.

Mortality in patients in septic shock remains high (50% to 80%) despite available treatment. In a 76-year-old women with hypodynamic septic shock intra-aortic balloon counterpulsation (IABC) successfully improved the hemodynamic status to the point at which the patient could maintain adequate cardiac output without assistance. The pertinent literature on experimental and clinical shock in which mechanical assistance devices were used, is reviewed. From the few clinical reports available it appears that IABC may be life-saving in those patients with hypodynamic septic shock who deteriorate despite the administration of antibiotics, steroids and vasopressors. Its value in hyperdynamic shock remains doubtful. Since the mortality associated with septic shock has not decreased despite modern management, there is justification in searching for new modalities of treatment, and the use of IABC seems most appropriate and promising.

Aged↗

PubMed1980

Pulmonary artery balloon counterpulsation for acute right ventricular failure.

The development and availability of right ventricular assist devices has not kept pace with the evolution of devices designed to mechanically support the systemic circulation. This report describes the application of the counterpulsation concept to the pulmonary circuit to unload the failing right ventricle and augment pulmonary blood flow. Conventional, widely available balloon pumping equipment was employed. Use of this double balloon pump system enabled a patient to be weaned from cardiopulmonary bypass after all other measures had failed. Other relevant potential clinical applications for this technique are discussed.

Assisted Circulation↗

PubMed1995

Anaerobic metabolism in patients undergoing intra-aortic balloon counterpulsation for cardiogenic shock.

To find the best predictors of outcome for patients undergoing intra-aortic balloon counterpulsation (IABP) for cardiogenic shock, we prospectively studied 30 consecutive patients by examining hemodynamic parameters and cardiac lactic acid extraction ratios before the procedure. 1 hour after and then every 6 hours for 3 days. Complete hemodynamic data were obtained from the recordings of Swan-Ganz catheterization. Blood samples were drawn from the peripheral artery, central vein, pulmonary artery wedge position (PAW) and right atrium (RA) to quantify lactic acid levels. The simplified lactic acid extraction ratio was defined as the concentration of lactic acid in RA--the concentration of lactic acid in PAW/the concentration of lactic acid in PAW. The traditional systemic lactic acid production ratio was defined as the concentration of lactic acid in the central vein--the concentration of lactic acid in the peripheral artery/the concentration of lactic acid in the peripheral artery. Of the 30 patients studied, 19 died of cardiogenic shock, (group 1), while the surviving 11 patients formed group 2. The lactic acid extraction ratios at each of the time periods after the procedure were all significantly different, while the differences in the systemic lactic acid production ratio and hemodynamic parameters, including the systemic arterial pressure, cardiac output, cardiac index and PAW pressure, became significant at varying times after IABP. In group 2, the lactic acid extraction ratios 1 hour after IABP and later were all significantly higher than at baseline. This trend was not seen in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[Mechanical circulatory support. 1: Intra-aortic balloon counterpulsation (IABP)].

In cardiac surgery mechanical circulatory support with intra-aortic balloon counterpulsation (IABP) is an established measure for the therapy of perioperative low-output-syndrome and refractory cardiogenic shock. The favourable influence on the myocardial oxygen supply and demand-relationship with an improvement of the energetic balance guarantees the functional and ultrastructural recovery of reversibly damaged ischemic myocardium. The efficacy of IABP is uncontradicted and verified by high survival rates even in patients with severe impairment of the ventricular function. The system is easy to applicate by standardized surgical techniques of im- and explantation, safely to handle due to improvements of the technical equipment and can be applied at a low risk.

Cardiac Output, Low↗