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(Circulation. 2000;102:364.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Augmentation of Coronary Blood Flow With Intra-Aortic Balloon Pump Counter-Pulsation

Elizabeth W. Ryan, MBBS; Elyse Foster, MD

From the University of California San Francisco.

Correspondence to Dr Elyse Foster, Director, Adult Echocardiographic Laboratory, University of California San Francisco, 505 Parnassus Ave, Room M 322, San Francisco, CA 94143-0214. E-mail foster{at}medicine.ucsf.edu

A78-year-old woman with reduced left ventricular contractile function underwent coronary artery bypass graft surgery (3 saphenous vein grafts and an internal mammary artery graft) and mitral valve repair. Inotropic support and intra-aortic balloon pump (IABP) counterpulsation were required for weaning from cardiopulmonary bypass. The intra-aortic pressure and ECG tracings (Figure 1) on day 2 after surgery are shown. During continuous atrioventricular sequential pacing and 2:1 IABP counterpulsation, enhanced early diastolic aortic pressure (arrows) and reduced aortic end-diastolic pressure during every second cardiac cycle are demonstrated.

View larger version (168K): [in this window] [in a new window]   Figure 1. ECG (top) showing atrioventricular sequential paced rhythm. Aortic pressure trace (bottom) in mm Hg showing augmentation of aortic pressure by an IABP in the descending aorta and synchronized to inflate during alternate cardiac cycles, denoted by arrows.

Figure 2 is a transesophageal echocardiographic image and schematic diagram demonstrating a postoperative pericardial collection and diastolic flow in an epicardial vessel (arrow), representing the saphenous vein graft anastomosed to an obtuse marginal artery. A Doppler signal of this vessel demonstrates increased flow velocity with alternative cardiac cycles (Figure 3). This phenomenon is absent without IABP inflations. Similar Doppler findings of augmented flow velocity with IABP counterpulsation were also noted proximally in the native left anterior descending coronary artery (not shown).

View larger version (34K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiographic 2D image with color Doppler and (inset) schematic diagram. Pericardial effusion (PE) surrounds left ventricle (LV). Color Doppler shows epicardial diastolic flow (arrow).

View larger version (31K): [in this window] [in a new window]   Figure 3. Spectral Doppler recordings of epicardial vessel shown in Figure 2. Augmented diastolic velocity is noted with alternate cardiac cycles (top) during 2:1 IABP counterpulsation. This phenomenon is absent without IABP inflations (bottom).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ryan, E. W. Articles by Foster, E. Search for Related Content PubMed PubMed Citation Articles by Ryan, E. W. Articles by Foster, E. Related Collections Coronary circulation Coronary imaging: angiography/ultrasound/Doppler/CC Echocardiography CV surgery: coronary artery disease Imaging