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