The hemodynamic effects and mechanism of action of pulmonary artery balloon counterpulsation in the treatment of right ventricular failure during left heart bypass

P. A. Spence, R. D. Weisel, J. Easdown, A. K. Jabr, V. Yap, Tomas Salerno

Research output: Contribution to journalArticle

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Abstract

The efficacy of pulmonary artery balloon counterpulsation (PABC) was evaluated in improving right ventricular (RV) output during left heart bypass for global cardiac failure. In 13 pigs, a 40-ml balloon was positioned within a graft anastomosed to the pulmonary artery distal to the pulmonary valve, and left heart bypass was instituted from the left atrium to the carotid artery. Global myocardial failure was produced by an infusion of propranolol (range, 25 to 78 mg). In this model, RV output decreased despite volume loading to a right atrial pressure of 15 mm Hg and atrioventricular sequential pacing at 100 beats per minute. Pulmonary artery balloon counterpulsation increased both RV output (from 519 ± 76 to 1,117 ± 110 ml/min; p < 0.01) and RV systolic stroke work (from 1.3 ± 0.4 to 2.3 ± 0.6 gm-m; p < 0.01). Right atrial pressure decreased (from 15.5 ± 0.9 to 10.7 ± 1.0 mm Hg; p < 0.01) in 8 of the pigs studied during RV failure. In 5 pigs, ventricular fibrillation occurred without a stable model of RV failure, and there was no cardiac output before or after counterpulsation. The mechanism of action of PABC was studied by placing a flow probe around a large branch of the right pulmonary artery. During RV failure, balloon inflation caused flow through the pulmonary circulation, and ventricular systole resulted in filling of the graft. During ventricular fibrillation, balloon inflation and deflation produced only a to-and-fro movement of blood in the pulmonary artery branch without net forward flow. These results suggest that PABC may be effective in the treatment of RV failure during left heart bypass if ventricular fibrillation does not occur.

Original languageEnglish
Pages (from-to)329-335
Number of pages7
JournalAnnals of Thoracic Surgery
Volume39
Issue number4
StatePublished - Dec 1 1985
Externally publishedYes

Fingerprint

Left Heart Bypass
Counterpulsation
Pulmonary Artery
Hemodynamics
Ventricular Fibrillation
Atrial Pressure
Swine
Economic Inflation
Heart Failure
Transplants
Pulmonary Valve
Pulmonary Circulation
Systole
Heart Atria
Carotid Arteries
Propranolol
Cardiac Output
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The hemodynamic effects and mechanism of action of pulmonary artery balloon counterpulsation in the treatment of right ventricular failure during left heart bypass. / Spence, P. A.; Weisel, R. D.; Easdown, J.; Jabr, A. K.; Yap, V.; Salerno, Tomas.

In: Annals of Thoracic Surgery, Vol. 39, No. 4, 01.12.1985, p. 329-335.

Research output: Contribution to journalArticle

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