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

Abstract

A 78-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.

Enhanced coronary flow velocity during intra-aortic balloon pumping assessed by transthoracic doppler echocardiography

“…Although intra-aortic balloon pumping (IABP) has beneficial effect on cardiac afterload, controversy exists about its ability to increase coronary blood flow in patients with reperfused acute myocardial infarction (MI) or in those who have significant coronary stenosis (1)(2)(3)(4)(5)(6). Previous studies using Doppler-tipped angioplasty guide wire demonstrated lack of significant flow improvement beyond most critical stenosis with IABP, and IABP mediated significant flow enhancement after amelioration of severe coronary obstructions in patients after successful coronary angioplasty (3).…”