| Right ventricular failure resulting from pressure overload: role of intra-aortic balloon counterpulsation and vasopressor therapy. | |
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MedLine Citation:
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PMID: 19766243 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Augmentation of coronary perfusion may improve right ventricular (RV) failure following acute increases of RV afterload. We investigated whether intra-aortic balloon counterpulsation (IABP) can improve cardiac function by enhancing myocardial perfusion and reversing compromised biventricular interactions using a model of acute pressure overload. MATERIALS AND METHODS: In 10 anesthetized pigs, RV failure was induced by pulmonary artery constriction and systemic hypertension strategies with IABP, phenylephrine (PE), or the combination of both were tested. Systemic and ventricular hemodynamics [cardiac index(CI), ventricular pressures, coronary driving pressures (CDP)] were measured and echocardiography was used to assess tricuspid valve regurgitation, septal positioning (eccentricity index (ECI)), and changes in ventricular and septal dimensions and function [myocardial performance index (MPI), peak longitudinal strain]. RESULTS: Pulmonary artery constriction resulted in doubling of RV systolic pressure (54 ± 4mm Hg), RV distension, severe TR (4+) with decreased RV function (strain: -33%; MPI: +56%), septal flattening (Wt%: -35%) and leftward septal shift (ECI:1.36), resulting in global hemodynamic deterioration (CI: -51%; SvO(2): -26%), and impaired CDP (-30%; P<0.05). IABP support alone failed to improve RV function despite higher CDP (+33%; P<0.05). Systemic hypertension by PE improved CDP (+70%), RV function (strain: +22%; MPI: -21%), septal positioning (ECI:1.12) and minimized TR, but LV dysfunction (strain: -25%; MPI: +31%) occurred after LV afterloading (P<0.05). With IABP, less PE (-41%) was needed to maintain hypertension and CDP was further augmented (+25%). IABP resulted in LV unloading and restored LV function, and increased CI (+46%) and SvO(2) (+29%; P<0.05). CONCLUSIONS: IABP with minimal vasopressors augments myocardial perfusion pressure and optimizes RV function after pressure-induced failure. |
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Authors:
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Oliver J Liakopoulos; Jonathan K Ho; Aaron B Yezbick; Elizabeth Sanchez; Vivek Singh; Aman Mahajan |
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Publication Detail:
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Type: Journal Article Date: 2009-05-28 |
Journal Detail:
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Title: The Journal of surgical research Volume: 164 ISSN: 1095-8673 ISO Abbreviation: J. Surg. Res. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376340 Medline TA: J Surg Res Country: United States |
Other Details:
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Languages: eng Pagination: 58-66 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Surgery, Division of Cardiothoracic Surgery, David Geffen School of Medicine at University of California Los Angeles, California, USA. oliver.liakopouos@uk-koeln.de |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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