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Effects of intra-aortic balloon counterpulsation on cardiac performance, oxygen consumption, and coronary blood flow
ABSTRACTS
Thermographic Patterns of Pulmonary Vascular Disease CONSTANTINE POTANIN, MD/JAMES PITTMAN, MD RICHARD 0. RUSSELL, Jr., MD, FACC and CHARLES E. RACKLEY, MD, FACC Birmingham, Alabama
liquid crystals with a discriminating temperature range of 30 to 37C were used in conjunction with an infrared detector to map thoracic thermographic patterns in 9 patients with pulmonary vascular disease and 7 with infection or neoplastic disease. Thermographic asymmetry was the criterion of abnormality, and was recorded as the temperature difference (AT) between two anatomically symmetrical point’s on the thorax. Five of 6 patients with recent thromboembolism and 3 with postpneumonic fibrosis had cool patches of skin (s?rT = -0.5 to -2C) over pulmonary segments shown to be affected by angiography or radioisotope scanning, or both. One patient with thromboembolism had a symEncapsulated
metrical t.hermogram; and both angiography and radioisotope scanning demonstrated bilatera.1 basal abnormalities. By contrast, 4 patients with pneumonia and 4 with carcinoma had areas of skin over affected pulmonary segments that were warmer (AT = +0.5 to +2.5C). With therapy, the patterns of pneumonia receded or reversed. In the absence of chest pain or t’otal body asymmetry, an asymmetrical thermogram over the chest is significant. Areas of unmatched coolness suggest underlying pulmonary vascular disease but do not indicate whether the latter is from thromboembolism or secondary to regional pulmonary fibrosis.
Effects of Intra-Aortic Balloon Counterpulsation on Cardiac Performance, Oxygen Consumption, and Coronary Blood Flow WILLIAM JOHN POWELL, Jr., MD/WILLARD M. DAGGETT, MD/ALFRED E. MAGRO JESUS A. BIANCO, MD/MORTIMER J. BUCKLEY, MD/CHARLES A. SANDERS, MD ARTHUR R. KANTROWITZ, PhD and W. GERALD AUSTEN, MD, FACC Boston, Massachusetts
The effect of intra-aortic counterpulsation with the AvcoM.G.H. balloon upon myocardial oxygen consumption (VO,), coronary blood flow and left ventricular performance was studied in 23 anesthetized canine right heart bypass preparations at constant heart rate and cardiac output. In nonhypotensive preparations, without limitation of corona.ry blood flow, counterpulsation produced a fall (-10 f 3 SEM mm Hg) in left ventricular peak systolic pressure and a decrease in MVO, (- 1.1 2 0.2 ml,/min per 100 g left ventricle [LV]). In these animals there was little steady state change in coronary blood flow (-5.6 * 5.9 ml/min), secondary to autoregulation by the coronary vascular bed. Left ventricular end-diastolic pressure (LVEDP) fell if elevated but exhibited little change if initially normal. However, in hypotensive preparations in which left ventricular performance was substantially limited by a decreased coronary blood flow, counterpulsation produced a striking increase in coronary blood flow (+40.9 -C 8.6 ml/ min) accompanied by an increase in MVOZ (+ 1.2 + 0.3
ml/min per 100 g LV) and a small decrease in peak left ventricular systolic pressure (-5 1 1 mm Hg) ; elevated end-diastolic pressures fell substantially (-9.9 + 1.6 cm HaO) toward normal. Directionally similar changes in LVEDP could be produced by increasing coronary blood flow alone in the absence of balloon pumping. When coronary blood flow was ma.intained constant in the hypotensive preparation with limited coronary blood flow, counterpulsation produced a fall in left ventricular peak systolic and enddiastolic pressures. These data document two effects of intra-aortic balloon counterpulsation upon cardiac dynamics : (1) Counterpulsation can decrease left ventricular peak systolic pressure and end-diastolic pressure independent of changes in coronary flow. (2) A major effect of counterpulsation in the hypotensive, failing, coronary flow-limited preparation is to improve cardiac performance by increasing coronary blood flow wit.h an associated increase in myocardial oxygen consumption.
Evaluation of Selective Coronary Flow in the Normal and Hypertrophic Human Ventricle AlTILl REALE, MD, FACC/ANTONIO and PIER AGOSTINO GIOFFRE, MD Rome, lta/y
NIGRI,
MD
In a group of normal subjects and in patients with acquired and congenital heart diseases with hypertrophic right or left ventricle, or both, coronary flow was evaluated by selective coronary artery injection of *zkrypton.
None of the patients had clinical or arteriographic evidence of coronary artery disease. It was assumed that the right ventricle was supplied mainly by the right, and the left ventricle by the left coronary artery. A comparison was made of the right coronary flow in 12 normal
The American Journal of CARDIOLOQY
Thermographic Patterns of Pulmonary Vascular Disease CONSTANTINE POTANIN, MD/JAMES PITTMAN, MD RICHARD 0. RUSSELL, Jr., MD, FACC and CHARLES E. RACKLEY, MD, FACC Birmingham, Alabama
liquid crystals with a discriminating temperature range of 30 to 37C were used in conjunction with an infrared detector to map thoracic thermographic patterns in 9 patients with pulmonary vascular disease and 7 with infection or neoplastic disease. Thermographic asymmetry was the criterion of abnormality, and was recorded as the temperature difference (AT) between two anatomically symmetrical point’s on the thorax. Five of 6 patients with recent thromboembolism and 3 with postpneumonic fibrosis had cool patches of skin (s?rT = -0.5 to -2C) over pulmonary segments shown to be affected by angiography or radioisotope scanning, or both. One patient with thromboembolism had a symEncapsulated
metrical t.hermogram; and both angiography and radioisotope scanning demonstrated bilatera.1 basal abnormalities. By contrast, 4 patients with pneumonia and 4 with carcinoma had areas of skin over affected pulmonary segments that were warmer (AT = +0.5 to +2.5C). With therapy, the patterns of pneumonia receded or reversed. In the absence of chest pain or t’otal body asymmetry, an asymmetrical thermogram over the chest is significant. Areas of unmatched coolness suggest underlying pulmonary vascular disease but do not indicate whether the latter is from thromboembolism or secondary to regional pulmonary fibrosis.
Effects of Intra-Aortic Balloon Counterpulsation on Cardiac Performance, Oxygen Consumption, and Coronary Blood Flow WILLIAM JOHN POWELL, Jr., MD/WILLARD M. DAGGETT, MD/ALFRED E. MAGRO JESUS A. BIANCO, MD/MORTIMER J. BUCKLEY, MD/CHARLES A. SANDERS, MD ARTHUR R. KANTROWITZ, PhD and W. GERALD AUSTEN, MD, FACC Boston, Massachusetts
The effect of intra-aortic counterpulsation with the AvcoM.G.H. balloon upon myocardial oxygen consumption (VO,), coronary blood flow and left ventricular performance was studied in 23 anesthetized canine right heart bypass preparations at constant heart rate and cardiac output. In nonhypotensive preparations, without limitation of corona.ry blood flow, counterpulsation produced a fall (-10 f 3 SEM mm Hg) in left ventricular peak systolic pressure and a decrease in MVO, (- 1.1 2 0.2 ml,/min per 100 g left ventricle [LV]). In these animals there was little steady state change in coronary blood flow (-5.6 * 5.9 ml/min), secondary to autoregulation by the coronary vascular bed. Left ventricular end-diastolic pressure (LVEDP) fell if elevated but exhibited little change if initially normal. However, in hypotensive preparations in which left ventricular performance was substantially limited by a decreased coronary blood flow, counterpulsation produced a striking increase in coronary blood flow (+40.9 -C 8.6 ml/ min) accompanied by an increase in MVOZ (+ 1.2 + 0.3
ml/min per 100 g LV) and a small decrease in peak left ventricular systolic pressure (-5 1 1 mm Hg) ; elevated end-diastolic pressures fell substantially (-9.9 + 1.6 cm HaO) toward normal. Directionally similar changes in LVEDP could be produced by increasing coronary blood flow alone in the absence of balloon pumping. When coronary blood flow was ma.intained constant in the hypotensive preparation with limited coronary blood flow, counterpulsation produced a fall in left ventricular peak systolic and enddiastolic pressures. These data document two effects of intra-aortic balloon counterpulsation upon cardiac dynamics : (1) Counterpulsation can decrease left ventricular peak systolic pressure and end-diastolic pressure independent of changes in coronary flow. (2) A major effect of counterpulsation in the hypotensive, failing, coronary flow-limited preparation is to improve cardiac performance by increasing coronary blood flow wit.h an associated increase in myocardial oxygen consumption.
Evaluation of Selective Coronary Flow in the Normal and Hypertrophic Human Ventricle AlTILl REALE, MD, FACC/ANTONIO and PIER AGOSTINO GIOFFRE, MD Rome, lta/y
NIGRI,
MD
In a group of normal subjects and in patients with acquired and congenital heart diseases with hypertrophic right or left ventricle, or both, coronary flow was evaluated by selective coronary artery injection of *zkrypton.
None of the patients had clinical or arteriographic evidence of coronary artery disease. It was assumed that the right ventricle was supplied mainly by the right, and the left ventricle by the left coronary artery. A comparison was made of the right coronary flow in 12 normal
The American Journal of CARDIOLOQY