Abstract
Intra-aortic balloon pump (IABP) is normally contraindicated in significant aortic regurgitation (AR). It causes and aggravates pre-existing AR while performing well in the event of mitral regurgitation (MR). Indirect parameters, such as the mean systolic pressure, product of heart rate and peak systolic pressure, and pressure–volume are used to quantify the effect of IABP on ventricular workload. However, to date, no studies have directly quantified the reduction in workload with IABP. The goal of this study is to examine the effect of IABP therapy on ventricular mechanics under valvular insufficiency by using a computational model of the heart. For this purpose, the 3D electromechanical model of the failing ventricles used in previous studies was coupled with a lumped parameter model of valvular regurgitation and the IABP-treated vascular system. The IABP therapy was disturbed in terms of reducing the myocardial tension generation and contractile ATP consumption by valvular regurgitation, particularly in the AR condition. The IABP worsened the problem of ventricular expansion induced as a result of the regurgitated blood volume during the diastole under the AR condition. The IABP reduced the LV stroke work in the AR, MR, and no regurgitation conditions. Therefore, the IABP helped the ventricle to pump blood and reduced the ventricular workload. In conclusion, the IABP partially performed its role in the MR condition. However, it was disturbed by the AR and worsened the cardiovascular responses that followed the AR. Therefore, this study computationally proved the reason for the clinical contraindication of IABP in AR patients.
Highlights
An intra-aortic balloon pump (IABP) is used to increase myocardial oxygen perfusion, while simultaneously increasing cardiac output and decreasing the workload of the ventricle
The intracellular Ca2+ concentrations throughout the ventricles were mapped onto the mechanical mesh of the ventricle as input parameters to trigger crossbridge cycling for all the cases of mechanical simulation
Under the mitral regurgitation (MR) condition, the left atrial pressure shape was similar to the left ventricle (LV) pressure profile, whereas the pressure shape did not follow the shape of the LV pressure profile in the aortic regurgitation (AR) condition
Summary
An intra-aortic balloon pump (IABP) is used to increase myocardial oxygen perfusion, while simultaneously increasing cardiac output and decreasing the workload of the ventricle. This is realized via counterpulsation of the IABP. The most common heart valve diseases include aortic and mitral insufficiencies Cardiac responses such as cardiac output and blood pressure vary according to the type of valve that is affected and the severity of the regurgitation. This can affect the efficacy of the IABP function when patients are treated with IABP therapy [2]. A question of clinical significance arises since the AR can co-exist with the IABP
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