Intra-aortic Balloon Catheter Research Articles

Percutaneous treatment of a ventricular septal defect caused by MINOCA

We present a case of a 78-year-old female with a history of hypertension, paroxysmal atrial fi brillation and ischemic stroke which was admitted due to an hour-long chest pain with ECG changes indicating sinus rhythm and a newly formed LBBB. Subsequently a ventricular septal defect (VSD) was discovered which we successfully treated percutaneously. At admission, echocardiography revealed septo-apical hypokinesis with an accompanying reduced left ventricular ejection fraction of 38%, in addition to the mid-ventricular septal defect (7/14 mm in size) causing a signifi cant left to right shunt (QP/QS = 1.8/1.0). Coronary angiography demonstrated lack of obstruction of the coronary vessels – MINOCA. Rapid response and Intensive care treatment, including Intra-Aortic Balloon Catheter insertion, lead to LV-functional improvement and hemodynamic stabilization. A dual access approach through the right jugular vein and right radial artery was used and eventual closure of the VSD was achieved with an Occlutech ASD occluder (20.5/16.5 mm), inserted via the venous introducer, while under constant angiographic and transesophageal echo guidance. Immediate VSD shunt elimination was disclosed by EchoCG and angiography. Overall, an uneventful in-hospital stay and six months event-free follow-up period were registered including further EchoCG which confi rmed lack of major cardio-vascular events and the stable position of the occluder, without a visible shunt.

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Unusual rupture of left ventricular pseudo-false aneurysm secondary to subacute anterolateral myocardial infarction: a case report

BackgroundLeft ventricular (LV) pseudo-false aneurysm is a rare complication secondary to myocardial infarction and is caused by intramyocardial dissecting hematoma due to fragile myocardium. Very occasionally, intramyocardial dissecting hematoma appears as a neocavitation entirely contained within the myocardial wall (so called “pseudo-false LV”) and is an unusual form of subacute cardiac rupture.Case presentationA 38-year-old male experienced chest discomfort 3 weeks ago, which improved within few days. However, after that episode, he presented at our hospital with rapidly deteriorating severe breathlessness in a preshock state with acute heart failure. Emergency coronary angiography revealed an occluded left anterior descending artery. An intra-aortic balloon catheter was inserted because of unstable hemodynamics. Enhanced computed tomography revealed extensive aneurysm formation in the LV anterior wall and contrast leakage from the inner cavity to the LV myocardium, with a moderately accumulated pericardial effusion. Emergency surgery revealed a large aneurysmal sac on the anterior wall, slightly attached to the pericardium. A 5-mm, slit-like, oozing-type, rupture site was detected in the LV after dissecting the pericardium.ConclusionsTo our knowledge, this is the first report of a pseudo-false aneurysm on the LV anterior wall. Subacute rupture of pseudo-false LV aneurysm is rare.

Examination of the pressure assist effect by intra-aortic balloon catheter size

Examination of the pressure assist effect by intra-aortic balloon catheter size

Examination of the pressure assist effect by intra-aortic balloon catheter size

Examination of the pressure assist effect by intra-aortic balloon catheter size

Arrow International Intra-Aortic Balloon Catheter Kits and Percutaneous Insertion Kits

Arrow International Intra-Aortic Balloon Catheter Kits and Percutaneous Insertion Kits

A New 35-mm Short Intra-aortic Balloon Catheter: A Suitable Option Also for Non-Small-Sized Patients?

Visceral ischemia can be a potentially life-threatening complication of intra-aortic balloon pump (IABP) support. A shorter IABP catheter might lead to a reduction of visceral complications. In this animal study, we evaluate the effects of a 35-mL short catheter in comparison with a 40-mL standard-sized catheter. Eighteen healthy swine underwent 120-minute ligation of the left anterior descending coronary artery followed by 6 hours of reperfusion being supported by either a short IABP catheter (short group) (n = 6) or a long IABP catheter (long group) (n = 6) or with no assistance (controls) (n = 6). Hemodynamics, visceral and coronary flows, as well as biochemical markers were evaluated throughout the different phases of the protocol. Mesenteric flows increased significantly at reperfusion (P < 0.001 both) remaining constant afterward (all, P > 0.05) in the short group, while remaining significantly lower in the long group at the start of reperfusion, remaining constantly lower than the short group and controls (P < 0.001 vs short, P < 0.003 vs controls). In both long and short groups, catheters improved renal flows at reperfusion (P < 0.001 both) without any further variation (P > 0.05). In the short group, the flows were higher during the whole of reperfusion (all, P < 0.05). Intra-aortic balloon pump support improved hemodynamic indices and coronary blood flows during reperfusion to a similar extent in both the small and the long group (P > 0.05). The short IABP catheter proved to be as effective as the standard-sized catheter in supporting hemodynamics and coronary circulation. Furthermore, it even improves visceral flows in comparison with conventional IABP catheters.

A New 35-mm Short Intra-aortic Balloon Catheter: A Suitable Option also for Non-Small-Sized Patients?

A New 35-mm Short Intra-aortic Balloon Catheter: A Suitable Option also for Non-Small-Sized Patients?

TCTAP A-146 Virtual 5-French Intra-Aortic Pumping Using a Glidesheath Slender and 6-French Intra-Aortic Balloon Catheter

In recent years, major technical advances in intra-aortic balloon pumping (IABP) catheters have been made, including the introduction of low-profile catheters and the use of percutaneous insertion through a sheath introducer. To date, many clinical studies have confirmed the impact of lower profile

Standard Intra-Aortic Counterpulsation Balloon May Cause Temporary Occlusion of Mesenterial and Renal Arteries

The study was to test the hypothesis that mesenteric and renal arteries may be occluded by intra-aortic balloon pumps (IABPs), despite correct positioning. Computed tomography scans of 107 patients (34.6% women and 65.4% men) were evaluated for diameter and distance measurements of the descending aorta. Renal perfusion was examined with duplex sonography. Mean distances between left subclavian artery and celiac trunk, between the left subclavian and superior mesenteric artery, and between the left subclavian and renal artery were 214.5 ± 22.3, 229.5 ± 22.3, and 242.9 ± 22.1 mm, respectively. Statistical assessment of aortic distances in patient population showed no correlation between the length of the descending aorta and body mass index (BMI) and height (men: R(2) < 0.13; women: R(2) < 0.3). An impaired arterial perfusion of the renal parenchyma existed in three of the 12 patients; three of the 12 demonstrated diastolic oscillatory flow over the renal arteries; two of the 12 patients presented both during IABP support. Autopsy observation was used to observe the position of the IABP catheter. The correlation between patient height/BMI and the distances between subclavian artery and renal/visceral branches is weak. Therefore, even if positioned correctly, intra-aortic balloon catheters may be too long and could potentially cause occlusion of aortic branches.

Ethicality of Heart Transplantation from Donation after Circulatory Death Donors

rd of transplants performed in the United Kingdom are now undertaken using organs obtained from DCD donors [1]. Historically, the transplantation of organs procured after cardiac arrest was instrumental in pioneering transplantation. The initial heart and liver transplants were performed using organs removed after death of the donor [2,3]. Prior to definition of criteria for brainstem death (BSD), cardiac arrest and loss of circulation were considered essential for confirmation of donor death. The practice of DCD organ donation has raised many ethical concerns and continues to have detractors. Loss of cardiac output and cessation of circulation are the principal requirements for certification of death in the DCD donor. The ethicality of resuscitating the heart in DCD donors has been questioned. It is suggested by some that “cardiac death” should be an irreversible occurrence. Once established it is argued that resuscitation of the heart by any means would potentially negate the diagnosis of death due to recovery of heart beat and restoration of circulation within the donor. The terminal event that precedes the decision to withdraw therapy in the majority of DCD donors is usually severe neurological injury. However, neurologic testing in these donors does not identify irreversible loss of brain-stem function. Consequently, conventional heart-beating cadaveric donation is not an option. The lack of a clear definition of death contributes towards further confusion. In a recent clinical case of human DCD heart resuscitation, we utilized an extracorporeal perfusion circuit to deliver oxygenated blood to the donor after circulatory arrest [4]. The commonest protocol for DCD organ procurement relies on the rapid infusion of cold preservation solution into the donor circulation with the aim of initiating organ protection and preservation through cooling of organs. More recently, the use of extracorporeal membrane oxygenation (ECMO to reperfuse the donor with normothermic oxygenated blood has also been undertaken on the basis that warm blood perfusion may be a physiologically more appropriate means for organ resuscitation and preservation [5,6]. Currently, this practice is limited to the procurement of the kidneys and liver. The majority of retrieval teams who undertake ECMO reperfusion of the DCD donor have achieved this through cannulation of peripheral vessels, most commonly the femoral artery and vein. Institution of ECMO leads to retrograde perfusion of the abdominal viscera. During the early experience with ECMO in DCD donors, cardiac resuscitation was observed upon reperfusion. As this was deemed unnecessary, specific measures were undertaken to depress cardiac activity including the establishment of systemic hyperkalemia to produce cardiac arrest. The deployment and inflation of intra-aortic balloon catheters for occlusion of the descending aorta was another means of preventing coronary reperfusion, whilst maintaining perfusion of transplantable abdominal organs [7,8]. There remain several important ethical issues relating to DCD heart resuscitation which require discussion and debate: 1.� The appropriateness of restoration of circulation and recovery of heart beat within the donor for purposes of organ resuscitation and evaluation of function 2.� The ethicality of pre-treatment of the donor prior to withdrawal of support to facilitate the organ retrieval and procurement process (i.e. systemic heparinization, insertion of vascular catheters for delivery of preservation solutions)

A Novel Technique for Intra-aortic Balloon Positioning in the Intensive Care Unit

Proper positioning of the intra-aortic balloon catheter is very important as an improperly placed balloon can cause problems. A balloon placed too high can block off the arch vessels, whereas one placed too low can block the renal and splanchnic vessels. We propose a simple and reliable technique to properly position the intra-aortic balloon pump (IABP) catheter without the use of any sophisticated or expensive equipment in the intensive care unit if the catheter has migrated from the previously placed desired position. In this technique, we rely on the left radial arterial trace obliteration as the IABP catheter is pushed in along a guidewire as a marker for tip positioning.

EComment. Re: Is heparin needed for patients with an intra-aortic balloon pump?

The article by Pucher et al. [1] showed the expected results of heparin need for patients with an intra-aortic balloon pump (IABP). At the same time, they observed that the use of heparinization with IABP, which was intended to reduce the risk of thrombus, thromboembolus or limb ischaemia, will concomitantly increase the risk of bleeding as a side-effect. They therefore concluded from the studies that omitting or implementing a selective use strategy of heparinization during IABP counterpulsation could significantly decrease the incidence of bleeding without an increase in limb ischaemic events[1]. It is important to state that the use of IABP showed be holistic, especially when considering ischaemic complications such as limb ischaemia. While it is true that judicious use of an adjunct like heparin should be seriously considered in light of the attendant complications, the physical properties of the IAPB should also be seriously considered vis a vie the size of the balloon/catheter and sheathless technique. In particular, the height/ body surface area of the patients should be taken into account to avoid the occlusive effect of the balloon/catheter, which can lead to an increased effect of limb ischaemia. Scholz et al. observed that using thinner catheters for percutaneous placement was associated with a reduction in the rate of complications, from 20.7 % (17 of 82 patients) for 12 French catheters to 9.9 % (10 of 101 patients) for 10.5 French catheters (P= 0.04), and 8.4 % (14 of 167 patients) for 9.5 French catheters (P = 0.006) and with multivariate logistic regression analysis identified catheter size (odds ratio 3.4 for 12 French catheters) and other factors were independent risk factors for counterpulsation-associated complications[2]. Nash et al., whilst stating that IABP was helpful for controlling myocardial ischaemia and providing haemodynamic support, pointed out that its applicability was limited by lower extremity ischemic complications in a significant percentage of patients. They developed a new sheathless technique for percutaneous intra-aortic balloon catheter insertion, which reduced the effective catheter size. A pilot study conducted using this new technique resulted in a 10% rate of limb ischemia, without compromise of balloon function. They concluded that the technique was useful in reducing the incidence of limb ischaemia associated with IAPB [3]. Thus in the use of IAPB, especially when heparinization is to be discouraged or omitted for fear of bleeding, the balloon/catheter size, and possibly the avoidance of a sheath should be considered. Conflict of Interest: None declared

Abstract 257: The Induction of Mild Hypothermia Improves Myocardial β-Adrenergic Responsiveness During Endotoxemia in Pigs

Background: Mild hypothermia (MH) exerts anti-inflammatory effects in experimental settings. We tested the effect of MH on myocardial ß-adrenergic responsiveness during experimental endotoxemia. Methods: Anesthetized pigs (65±2 kg) were acutely instrumented (closed chest) with a series of catheters including a Swan-Ganz catheter, a left ventricular (LV) pressure-volume catheter, an intraaortic balloon catheter and an intravascular cooling device. Endotoxemia, a model of septic shock, was induced by lipopolysaccharid (LPS) infusion at 0.5 µg/kg/h for 1 hour and 1 µg/kg/h for further 3 hours. With the beginning of LPS infusion, pigs were assigned to either normothermia (NT, 38 °C, n=7) or MH (33 °C, n=6). Animals were followed for a total of 8 hours. After sacrifice, ventricular muscle strips were isolated, stretched to optimal length in Tyrode solution containing 2,5 mmol calcium, stimulated at 1 Hz and exposed to increasing concentrations of isoproterenol. All muscle strips were examined at 38 °C. Results: In vivo, LV pressure-time (dP/dt) and pressure-volume analysis indicated a similar impairment of LV contractile parameters. In vitro, the increase of developed force in response to isoproterenol was higher in muscle strips isolated from hearts of the MH group than of the NT group. The logEC50% was not different between groups. Conclusion: These data indicate that MH counteracts the loss of myocardial ß-adrenergic responsiveness typically associated with the development of sepsis. MH may be a therapeutic option for septic cardiomyopathy.

Effects of Minocycline on Hind-Limb Motor Function and Gray and White Matter Injury After Spinal Cord Ischemia in Rats

A prospective, randomized laboratory investigation. To investigate whether administration of minocycline attenuates hind-limb motor dysfunction and gray and white matter injury after spinal cord ischemia. Minocycline, a semisynthetic tetracycline antibiotic, has been shown to have neuroprotective effects in models of focal and global cerebral ischemia. However, there have been no data available regarding the effects of minocycline in a model of spinal cord ischemia. Thirty-six rats were randomly allocated to one of three groups; control (C) group (n = 11), minocycline (M) group (n = 13), or sham group (n = 12). Minocycline or saline was intraperitoneally administered for 3 days beginning at 12 hours before 10 minutes of spinal cord ischemia or sham operation. Spinal cord ischemia was induced with intraaortic balloon catheter and blood withdrawal. Seventy-two hours after reperfusion, hind-limb motor functions were assessed using Basso, Beattie, Bresnahan (BBB) Scale (0 = paraplegia, 21 = normal). For histologic assessments, the gray and white matter injury was evaluated using the number of normal neurons and the extents of vacuolations in the white matter, respectively. Activated microglia was also evaluated using Iba-1 immunohistochemistry. BBB scores and the numbers of normal neurons in the M group were significantly higher than those in the C group. The percentage areas of vacuolations in the white matter and the number of Iba-1 positive cells were significantly lower in the M group compared with those in the C group. The results indicated that minocycline administration improved hind-limb motor function and attenuated gray and white matter injury and microglial activation after spinal cord ischemia in rats.

Use of the Impella 2.5 in High-Risk Percutaneous Coronary Intervention

The Impella 2.5 is a percutaneously placed partial circulatory assist device that is increasingly being used in high-risk coronary interventional procedures to provide hemodynamic support. The Impella 2.5 is able to unload the left ventricle rapidly and effectively and increase cardiac output more than an intra-aortic balloon catheter can. Potential complications include bleeding, limb ischemia, hemolysis, and infection. One community hospital's approach to establishing a multidisciplinary program for use of the Impella 2.5 is described.

Bedside Use of a Dual Aortic Balloon Occlusion for the Treatment of Cerebral Vasospasm

Delayed ischemic neurological deficits (DIND) due to cerebral vasospasm remains a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Methods to prevent DIND remain limited both in safety and efficacy. A novel intra-aortic dual balloon catheter (NeuroFlo™: CoAxia, Maple Grove, MN) is under investigation for treatment of ischemic stroke, including DIND. Because this technique does not require cerebral artery navigation, it may be useful as a bedside procedure, outside of the conventional angiography suite. We report the first case of ultrasound-guided application of the NeuroFlo™ system at bedside in the Neurological Intensive Care Unit. A 52-year-old woman presented with Hunt Hess IV aSAH complicated by medically refractory cerebral vasospasm. Despite surgical clipping of her aneurysm, the patient remained critically ill, failing maximal conventional medical therapy. For that reason, the NeuroFlo™ system was deployed using two-dimensional, spectral and color-flow Doppler ultrasound guidance at the patient's bedside while maintaining all forms of cerebral blood flow monitoring. The procedure was well tolerated and there was no complication. Bedside application of the NeuroFlo™ system may be safely performed in critically ill patients. The NeuroFlo™ system is under investigation for treatment of refractory cerebral vasospasm to prevent delayed ischemic neurological disease.

Resuscitation strategy for exanguinating intraperitoneal hemorrhage, not responding to initial fluid management, by an intra-aortic occlusion balloon catheter

Resuscitation strategy for exanguinating intraperitoneal hemorrhage, not responding to initial fluid management, by an intra-aortic occlusion balloon catheter

Optimization and safety of the intra-aortic balloon pumping balloon catheter

Tokai Medical Products developed an intra-aortic balloon pumping (IABP) balloon catheter with the following unique characteristics: the balloon can be applied to any patient irrespective of their physical size, and is therefore suitable for Japanese patients of small stature; a long soft tip is used, which is designed to avoid damage to blood vessels; the size of the catheter is reduced to 7 Fr, and the catheter can be used as a multifunctional balloon catheter, such as the Yoshioka type, that allows simultaneous percutaneous coronary intervention (PCI). The safety of this catheter has been proven in scientific studies. In this review, we report the development of our IABP balloon catheter and give an outline of its characteristics.

The way the intra-aortic balloon catheter moves within the aorta as a possible mechanism of balloon associated morbidity☆

This study set off to investigate which mode of weaning of an intra-aortic balloon pump (IABP) produces more aortic trauma. With the use of a perfusion pump, an intact porcine aorta with an IABP in situ, was studied. Angioscopic images of the interior of the aorta were obtained. Whilst keeping steady blood pressure and flow, an 'aortic impact score' was calculated. Endoscopically there is a 'whipping' effect of the balloon shaft on the lateral aortic wall, which appears to be prominent in 1:3 mode. The aortic impact score at 0.5, 6 and 12 h during the experiments was: (1) When weaning by mode: a) 1:1 3.3+/-0.6, 4.0+/-1.0 and 4.3+/-0.6; b) 1:2 4.7+/-0.6, 6.7+/-0.6 and 7.0+/-0.0; c) 1:3 8.7+/-0.6, 11+/-1.0 and 11.7+/-0.6. (2) Weaning by augmentation: a) 75% 2.3+/-0.6, 2.7+/-0.6 and 3.0+/-0.0; b) 50% 1.3+/-0.6, 1.3+/-0.6 and 1.7+/-0.6. An increasing score was observed while weaning by mode (P<0.05). The 1:3 mode produces marked intimal disruption that worsens with time.