EFFECTS OF INTRA-AORTIC BALLOON PUMPING ON REGIONAL AND TOTAL CORONARY FLOW IN PATIENTS WITH CORONARY DISEASE. James L. Whittle, MD; Robert L. Feldman, MD; Carl J. Pepine, MD, FACC; Wilmer W. Nichols, Ph.D., FACC; John Selby, MD, FACC; Thomas Kelly, MD; C. Richard Conti, MD, FACC; University of Florida, Gainesville, Florida. To clarify coronary hemodynamic effects due to intra-aortic balloon pumping(IABP) we studied total and regional coronary hemodynamic responses in 12 pts with coronary artery(CA) disease. Measurements were made during and 5 min after IABP was turned off. The left ventricle(LV) was divided into anterior (supplied by the anterior descending) and inferior (supplied by the circumflex and/or right CA regions). These LV regions were considered ischemic (isch) when ST segment shifts were observed in either anterior or inferior ECG leads during angina. All indentified'isch regions were supplied by CA's with >90% diameter narrowing. Total anterior and inferior flow(F) and oxygen delivery(002) were measured by coronary sinus and great cardiac vein(GCV) sampling using continuous regional thermodilution. RESULTS: Heart rate and mean aortic pressure were similar during and off IAFiP. CSF was higher during IABP compared to off (157+21 to 142+20 ml/min, pcO.05). Isch region F was higher during IABF than off IABP (6158 to 50+_7 ml/min, pcO.05) while non-isch region F was unchanged (96_t18 to 92+18 ml/min, p=NS). Total L#02 was similar during and off IABP (12.8+0.9 to 12.421.9 ml/min, p=NS). However, isch region 002 was greater during IABP compared to off IABP (5.1+0.7 to 3.6+0.6 ml/min, pcO.01). Non-isch region 00 ml min, 3 was i Melvin B. Weiss, M.D., FACC; William J. Casarella. M.D.. Columbia University. New York. New York -, A 4Occ percutaneous intra-aortic balloon (PIAB) has been developed which obviates the need for the usual surgical procedure to insert an intra-aortic balloon pump. The balloon can be tightly wrapped around a central wire within the balloon membrane so that it can be inserted by the standard Seldinger tecbmique through a 12 French angiographic sheath. Insertion and removal are rapid and the resultant hexodynanics are similar to standard intra-aortic balloon pumping. The PIAB has been employed in 9 patients (7 males, 2 females) at the Columbia Presbyterian Medical Center without complication. The average time for balloon insertion was between 3 and 4 minutes. The clinical series includes 2 patients with crescendo angina refractory to medical therapy and 2 patients with postinfarction angina. These 4 patients underwent successful surgery, and all 4 patients survived and were discharged. PIAB was utilized to support an additional patient while undergoing treatment for septic shock. One patient underwent intraoperative PIAB for weaning from cardiopulmonary bypass who expired in the operating room. Three patients were treated in the recovery room for low cardiac output syndrome after open heart surgery and 2 of these 3 patients survived. In the 7 survivors the balloon was removed at the bedside with 30 minutes of external pressure on the femoral artery. No complications ensued and all patients had good distal pulses. Percutaneous intra-aortic balloon pumping appears to be a practical alternative to standard intra-aortic balloon pumping in patients who require either pre-, intra-, or postoperative counterpulsation. MONOAY, MARCH 10, 1980 AM CARDIOMYOPATHIES 10:3012:oo THE HEART IN POLYARTERITIS NODOSA: A CLINICOPATHOLOGIC STUDY OF 36 PATIENTS Margaret L. Schroder; Bernadine H. Bulkley, MD, FACC. The Johns Hopkins Medical Institutions, Baltimore, Maryland. Although polyarteritis nodoso (PAN) is known to affect the heart, there is little recent information on its cardiac pathology in the light of current therapies. We studied 36 autopsied patients with PAN that came to autopsy at this institution since 1935. Excluded were those with acute rheumatic fever, other collagen vo~culor diseases or arteritis of large vessels. Included were cases with healed or active lesions of small or medium sized vessels in at least two organs other than heart. The patients ranged in age from 11 months to 76 years, and 46% were women. Systemic hypertension was present in 72% of patients and congestive heart failure in 61% and was not less in recent or steroidtreated cases. At autopsy 24 (67%) heorts were hypertrophied; 10 (28%) had fibrous or fibrofibrinous pericorditis. Coronary arteritis, present in 18 (50%) potients, was healed in 6, subacute in 5, and acute in 7. Of these patients, 16 (89%) had focal myocordial necrosis and/or fibrosis; in 3 (17%) grossly evident myocardial infarction wets present. Although the incidence of coronary involvement was not significantly different, active arteritis was evident most frequently in patients dying before 1952 (29%) and was least frequent in those treated with corticosteroids (8%). The findings suggest that clinically significant cardiac abnormalities in PAN are common but are now mostly due to hypertension and renal failure. Coronary arteritis, although evident in‘half of patients, is now mostly healed or mild. Thus, although not diminishing and possibly aggrovoting, the secondary consequences of PAN on the heart, corticosteroid therapy oppeors to have altered the extent and quality of its coronary orteritis. THE HEART IN PANCREATITIS: A COMBINED CLINICO-PATHOLOGIC STUDY OF 128 CASES John R. Darsee, MD, Ruth E. Fincher, MD, Michael Fincher, MD, Candace L. Miklozek, MD, Ayten 0. Someren, MD, J. Willis Hurst, MD, FACC. Emory University School of Medicine, Atlanta, Georgia Since pancreatitis is thought to mimic electrocardiographic (ECG) features of acute myocardial infarction, produce cardiac dysfunction, pericarditis, and bizarre dysrhythmias, we characterized the cardiac features of 128 cases of pancreatitis: 42 clinical patients (P) studied prospectively and 86 clinical and necropsy cases studied retrospectively (22 also had hypertension and 14 had diabetes); 42 alcoholic patients and 86 disease-matched necropsy cases without pancreatitis served as controls CC). In clinical P, there was hypocalcemia-related QT prolongation in 8 (controls=6), transient atria1 fibrillation in 4 (C=6), new T-wave inversion in 6 (C=5), and a transient moderate-sized pericardial effusion by echocardiography in 5 (C=7). Necropsy P and C showed a similar frequency of patchy interstitial myocardial fibrosis (P=36%, C=39%) associated with ECG conduction disturbances, heart block or T-wave inversion, pericardial effusions (10-300~~) (P=31%; C=27%), and fibrinous pericarditis (P=8%; C=5%) in uremic patients only; pathological Q waves on the ECG were always associated with significant (>75% cross-section) extramural coronary atherosclerosis (P=lO%; C=12%). Although isolated case reports suggest that distinct cardiovascular manifestations of pancreatitis exist, this study of 128 cases supports the view that: 1) ECG abnormalities, pericarditis, and pericardial effusions are not caused by pancreatitis, but more likely by alcoholism, hypertension, uremia, and other coincident disorders; and 2) electrocardiographic signs of myocardial ischemia or infarction are due to coronary atherosclerosis and not to pancreatitis. February 1980 The American Journal of CARDIOLOGY Volume 45 395