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Intraaortic Balloon Assist Through Cannulation of the Ascending Aorta

1975; Elsevier BV; Volume: 19; Issue: 1 Linguagem: Inglês

10.1016/s0003-4975(10)65738-4

1552-6259

Terry L. Gueldner, G. Hugh Lawrence,

Cardiac and Coronary Surgery Techniques

This report describes a survivor and the technique of intraaortic balloon assistance through cannulation of the ascending aorta.Other sites of balloon insertion and their complications are briefly discussed.The thoracic aorta route for balloon assistance has proved effective and may well be preferable when significant aortoiliac disease exists.n many of the major cardiac surgery centers, intraaortic balloon assistance (IABA) has become an accepted means of dealing with I cardiac failure following acute myocardial infarction or cardiopulmonary bypass [ 1-3, 51.The usual means of inserting the balloon is through either common femoral artery within a prosthetic graft, thereby allowing perfusion of the distal extremities [4,6, 81.With its increasing use in various age groups, one not infrequently encounters patients with significant aortoiliac disease in whom successful insertion of the balloon into the descending aorta is difficult [2, 3, 81.This report describes a patient who required cannulation of the ascending aorta for balloon insertion following cardiopulmonary bypass; the balloon was removed some 24 hours after cardiovascular stabilization.This 64-year-old white woman had mild adult-onset diabetes mellitus, rheumatic heart disease with severe mitral regurgitation, mild compensated congestive heart failure, and coronary artery disease with angina pectoris, N.Y.H.A. Class I11 to IV. Angiography revealed nearly total occlusion of the proximal right coronary artery and only minimal irregularities in the anterior descending coronary artery and circumflex vessels.There was calcification of the mitral annulus and leaflets with marked mitral regurgitation, good left ventricular contractility, and no evidence of aortic regurgitation.Catheterization data were as follows: cardiac output, 3.653 L/min; cardiac index, 2.56 L/min/m2; total pulmonary resistance, 525 dynes sec cm"; pulmonary vascular resistance, 197 dynes sec cm-6; mean right atrial pressure, 6 mm Hg; mean pulmonary artery pressure, 24 mm Hg; mean pulmonary capillary wedge pressure, 15 mm Hg; mean left ventricular pressure, 130/0-19 mm Hg.Operation was begun through a median sternotomy incision, and the