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Improving hemodynamics - Prolonged intra-aortic balloon pump usage in posterior ventricular septal rupture with right ventricle dysfunction.

ABSTRACT: The associated mortality and morbidity of posterior ventricular septal rupture (VSR) is quite high increasing to almost 80% due to severe right ventricle dysfunction and pulmonary artery hypertension. Herein, we present a case of posterior VSR due to inferior wall myocardial infarction who underwent surgery. Premature removal of intra-aortic balloon pump (IABP) led to hemodynamic deterioration and he was salvaged with prolonged and prompt re-institution of IABP. This case also highlights the importance of IABP in right ventricle failure.

SUBMITTER: Raman K

PROVIDER: S-EPMC7034194 | biostudies-literature | 2020 Jan-Mar

REPOSITORIES: biostudies-literature

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Improving hemodynamics - Prolonged intra-aortic balloon pump usage in posterior ventricular septal rupture with right ventricle dysfunction.

Raman Karthik K Desugari Thapo T TT Sowmya S S Angula Samuel S SS Uthayakumaran Kalaichelvan K Mohanraj Anbarasu A

Annals of cardiac anaesthesia 20200101 1

The associated mortality and morbidity of posterior ventricular septal rupture (VSR) is quite high increasing to almost 80% due to severe right ventricle dysfunction and pulmonary artery hypertension. Herein, we present a case of posterior VSR due to inferior wall myocardial infarction who underwent surgery. Premature removal of intra-aortic balloon pump (IABP) led to hemodynamic deterioration and he was salvaged with prolonged and prompt re-institution of IABP. This case also highlights the imp ...[more]

PMID: 31929262

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Project description:BACKGROUND:The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the 'Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery' (IABCS) trial. METHODS:This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction???40% or EuroSCORE???6 received preoperative IABP (n?=?90) or no IABP (n?=?91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n?=?34) and without IABP (n?=?33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded. RESULTS:There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5?±?1.9 vs. 5.7?±?1.7; T2: 4.0?±?1.9 vs. 4.1?±?1.6; T3: 5.7?±?2.0 vs. 5.7?±?1.6, p?=?0.97) or CBFV (T1: 57.3?±?19.4 vs. 59.3?±?11.8; T2: 74.0?±?21.6 vs. 74.7?±?17.5; T3: 71.1?±?21.3 vs. 68.1?±?15.1 cm/s; p?=?0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p?=?0.83), stroke (3.0% vs. 2.9%, p?=?1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p?=?0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p?=?1.00). CONCLUSIONS:The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registration http://www.clinicaltrials.gov (NCT02143544).

Dataset Information

Improving hemodynamics - Prolonged intra-aortic balloon pump usage in posterior ventricular septal rupture with right ventricle dysfunction.

Publications

Improving hemodynamics - Prolonged intra-aortic balloon pump usage in posterior ventricular septal rupture with right ventricle dysfunction.

Similar Datasets

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