Universität zu Köln

Liakopoulos, Oliver J., Ho, Jonathan K., Yezbick, Aaron B., Sanchez, Elizabeth, Singh, Vivek and Mahajan, Aman (2010). Right Ventricular Failure Resulting from Pressure Overload: Role of Intra-Aortic Balloon Counterpulsation and Vasopressor Therapy. J. Surg. Res., 164 (1). S. 58 - 67. SAN DIEGO: ACADEMIC PRESS INC ELSEVIER SCIENCE. ISSN 1095-8673

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Abstract

Background. Augmentation of coronary perfusion may improve right ventricular (RV) failure following acute increases of RV afterload. We investigated whether intra-aortic balloon counterpulsation (IABP) can improve cardiac function by enhancing myocardial perfusion and reversing compromised biventricular interactions using a model of acute pressure overload. Materials and Methods. In 10 anesthetized pigs, RV failure was induced by pulmonary artery constriction and systemic hypertension strategies with IABP, phenylephrine (PE), or the combination of both were tested. Systemic and ventricular hemodynamics [cardiac index(CI), ventricular pressures, coronary driving pressures (CDP)] were measured and echocardiography was used to assess tricuspid valve regurgitation, septal positioning (eccentricity index (Ed)), and changes in ventricular and septal dimensions and function [myocardial performance index (MPI), peak longitudinal strain]. Results. Pulmonary artery constriction resulted in doubling of RV systolic pressure (54 +/- 4 mm Hg), RV distension, severe TR (4+) with decreased RV function (strain: -33%; MPI: + 56%), septal flattening (Wt%:-35%) and leftward septal shift (ECI:1.36), resulting in global hemodynamic deterioration (CI:-51%; SvO(2):-26%), and impaired CDP (-30%; P < 0.05). IABP support alone failed to improve RV function despite higher CDP ( +33%; P < 0.05). Systemic hypertension by PE improved CDP ( +70%), RV function (strain: +22%; MPI: -21%), septal positioning (ECI:1.12) and minimized TR, but LV dysfunction (strain: -25%; MPI: +31%) occurred after LV afterloading (P < 0.05). With IA13P, less PE (-41%) was needed to maintain hypertension and CDP was further augmented ( +25%). IABP resulted in LV unloading and restored LV function, and increased CI ( +46%) and SvO(2) (+29%; P < 0.05). Conclusions. IABP with minimal vasopressors augments myocardial perfusion pressure and optimizes RV function after pressure-induced failure. (C) 2010 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liakopoulos, Oliver J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ho, Jonathan K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Yezbick, Aaron B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sanchez, Elizabeth UNSPECIFIED UNSPECIFIED UNSPECIFIED Singh, Vivek UNSPECIFIED UNSPECIFIED UNSPECIFIED Mahajan, Aman UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-493651
DOI:	10.1016/j.jss.2009.04.044
Journal or Publication Title:	J. Surg. Res.
Volume:	164
Number:	1
Page Range:	S. 58 - 67
Date:	2010
Publisher:	ACADEMIC PRESS INC ELSEVIER SCIENCE
Place of Publication:	SAN DIEGO
ISSN:	1095-8673
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE PULMONARY-HYPERTENSION; RIGHT CORONARY-ARTERY; BLOOD-FLOW; DOGS; PERFORMANCE; PHENYLEPHRINE; CONSTRICTION; EMBOLISM; HEART Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49365