Balón de contrapulsación e inotrópicos no catecolamínicos en el manejo del shock cardiogénico secundario a cardiopatía de Takotsubo: Una serie de casos / Intraaortic balloon pump and non-catecholamine inotropic drugs in the management of cardiogenic shock due toTakotsubo cardiomyopathy: A series of cases / Balão de contra-pulsação intra-aórtico e drogas inotrópicas não catecolamínicas no manejo de choque cardiogênico por cardiomiopatia de Takotsubo: Uma série de casos

Introducción. La cardiopatía por estrés o síndrome de Takotsubo suele complicarse con el desarrollo de shock cardiogénico, pudiendo requerir de apoyo inotrópico. En dicha situación la utilización de fármacos derivados de catecolaminas ha sido cuestionada, planteándose la utilidad del balón de contrapulsación e inotrópicos no catecolamínicos. Material y métodos. Fueron incluidos pacientes con cardiopatía de Takotsubo y desarrollo de shock cardiogénico tratados con balón de contrapulsación e inotrópicos no catecolamínicos, en dos hospitales universitarios. Resultados. Entre el 1º de Enero de 2010 y el 1º de Enero de 2014 fueron incluidas 6 pacientes de sexo femenino con un promedio de edad de 54 años, con criterios hemodinámicos de shock cardiogénico. En todas se implantó balón de contrapulsación, recibiendo además tres de ellas tratamiento con milrinona y tres con levosimendan. La evolución hemodinámica fue favorable, desarrollando una paciente fibrilación auricular y otra paciente pérdida de pulso en el miembro del balón. Conclusiones. En una serie de pacientes con cardiopatía de Takotsubo y desarrollo de shock cardiogénico, el manejo con balón de contrapulsación e inotrópicos no derivados de catecolaminas resultó efectivo y seguro. Estudios con un número apropiado de pacientes determinarán la utilidad de dicha terapéutica.

Introduction. Stress cardiomyopathy or Takotsubo's syndrome could be complicated with development of cardiogenic shock requiring inotropic support. In that situation the use of catecholamines drugs has been questioned, being proposed the utilization of intraaortic balloon pump and non-catecholamines inotropic drugs. Materials and methods. There were included patients with Takotsubo's cardiomyopathy and development of cardiogenic shock who were treated with intraaortic balloon pump and non-catecholamines inotropic drugs, in two university hospitals. Results. Between January 1 of 2010 and January 1 of 2014 there were admitted 6 female patients with an average age of 54 years, showing hemodynamic criteria of cardiogenic shock. All of them received an intraaortic balloon pump and were also treated with milrinone, in 3 cases, and levosimendan, the other 3 patients. The hemodynamic evolution was favorable presenting, as complications, an atrial fibrillation, in one case, and loosing pulse in the balloon`s limb in another case. Conclusions. In a series of patients with Takotsubo`s cardiomyopathy developing cardiogenic shock the treatment with intraaortic balloon pump and non-catecholamine inotropic drugs was effective and safe. Studies with an appropriate number of patients will determine the utility of this approach.

Introdução. A cardiomiopatia do estresse ou síndrome de Tako-tsubo poderia ser complicada com o desenvolvimento de choque cardiogênico, necessitando de suporte inotrópico. Nessa situação, o uso de drogas catecolamínicas tem sido questionado, sendo proposta a utilização de balão de contra-pulsação intra-aórtico e drogas inotrópicas não catecolamínicas. Materiais e métodos. Foram incluídos pacientes com cardiomiopatia de Tako-tsubo e desenvolvimento de choque cardiogênico que foram tratados com balão de contra-pulsação intra-aórtico e drogas inotrópicas não catecolamínicas, em dois hospitais universitários. Resultados. Entre 1 de Janeiro de 2010 e 1 de Janeiro de 2014 foram internadas 6 pacientes do sexo feminino, com uma média idade de 54 anos, mostrando critérios hemodinâmicos de choque cardiogênico. Todos eles receberam um balão de contra-pulsação intra-aórtico e também foram tratados com milrinona, em 3 casos, e levosimendan, os outras 3 pacientes. A evolução hemodinâmica foi favorável, desenvolvendo uma paciente fibrilação atrial e outra perda de pulso A evolução hemodinâmica estava apresentando favorável, como complicações, uma fibrilação atrial, em um caso, e perdendo impulso no membro do balão de contra-pulsação em outro caso. Conclusões. Em uma série de pacientes com cardiomiopatia Tako-tsubo e desenvolvimento de choque cardiogênico, o tratamento com balão de contra-pulsação intra-aórtico e drogas inotrópicas não catecolamínicas foi eficaz e segura. Estudos com um número apropriado de pacientes irão determinar a utilidade desta terapia.

Treatment with intraaortic balloon pump in a patient with right ventricular failure during cholecystectomy for acute cholecystitis after cardiac surgery : A case report

Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Intraaortic balloon pump (IABP) is effective and useful device for mechanical assistance for heart. We reported a case of 34-year-old patient who had experienced pulmonary hypertension and right ventricular failure during cholecystectomy for acute cholecystitis after cardiac surgery. Thus, the patient was mechanically supported with IABP and hemodynamics and cardiac function were improved.

Effect of Intraaortic Balloon Pump Used During Emergency Percutaneous Coronary Intervention / 中国康复理论与实践

@#Objective To observe the effect of intraaortic balloon pump (IABP) on tolerance of percutaneous coronary intervention (PCI), life signs of patients with acute myocardial infarction (AMI) during emergency PCI performed.Methods46 AMI patients complicated with or without cardiogenic shock were put on IABP at same time of coronary angiography when emergency PCI performed, and tolerance of PCI, blood pressure, heart rate and immediate death rate of patients were observed before and after operation.Results45 cases had IABP successful and 1 case failed. 40 patients (86.96%) could endure whole emergency PCI process, the total death rate was 10.87%. 66.67% of patients with obvious cardiogenic shock could endure emergency PCI, the death rate was 33.33%; 94.12% of patients without cardiogenic shock could endure PCI treatment and the death rate was 2.94%. 35 cases completed PCI treatment and the successful rate was 85.36%.ConclusionPCI supported by IABP can prevent AMI patients from cardiogenic shock, ease symptoms of patients complicated with cardiogenic shock, improve the tolerance and successful rate of the PCI treatment, and decrease immediate death rate.

Use of Intraaortic Balloon Pump in a Patient with Right Ventricular Failure after Cardiac Surgery: A case report / 대한마취과학회지

The intraaortic balloon pump (IABP) is the most effective and widely used device for temporary mechanical assistance of left heart. Considering left and right ventricular (RV) interdependence, IABP may also alleviate predominantly RV dysfunction following cardiac surgery. This is the case of a 61-year-old female patient who had experienced RV failure after cardiac surgery. After tricuspid valve replacement, preexisting RV failure was progressively aggravated and systemic blood pressure could not be maintained in spite of aggressive pharmacological support on second postoperative day. Thus, mechanical support with IABP was considered to increase coronary perfusion pressure in this case. IABP dramatically improved hemodynamics and cardiac function. It was removed on fifth postoperative day and she has remained well. In conclusion, IABP could play a role in RV failure following cardiac surgery and timely treatment of the heart failure with mechanical circulatory assistance would prevent further complications.

The efficacy of PCI and IABP in the treatment of acute myocardial infarction complicated with cardiogenic shock / 中国介入心脏病学杂志

Objective To investigate the effect of percutaneous transluminal coronary angioplasty (PTCA) and stent implantation with intraaortic balloon pump (IABP) on immediate death rate and cardiac function of patients with acute myocardial infarction (AMI) complicated with cardiogenic shock.Methods Emergency coronary angiography was taken 0.5-32 h after the attack, and PTCA and stent implantation performed on infarction related artery (IRA), supported by IABP until patients′ complications improved. Myocardial echocardiography was taken 5 weeks after operation.Results Except for 4 patients who died of aggravated shock or cardiac failure, all the patients had IRA reperfusion. Twenty-four patients had stents implanted (85.71%). Mean time from attack to reperfusion was 8.6 h, and death rate in the period of 5 weeks was 31.25%. EF of the 22 patients who survived was 0.43～0.67.Conclusion PTCA and stent implantation supported by IABP can improve results of operation,increase reperfusion rate, decrease immediate death rate and improve cardiac function.

Role of Intra-aortic Balloon Pump in High Risk Patients undergoing Off-Pump Coronary artery bypass graft / 대한흉부외과학회지

BACKGROUND: This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease(>75 % stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction<35 %). MATERIAL AND METHOD: One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. RESULT: There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5+/-0.9 vs 3.4+/-0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. CONCLUSION: IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients.

Pump failure complicating acute myocardial infarction: the use of the intraaortic balloon pump support in emergency interventional procedures / 中国介入心脏病学杂志

Objective To evaluate the effects of intraaortic balloon pump (IABP) support in the emergency interventional procedures on pump failure or cardiogenic shock complicating acute myocardial infarction (AMI). Methods Group A included 21 patients with IABP support during the emergent interventional procedures, and group B included 66 patients without IABP. The two groups were compared for clinical criteria and in-hospital events or complications.Results No significant differences were noted between the two groups witch regard to baseline age, gender, onset of chest pain, timing of intervention, location of AMI, the number of coronary artery diseases, individual infarct-related artery, and TIMI grade before intervention. The degree of pump failure was significantly worse in group A than in group B. In a follow-up period of in-hospital, mortality and revascularization in-hospital were lower in the patients with IABP than in the patients without IABP. Conclusion The combination of early IABP and successful emergency coronary intervention is associated with improved survival in patients with pump failure or cardiogenic shock complicating AMI.