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Langseth MS, Nordstrand N, Erikssen G. Intra-aortic balloon pump treatment in an adult patient with a Fontan circulation and acute heart failure: a case report. Eur Heart J Case Rep 2024; 8:ytae289. [PMID: 38912116 PMCID: PMC11192165 DOI: 10.1093/ehjcr/ytae289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/05/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
Background There is limited evidence for the use of an intra-aortic balloon pump (IABP) in adult patients with a total cavopulmonary, or Fontan circulation. Case summary A patient in his twenties with a Fontan circulation presented with sepsis, pneumonia, and pulmonary oedema. He was born with a hypoplastic left ventricle, atrioventricular septal defect, and hypoplastic aortic arch, and a total cavopulmonary circulation had been established within his first years of life. Standard of care treatment with antibiotics, non-invasive ventilatory support, loop diuretics, and vasopressors was initiated. Due to persistent pulmonary congestion and increasing general fatigue, an IABP was placed via a femoral artery to offload the failing systemic ventricle. Secondary to IABP treatment, mean arterial pressure rose, and vasodilatory nitroprusside could be introduced. Over 4 days of IABP treatment, the patient's general condition and ventricular systolic function improved significantly. Discussion This case suggests that IABP treatment was important in the recovery of our patient with a Fontan circulation, pneumonia, and heart failure. We propose that during IABP treatment, an increase in stroke volume and a reduction in ventricular filling pressure is achieved, thereby increasing the transpulmonary pressure gradient that is central to pulmonary blood flow in Fontan patients. More definitive evidence is necessary to confirm our hypotheses.
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Affiliation(s)
- Miriam Sjåstad Langseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
| | - Njord Nordstrand
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
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Rodriguez M. Reply to 'Using intraaortic balloon pump to increase afterload during extracorporeal membrane oxygenation'. Perfusion 2019; 34:438. [PMID: 30854924 DOI: 10.1177/0267659119833535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chowdhury UK, Diplomate NB, Jena JK, Hasija S, Sankhyan LK. Successful Use of Intra-aortic Balloon Counterpulsation for Systemic Ventricular Failure Following Total Pericardiectomy for Calcific Chronic Constrictive Pericarditis. World J Pediatr Congenit Heart Surg 2018; 11:NP203-NP206. [PMID: 30319033 DOI: 10.1177/2150135118769321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report two male patients aged 18 and 19 years, respectively, undergoing total pericardiectomy for chronic calcific constrictive pericarditis who developed systemic ventricular failure unresponsive to medical management following surgery. The failing circulation was successfully reestablished using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of ventricular function and appears to be a reasonable alternative in select instances of refractory cardiac failure following pericardiectomy.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - N B Diplomate
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Jhulana Kumar Jena
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Suruchi Hasija
- Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Abstract
Over the past two decades clinicians and researchers have sought to bring mechanical circulatory support (MCS) to pediatric patients with heart failure. ECMO, IABPs, and VADs have all been used in infants and children as a bridge to myocardial recovery or as a bridge to transplant. However, until recently, a commitment by industry, government, and researchers towards the development of pediatric MCS has not been present, especially in the United States. Advancements in adult VAD design to smaller, quieter, and fully implantable pumps capable of complete outpatient support have sparked curiosity in the application of this technology to children. Also, the increasing success of palliating congenital heart disease is creating an ever-growing cohort of children and adolescents with heart failure. These changing demographics and technological advances have caused a refocus of attention. This is most clearly demonstrated by the international use of several established MCS pediatric and neonatal systems, by the FDA's increasing proclivity to allow the use of international pediatric VADs in the USA, and by the recent National Heart, Lung, and Blood Institute funding of several institutions to develop pediatric VADs. This review describes the different aspects of pediatric MCS including indications, the features of the various VADs, and their current application in children worldwide.
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Affiliation(s)
- D L S Morales
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
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Chopski SG, Moskowitz WB, Stevens RM, Throckmorton AL. Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease. Artif Organs 2016; 41:E1-E14. [DOI: 10.1111/aor.12760] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Steven G. Chopski
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
| | - William B. Moskowitz
- Division of Pediatric Cardiology, Children's Hospital of Richmond and School of Medicine; Virginia Commonwealth University; Richmond VA
| | - Randy M. Stevens
- St. Christopher's Hospital for Children, Tenet Healthcare Corporation; Philadelphia PA USA
| | - Amy L. Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
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Moreno GE, Magliola R, Pilán ML, Althabe M, Balestrini M, Lenz AM, Krysnki M, Rodríguez R, Salgado G, Martin A, Cardoso H, Ruffa P, Cornelis CJ, Barreta J, García Delucis P. [Mechanical circulatory support in pediatrics. Experience at the Dr. Juan P. Garrahan Pediatric Hospital. Argentina]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:256-61. [PMID: 25001058 DOI: 10.1016/j.acmx.2013.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/17/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Mechanical circulatory support provides oxygen to the tissues in patients with cardiac and/or respiratory reversible disease refractory to conventional treatments. OBJECTIVE The aim of this study is to show our initial results of mechanical circulatory support in children with heart disease. METHOD Retrospective cohort between March 2006 and March 2012. Demographic data (age, sex, weight, cardiac diagnosis), surgery (technique, pump, aortic cross clamping time) and mechanical circulatory support (type of assistance, indication, duration, complications and outcome) were collected. RESULTS Thirty-three patients were supported (1.3% of all surgeries), extracorporeal membrane oxygenation 32 cases and one ventricular assist device. The median age 7.4 months (one day-18 years) and weight 6kg (2.3-75). The most frequent cardiac malformations supported were the transpositions of the great arteries associated with other anomalies and the corrected transpositions (ventricular inversion or double discordance). The most common reason for admission was post-cardiotomy biventricular dysfunction. Twenty-eight patients were supported in the postoperative period, 4 in the preoperative period and in one with myocarditis. Median days of support were 3 days (1-10). The most common complications were infection (21%), bleeding (21%). Elective decannulation was achieved in 94% of cases. Hospital discharge survival: 52%. CONCLUSIONS The mechanical circulatory support in our institution is a safe and standard procedure. We have been using it in a small number of cases with a similar survival to that reported internationally. This complex procedure is widely justified because it allows for the recovery of more than half of the patients who otherwise would have died.
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Affiliation(s)
- Guillermo E Moreno
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Ricardo Magliola
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Luisa Pilán
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Althabe
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Balestrini
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Miriam Lenz
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela Krysnki
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ricardo Rodríguez
- Unidad de Cuidados Intensivos Cardiacos (UCI35), Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gladys Salgado
- Servicio de Cardiología, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía Martin
- Servicio de Cardiología, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo Cardoso
- Servicio de Cirugía Cardiovascular, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pablo Ruffa
- Servicio de Cirugía Cardiovascular, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Javier Cornelis
- Servicio de Cirugía Cardiovascular, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge Barreta
- Servicio de Cirugía Cardiovascular, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pablo García Delucis
- Servicio de Cirugía Cardiovascular, Hospital de Pediatría Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
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Bartoli CR, Rogers BD, Ionan CE, Pantalos GM. End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation. J Thorac Cardiovasc Surg 2014; 147:1660-7. [PMID: 24139614 PMCID: PMC3988268 DOI: 10.1016/j.jtcvs.2013.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/06/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Counterpulsation with an intra-aortic balloon pump (IABP) has not achieved the same success or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS In Yorkshire piglets (n = 19; weight, 13.0 ± 0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7 mL) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105 ± 3 beats per minute, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted.
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Affiliation(s)
- Carlo R Bartoli
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa; MD/PhD Program, University of Louisville School of Medicine, Louisville, Ky
| | | | - Constantine E Ionan
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky
| | - George M Pantalos
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky; Department of Bioengineering, University of Louisville, Louisville, Ky; Department of Surgery, University of Louisville, Louisville, Ky.
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Abstract
Partial mechanical support devices are capable of partially unloading only one ventricle, often the systemic one, in the setting of acute circulatory failure. They are rarely used in the pediatric population, as the mode of circulatory failure in patients with congenital heart disease often involves biventricular or a predominantly right ventricular component. The devices include intra-aortic balloon pumping, Impella, TandemHeart, and CentriMag. They are rarely used as a bridge-to-recovery, but more often as a bridge-to-decision, or bridge-to-conversion to full mechanical support systems, such as extracorporeal membrane oxygenation or ventricular assist devices. Currently, lack of availability of more complete support devices, cost issues, or lack of infrastructure and personnel may still be indications to continue using partial mechanical support as opposed to more complete forms of biventricular circulatory support.
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Pantalos GM, Koenig SC, Gillars KJ, Haugh GS, Dowling RD, Gray Jr LA. Intraaortic Balloon Pump Timing Discrepancies in Adult Patients. Artif Organs 2011; 35:857-66. [DOI: 10.1111/j.1525-1594.2011.01292.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chowdhury UK, Kothari SS, Rao K, Gharde P. Use of Intra-Aortic Balloon Counterpulsation in an Adult Patient With Left Ventricular Failure following Repair of Tetralogy of Fallot: A Case Report. World J Pediatr Congenit Heart Surg 2011; 2:517-9. [PMID: 23804009 DOI: 10.1177/2150135111403777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a 26-year-old male patient who developed primary left ventricular failure with subsequent biventricular failure early following intracardiac repair of tetralogy of Fallot. The failing biventricular circulation was successfully supported using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of biventricular function and appears to be a reasonable alternative in select instances of systemic ventricular failure following repair of tetralogy of Fallot.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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De Rita F, Barozzi L, Franchi G, Faggian G, Mazzucco A, Luciani GB. Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate. Artif Organs 2011; 35:416-20. [DOI: 10.1111/j.1525-1594.2010.01134.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Despite optimization of standard medical therapy, some patients with chronic heart failure will deteriorate to the point that they require hospitalization for intravenous therapies and inpatient monitoring. Once the condition is recognized, the therapeutic goals are to reverse hemodynamic derangements, correct metabolic abnormalities, and provide symptomatic relief. Achievement of these goals requires individualized care and a familiarity with the risks and benefits of particular therapies.
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Affiliation(s)
- John Lynn Jefferies
- Cardiomyopathy and Heart Failure, Cardiovascular Genetics Service, Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Should We Consider the Ethnic Difference in Selecting Size of Intraaortic Balloon by Commercial Guideline? ASAIO J 2009; 55:519-22. [DOI: 10.1097/mat.0b013e3181ac6a35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Krishna M, Zacharowski K. Principles of intra-aortic balloon pump counterpulsation. ACTA ACUST UNITED AC 2009. [DOI: 10.1093/bjaceaccp/mkn051] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Carberry KE, Gunter KS, Gemmato CJ, Morales DLS. Mechanical circulatory support for the pediatric patient. Crit Care Nurs Q 2007; 30:121-42. [PMID: 17356354 DOI: 10.1097/01.cnq.0000264256.98122.9c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In adult patients, mechanical circulatory support (MCS) devices are part of the standard of care for heart failure. There are several options available that clinicians may use to provide support for their patients and thus the choice of devices can be tailored to their individual needs. Unfortunately, this is not the case for pediatric patients with heart failure, where the options for MCS modalities are far more limited because of size constraints and regulatory hurdles. Furthermore, the pathophysiology of heart failure in children is not identical to that of adults; thus, the device selection and configuration require different considerations. Management of pediatric patients on MCS requires a highly specialized team of pediatric professionals. The nurse caring for a child on MCS is an active participant in all aspects of the patient's care and must have an in-depth understanding of the patient's underlying physiology, the circulatory physiology of the MCS system, the reason for mechanical support, and the goal of support.
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Affiliation(s)
- Kathleen E Carberry
- Center for Clinical and Outcomes Research, Congenital Heart Surgery Service, Texas Children's Hospital, Houston, Texas 77030, USA.
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Paul Collison S, Singh Dagar K. The role of the Intra-aortic balloon pump in supporting children with acute cardiac failure. Postgrad Med J 2007; 83:308-11. [PMID: 17488858 PMCID: PMC2600077 DOI: 10.1136/pgmj.2006.053611] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acute heart failure occurs in children following the operative correction of a congenital anomaly, as an acute change in a child with a congenital anomaly, or in a structurally normal heart with acute myocarditis. Acute heart failure in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices and the use of the intra-aortic balloon pump (IABP). The principles of intra-aortic balloon pump usage are described, and the literature regarding the indications and outcome of its use in children is reviewed.
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Affiliation(s)
- Sathiakar Paul Collison
- Department of Pediatric and Congenital Heart Surgery, Escorts Heart Institute And Research Centre, New Delhi, India.
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Chowdhury UK, Kothari SS, Subramaniam GK. Intra-aortic balloon counterpulsation in a patient with the failing Fontan circulation. Cardiol Young 2007; 17:102-4. [PMID: 17184574 DOI: 10.1017/s1047951106001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 11/07/2022]
Abstract
We report a 23-year-old patient undergoing functionally univentricular repair who developed cardiac failure due primarily to systemic ventricular dysfunction. The failing Fontan circulation was successfully re-established using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of systemic ventricular function, and appears to be a reasonable alternative in select instances of cardiac failure in patients with the Fontan circulation.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
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Kalavrouziotis G, Karunaratne A, Raja S, Ciotti G, Purohit M, Corno AF, Pozzi M. Intra-aortic balloon pumping in children undergoing cardiac surgery: an update of the Liverpool experience. J Thorac Cardiovasc Surg 2006; 131:1382-1382.e10. [PMID: 16733173 DOI: 10.1016/j.jtcvs.2006.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 02/19/2006] [Accepted: 02/24/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intra-aortic balloon pumping in children remains a rarity. We report our experience in supporting pediatric cardiac surgical patients with intra-aortic balloon pumping. METHODS We reviewed the cases of 24 children supported with intra-aortic balloon pumping after cardiac surgery in our institution from 1994 through 2003. RESULTS Mean age at the time of the operation was 5.0 +/- 5.6 years (range, 7 days-17.5 years). Ten patients were infants less than 6 months old. Mean weight was 18.9 +/- 18.1 kg (range, 3.5-58.7 kg). Indications for intra-aortic balloon pump deployment were postoperative hemodynamic deterioration (n = 11, 8 survivors), failure to wean off cardiopu(n = 7, 5 survivors), and prophylaxis before weaning off cardiopulmonary bypass (n = 6, 5 survivors). The balloon was inserted through the ascending aorta in infants and through the femoral artery in children. Eighteen children (7 infants) were weaned off the intra-aortic balloon pump successfully (intra-aortic balloon pump survival, 75%). Mean duration of intra-aortic balloon pump support was 121.3 +/- 140.60 hours (range, 8-670 hours). There were 3 post-intra-aortic balloon pump in-hospital deaths (survival to hospital discharge, 62.5%). Severe intra-aortic balloon pump-related complications were mesenteric ischemia in 1 patient and lower limb ischemia requiring intra-aortic balloon pump removal in 1 patient. At a mean follow-up of 85 +/- 31 months (range, 18-124 months), all 15 long-term survivors were alive and well. CONCLUSIONS Use of an intra-aortic balloon pump is an effective modality of cardiac support in properly selected pediatric cardiac surgical patients with refractory low cardiac output. It can be safely used in small infants and neonates. In selected cases with known left ventricular dysfunction, there is a place for prophylactic use of an intra-aortic balloon pump.
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Affiliation(s)
- Georgios Kalavrouziotis
- Department of Pediatric Cardio-Thoracic Surgery, Royal Liverpool Children's NHS Trust, Alder Hey Hospital, Liverpool, United Kingdom.
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Willert JL, Lobato EB. Intraoperative diagnosis of a ruptured intra-aortic balloon in a child undergoing thoracic surgery. J Cardiothorac Vasc Anesth 2005; 19:516-9. [PMID: 16085262 DOI: 10.1053/j.jvca.2005.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jessica L Willert
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
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Chang AC, McKenzie ED. Mechanical cardiopulmonary support in children and young adults: extracorporeal membrane oxygenation, ventricular assist devices, and long-term support devices. Pediatr Cardiol 2005; 26:2-28. [PMID: 15156301 DOI: 10.1007/s00246-004-0715-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A C Chang
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC 19345-C, Houston, TX 77030, USA.
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