A rational approach to the selection of an assist device for the failing right ventricle

Pulmonary artery balloon counterpulsation for intraoperative right ventricular failure

Two cases of severe low cardiac output and right ventricular failure after coronary artery bypass grafting necessitated pulmonary artery balloon counterpulsation after intraaortic balloon pumping and maximal inotropic/pressor support were unsuccessful in maintaining a satisfactory cardiac output. Hemodynamic improvement was sufficient to allow removal of the device 2 and 3 days postoperatively, with survival in 1 patient. Pulmonary artery counterpulsation is less morbid in comparison with other mechanical methods of right ventricular support and is applicable in right ventricular failure of intermediate severity.

Pulmonary artery counterpulsation to improve right ventricular function after heart transplantation

The effectiveness of pulmonary artery counterpulsation in improving right ventricular function after heart transplantation was evaluated in a pig model. The balloon catheter was introduced through the anterior wall of the pulmonary artery distal to the pulmonary valve. A Millar catheter with a distal high-fidelity pressure transducer was placed in the right ventricle, where the peak rate of pressure rise, dP/dT, was measured. Pulmonary artery counterpulsation significantly improved right ventricular function, increasing both dP/dT and systolic pressure. A diastolic dip in pulmonary artery pressure and a fall in the early portion of the right ventricular pressure curve were seen. Inflation of the balloon caused a second (suprasystolic) wave in that curve. Improved right ventricular function was also seen when normal pig hearts were counterpulsated after occlusion of the right coronary artery and following increased afterload due to occlusion of a main pulmonary artery. There were no changes in central venous or systemic pressure. The results indicate that pulmonary artery counterpulsation may be valuable when the transplanted heart has a poorly functioning right ventricle.