Type:
Educational Exhibit
Keywords:
Obstruction / Occlusion, Haemodynamics / Flow dynamics, Cardiac Assist Devices, Instrumentation, Education, Complications, CT, Conventional radiography, Interventional vascular, Cardiovascular system, Arteries / Aorta
Authors:
B. Gibney1, J. Ryan1, A. N. Murphy1, C. D. Gillespie 2, C. A. Ridge1; 1Dublin/IE, 2Dublin 7/IE
DOI:
10.1594/ecr2018/C-0028
Background
Aortic counter-pulsation therapy using an intra-aortic balloon pump (IAPB) is the most commonly used mechanical circulatory assistance for a range of causes of compromised cardiac output [1].
The IABP is an elongated balloon mounted on an 8 Fr catheter placed in the descending aorta,
most commonly via the femoral artery.
It functions by inflating in diastole which increases flow to the coronary arteries and then rapid deflation immediately presystole reduces left ventricular (LV) afterload and LV myocardial oxygen requirement.
Furthermore,
it increases cardiac output and stroke volume by reducing afterload.
Indications for IABP placement include a range of acute or decompensated chronic left ventricular or biventricular failure with preserved oxygenation requiring mild short-term hemodynamic support [2].
Relative contraindications for IABP placement include moderate or severe aortic valve insufficiency,
severe peripheral arterial or aortoilliac atherosclerotic,
thoracic aortic aneurysmal disease,
recent thoracic aortic graft insertion and acute or chronic aortic dissection.
Choice of IABP balloon length is based on patient height or Body Mass Index (BMI).
The closer the balloon is to the aortic valve,
the greater the diastolic pressure elevation.
The proximal tip should be positioned 2-2.5cm distal to the left subclavian artery origin.
This can be guided by surface anatomy,
fluoroscopy or trans-esophageal echocardiography.
If positioned too proximal it may occlude the branches of the aortic arch.
If placed too distally,
it may occlude the visceral arteries.
Radiodense markers at the proximal and distal ends of the balloon are used to assess positioning on chest radiographs,
with the proximal marker suggested to be sited just cephalad to the carina [3] (FIG 1).