The Annals of Thoracic Surgery, Vol 41, 616-621, Copyright © 1986 by The Society of Thoracic Surgeons
Use of a counterpulsation balloon as a substitute for the pulmonic valve: a new application
J Frederiksen, MN Ilbawi, AJ Gorman, M Opravil, FS Idriss and JM Moran
An inflatable, 3-ml balloon positioned within the distal right ventricular
outflow tract was used to restore pulmonic valve function in 8 dogs that
had undergone open-chest valvectomy. Balloon inflation and deflation were
accomplished with a counterpulsation console. Valvectomy produced loss of
the pulmonic incisura, a decrease in pulmonary artery diastolic pressure
(PADP; mean +/- standard error) (9.5 +/- 1.3 versus 4.4 +/- 0.6 mm Hg, p
less than 0.01), and an increase in pulmonary artery pulse pressure (PAPP)
(8.6 +/- 0.7 versus 19.1 +/- 1.9 mm Hg, p less than 0.01) without
significantly affecting forward cardiac output (CO) (1,750 +/- 110 versus
1,880 +/- 230 ml/min, p is not significant). Properly timed
counterpulsation restored the pulmonic incisura, raised the PADP from 6.1
+/- 0.8 to 9.5 +/- 0.8 mm Hg (p less than 0.01), lowered the PAPP from 15.1
+/- 1.4 to 10.6 +/- 1.0 mm Hg (p less than 0.01), and raised the forward CO
from 1,850 +/- 260 to 1,920 +/- 260 ml/min (p less than 0.01). The
injection of glass beads, 40 to 150 microns in diameter, into the right
ventricular outflow tract increased pulmonary vascular resistance from 383
+/- 87 to 730 +/- 150 dyne . sec cm-5 (p less than 0.05) and decreased
forward CO from 1,850 +/- 260 to 1,570 +/- 230 ml/min (p less than 0.05).
Following this injection, counterpulsation again restored the pulmonic
incisura, raised the PADP from 9.3 +/- 1.4 to 16.0 +/- 1.8 mm Hg (p less
than 0.01), lowered the PAPP from 25.0 +/- 2.5 to 18.2 +/- 2.5 mm Hg (p
less than 0.01), and raised the forward CO from 1,570 +/- 230 to 1,720 +/-
220 ml/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)