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Enhanced coronary flow velocity during intra-aortic balloon pumping assessed by transthoracic doppler echocardiography

Masaaki Takeuchi, MD^*,*, Yuichi Nohtomi, MD, Hidetoshi Yoshitani, MD^*, Chinami Miyazaki, MD^*, Kazuo Sakamoto, MD^* and Junichi Yoshikawa, MD

^* Department of Internal Medicine, Tane General Hospital, Osaka, Japan
Department of Cardiology, Iizuka Hospital, Fukuoka, Japan
Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan

View larger version (80K): [in a new window]   Figure 1 Coronary flow velocity and pressure recordings demonstrating the effects of intra-aortic balloon pumping. (A) Left panel shows phasic coronary flow velocity during 1:2 balloon pumping in a patient with congestive heart failure and high-risk coronary angioplasty (two-vessel disease). First and third coronary flow velocity (CFV) is with augmented beat, and second and fourth CFV is with non-augmented beat. Diastolic CFV is augmented with balloon pumping. Right panel shows aortic pressure. The diastolic pressure before the balloon pumping is shown at D1. The augmented diastolic pressure was labeled S2. (B) Coronary flow velocity and aortic pressure in a patient with recent anterior MI and left main coronary stenosis plus two-vessel disease. First and third CFV is with augmented beat, and second and fourth CFV is with non-augmented beat. Again, diastolic CFV is enhanced with augmented beat.

View larger version (13K): [in a new window]   Figure 2 Effect of balloon pumping on coronary flow velocity among three groups according to the severity of proximal stenosis. APDV = time-averaged peak diastolic velocity (cm/s); DFVI = diastolic flow velocity integral (cm); IABP% = percent increase intra-aortic balloon pumping. Shaded bars = no significant stenosis; black bars = intermediate stenosis; open bars = severe stenosis.

View larger version (60K): [in a new window]   Figure 3 Adjustment of balloon timing during coronary flow velocity recording. Coronary flow velocity during 1:2 balloon pumping in a patient with high-risk percutaneous transluminal coronary angioplasty. Upper panel shows coronary flow velocity and lower panel shows aortic blood pressure. (A) Delayed inflation; there is a notch between diastolic deceleration flow and augmentation flow (arrow). (B) Optimal timing of balloon control; diastolic flow augmentation coincides with the upstroke of diastolic acceleration flow velocity (arrow). (C) Early deflation; flow velocity is terminated early before the R- wave on electrocardiogram (arrows).

View larger version (18K): [in a new window]   Figure 4 Individual value of coronary flow velocity during adjustment of the timing of balloon control. Abbreviations as in Figure 2.