Right ventricular failure resulting from pressure overload: role of intra-aortic balloon counterpulsation and vasopressor therapy.

Abstract

BACKGROUND:

Augmentation of coronary perfusion may improve right ventricular (RV) failure following acute increases of RV afterload. We investigated whether intra-aortic balloon counterpulsation (IABP) can improve cardiac function by enhancing myocardial perfusion and reversing compromised biventricular interactions using a model of acute pressure overload.

MATERIALS AND METHODS:

In 10 anesthetized pigs, RV failure was induced by pulmonary artery constriction and systemic hypertension strategies with IABP, phenylephrine (PE), or the combination of both were tested. Systemic and ventricular hemodynamics [cardiac index(CI), ventricular pressures, coronary driving pressures (CDP)] were measured and echocardiography was used to assess tricuspid valve regurgitation, septal positioning (eccentricity index (ECI)), and changes in ventricular and septal dimensions and function [myocardial performance index (MPI), peak longitudinal strain].

RESULTS:

Pulmonary artery constriction resulted in doubling of RV systolic pressure (54 ± 4mm Hg), RV distension, severe TR (4+) with decreased RV function (strain: -33%; MPI: +56%), septal flattening (Wt%: -35%) and leftward septal shift (ECI:1.36), resulting in global hemodynamic deterioration (CI: -51%; SvO(2): -26%), and impaired CDP (-30%; P<0.05). IABP support alone failed to improve RV function despite higher CDP (+33%; P<0.05). Systemic hypertension by PE improved CDP (+70%), RV function (strain: +22%; MPI: -21%), septal positioning (ECI:1.12) and minimized TR, but LV dysfunction (strain: -25%; MPI: +31%) occurred after LV afterloading (P<0.05). With IABP, less PE (-41%) was needed to maintain hypertension and CDP was further augmented (+25%). IABP resulted in LV unloading and restored LV function, and increased CI (+46%) and SvO(2) (+29%; P<0.05).

CONCLUSIONS:

IABP with minimal vasopressors augments myocardial perfusion pressure and optimizes RV function after pressure-induced failure.

• Authors: Oliver J Liakopoulos, Jonathan K Ho, Aaron B Yezbick, Elizabeth Sanchez, Vivek Singh, Aman Mahajan
• Journal: The Journal of surgical research (J Surg Res) Vol. 164 Issue 1 Pg. 58-66 (Nov 2010) ISSN: 1095-8673 [Electronic] United States
• PMID: 19766243 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Vasoconstrictor Agents
• Phenylephrine

Topics

• Animals
• Blood Pressure (drug effects)
• Combined Modality Therapy
• Coronary Circulation (drug effects)
• Disease Models, Animal
• Heart Failure (diagnostic imaging, drug therapy)
• Hypertension (chemically induced)
• Intra-Aortic Balloon Pumping
• Phenylephrine (pharmacology)
• Pulmonary Artery (physiopathology)
• Sus scrofa
• Ultrasonography
• Vasoconstrictor Agents (pharmacology)
• Ventricular Function, Left (drug effects)
• Ventricular Pressure (drug effects, physiology)