[Effectiveness and limitations of IABP or LVAD in right ventricular dysfunction].
IABP and well functioning left ventricular assist device for a failing left ventricle have potential for altering the loading condition of the right heart. Depending on the extent of myocardial damage and the pulmonary vascular resistance, IABP and LVAD can have different degree of hemodynamic effect on the right ventricle. We examined 20 clinical cases who required IABP support to wean from cardiopulmonary bypass. In 10 cases (group I), CVP rose up above 20 cmH2O within 12 hrs of post operative period. In another 10 cases (group II), CVP rose less than 20 cm H2O. Then we compared hemodynamic change (m-PAP, PVR, CVP, PAWP, CI and RVSWI) between two groups until 72 hrs of post operative period. No significant differences were noted in PVR and CI between two groups, but CVP, m-PAP, PAWP and RVSWI were markedly higher in I group. Reduction of RV afterload produced with an IABP may probably be due to degree of recovery of failing left ventricular function. It is though that IABP has less favorable effect on right ventricular in the cases whose CVP elevate above 20 mmH2O within 12 hrs after operation than in those with CVP below 20 cmH2O. Clinical studies were made on 4 cases with biventricular failure in our experiences of 8 LVAD cases (LV aneurysmectomy + VSP closure, MVR + AVR + CABG + LV aneurysmectomy, CABG + LV aneurysmectomy and MVR + CABG). LVAD seems to have more beneficial effect on RV afterload, than IABP right ventricular dysfunction, however, is likely to continue in the cases whose CVP elevates above 30 mmH2O even if LVAD is used.
Hata
H
H
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Hasegawa
T
T
Kitamura
S
S
Umeda
S
S
Shindo
S
S
Shiono
M
M
Imamura
Y
Y
Orime
Y
Y
Harada
Y
Y
Sezai
Y
Y
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged