Mechanical cardiopulmonary support during arteriography and surgical correction of coronary insufficiency producing myocardial infarction with cardiogenic shock.
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Aged↗
Biomedical subjects
D Bregman
Publications and source records attributed to D Bregman.
Guillain-Barre syndrome after administration of killed vaccines.
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Child↗
Effect of balloon counterpulsation on myocardial ischemia as measured by intramyocardial carbon dioxide tension.
Ischemic injury of the heart following coronary artery occlusion is related to distribution of coronary blood flow and regional myocardial metabolic activity. Myocardial injury during regional ischemia has been studied by measuring tissue pCO2 with mass spectrometry, a parameter which reflects anaerobic cellular metabolism. Myocardial carbon dioxide tension has been used to evaluate the effect of unidirectional intra-aortic balloon pumping on ischemic injury resulting from acute coronary occlusion. In a group of ten dogs, balloon counterpulsation was begun immediately prior to left anterior descending coronary artery occlusion. A significant metabolic sparing effect was observed in counterpulsed dogs as compared to a control group. A decrease of 33% in PCO2 response was evident as compared to control. These results that early application of unidirectional intra-aortic balloon pumping may delay ischemic injury by improving regional oxygen supply/demand ratio to an area of acute ischemia.
Acute Disease↗
The internal ventricular venting loop catheter. A new, simplified, single cannulation approach for a ventricular assist system.
The internal ventricular venting loop (IVVL) catheter is a coaxial, two lumen, bidirectional flow cannula introduced peripherally and advanced intraluminally to the pulmonary artery by its flow directed, balloon tipped inner tubing in a right ventricular assist system (RVAS), or to the left ventricle over a guide wire under fluoroscopy in a left ventricular assist system (LVAS). Its use was successfully tested in six acute canine experiments using a small IVVL catheter. Hemodynamic responses to increasing roller pump flow rates, to a maximum of 1 L/min, were initially measured. Then, hemodynamic changes to 600 ml/min, after left anterior descending artery ligation (in IVVL-LVAS) and 300 ml/min after right coronary artery ligation (in IVVL-RVAS) were regularly recorded every 15 min until cardiac arrest. The IVVL-LVAS was able to significantly decrease the pulmonary capillary wedge pressure, while the IVVL-RVAS was able to significantly decrease the central venous pressure. The IVVL system was able to partially unload the ventricles and restore about 33-60% of the cardiac output. However, it could not effectively support the heart during arrest. Thus, the IVVL catheter can facilitate simple and effective single cannulation for either RVAS or LVAS. This approach may enable ordinary cardiac centers to make use of already available blood pumps for temporary, inexpensive, and less invasive application of partially assisted circulation when intra aortic balloon pump assistance fails.
Animals↗
[Tetralogy of Fallot: long term results].
The experience of the Thoracic and Cardiovascular Surgery Service of the Columbia-Presbyterian Medical Center with the surgical correction of Tetralogy of Fallot was reviewed. This includes 444 patients operated on between 1960 and 1975. The operatory mortality was 5.6%. The major cause of death was related to a decreased cardiac output. The postoperatory mortality is minimal (2.9%) and reoperations are rarely necessary. The 91.3% of the patients presented right bundle branch block in the immediate postoperatory period and 8.7% was accompanied by left anterior hemiblock. All of these patients are clinically well and to not present syncopal crisis or signs of AV block. 145 patients (33%) were re-catheterized in the late postoperative period. The hemodynamic results and the clinical evaluation show that in 85.6% of these cases the results obtained are from "Good to Excellent".
Adolescent↗
Counterpulsation with a new pulsatile assist device (PAD) in open-heart surgery.
A new pulsatile assist device that converts roller pump flow to pulsatile flow has been developed and proven effective through clinical testing. The PAD is also a hemodynamically effective arterial counterpulsator both before and after cardiopulmonary bypass. The PAD has been found to be an important adjunct to the care of critically ill patients undergoing open-heart surgery. In addition, in selected patients, the PAD is a reasonable alternative to the elective use of intra-aortic balloon pumping.
Adolescent↗
Hemodynamic alterations with a reversed unidirectional intra-aortic balloon.
The hemodynamic effects of dual-chambered unidirectional balloon pumping in alternate directions were studied in 44 trials conducted on 8 dogs. Results indicate an increase in cardiac output in normal dogs with downstream pumping by unidirectional intra-aortic balloon, which may have important implications for the treatment of low output cardiac failure.
Animals↗