Clinical Case: Investigation of the Cerebral Blood Flow Alteration due to Intra-Aortic Counterpulsation Balloon Support in Early Postoperative Period
Abstract
Introduction. Intra-aortic counterpulsation balloon support is a most common supportive therapy method which increases coronary and cerebral blood flow in patients with left-sided heart failure.
The aim. To represent a clinical case of cerebral blood flow alteration due to intra-aortic counterpulsation balloon (IACPB) support in the early postoperative period.
Methods. A 78-year-old patient with unstable angina, history of infarction (1998, 2002) and cardiosclerosis. EchoCG: contractile function of the left ventricle is drastically reduced, EF 32 %, moderate pulmonary hypertension 45 mm Hg. ECG: Sinus rhythm, sinus tachycardia, 110 bpm, subendocardial ischemia of the anterior left ventricle wall. Coronary angiography: left ventricle contractility is diffusely reduced, high occlusion of the right coronary artery, occlusion of the distal third of the circumflex branch of the left coronary artery (LCA), 90 % stenosis of the LCA. Taking into account the protracted attack of angina pectoris which was not relieved by narcotic analgesics, and taking into account total damage of coronary arteries in combination with diffuse decrease in contractile capacity of the left ventricle, the patient underwent preventive implantation of intra-aortic balloon pump, and aortic coronary artery bypass was performed on a beating heart.
Results. The changes in general structure of EEG comprised increased theta activity in the central (hypothalamic) regions; increased alpha activity in central and parietal regions; reduction of total energy levels in left frontal lobe, left parietal and occipital regions.
Conclusions. Pulse wave created by intra-aortic balloon pump increases cerebral blood flow and improves energy balance of the brain tissue in patients with left-sided heart failure.
References
- Lim HS. Cardiogenic Shock: Failure of Oxygen Delivery and Oxygen Utilization. Clin Cardiol. 2016;39(8):477–83.
- Reyentovich A, Barghash MH, Hochman JS. Management of refractory cardiogenic shock. Nat Rev Cardiol. 2016;13(8):481–92. https://doi.org/10.1038/nrcardio.2016.96
- Kapur NK, Paruchuri V, Majithia A, Esposito M, Shih H, Weintraub A, et al. Hemodynamic effects of standard versus larger-capacity intraaortic balloon counterpulsation pumps. J Invasive Cardiol. 2015;27(4):182–8.
- Kovalenko VM, Kornatsky VM, Manoyilenko TS, Kyrychenko AH, Revenko IL. [The dynamics of people’s state of health in Ukraine and regional features: Analytical and statistical manual]. Kyiv; 2012. (in Ukrainian).
- Bratus VV, Shumakov VA, Talaieva TV. [Atherosclerosis, Coronary Heart Disease, Acute Coronary Syndrome: Pathogenesis, Diagnosis, Clinic, Treatment] [monograph]. Kyiv; 2004. p. 104–8. (in Russian).
- Kaplan JA, Graver JM. Assisted circulation. In: Kaplan J. Cardiac Anesthesia. New York; 1987. p. 441–69.
- Kantrowitz A, Tjonneland S, Freed PS, Phillips SJ, Butner AN, Sherman JL Jr. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA. 1968 Jan 8;203(2):113–8.
- Buckley MJ, Craver JM, Gold HK, Mundth ED, Daggett WM, Austen WG. Intra-aortic balloon pump assist for cardiogenic shock after cardiopulmonary bypass. Circulation. 1973 Jul;48(1 Suppl):III90–4.
- Stewart S, Biddle T, DeWeese J. Support of the myocardium with intra-aortic balloon counterpulsation following cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1976 Jul;72(1):109–14.
