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James Frederiksen
Michel N. Ilbawi
John M. Moran
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Ann Thorac Surg 1986;41:616-621
© 1986 The Society of Thoracic Surgeons

Articles

Use of a Counterpulsation Balloon as a Substitute for the Pulmonic Valve: A New Application

James Frederiksen, M.D.*, Michel N. Ilbawi, M.D., Andrew J. Gorman, M.D., Milos Opravil, M.D., Farouk S. Idriss, M.D., John M. Moran, M.D.

Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, the Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and the Department of Surgery, Northwestern University Medical School, Chicago, IL

Accepted for publication August 28, 1985.

* Address reprint requests to Dr. Frederiksen, Northwestern University Medical School, 303 E. Chicago, Chicago, IL 60611

An inflatable, 3-ml balloon positioned within the distal right ventricular outflow tract was used to restore pulmonic valve function in 8 dogs that had undergone open-chest valvectomy. Balloon inflation and deflation were accomplished with a counterpulsation console. Valvectomy produced loss of the pulmonic incisura, a decrease in pulmonary artery diastolic pressure (PADP; mean ± standard error) (9.5 ± 1.3 versus 4.4 ± 0.6 mm Hg, p < 0.01), and an increase in pulmonary artery pulse pressure (PAPP) (8.6 ± 0.7 versus 19.1 ± 1.9 mm Hg, p < 0.01) without significantly affecting forward cardiac output (CO) (1,750 ± 110 versus 1,880 ± 230 ml/min, p is not significant). Properly timed counterpulsation restored the pulmonic incisura, raised the PADP from 6.1 ± 0.8 to 9.5 ± 0.8 mm Hg (p < 0.01), lowered the PAPP from 15.1 ± 1.4 to 10.6 ± 1.0 mm Hg (p < 0.01), and raised the forward CO from 1,850 ± 260 to 1,920 ± 260 ml/min (p < 0.01). The injection of glass beads, 40 to 150 µm in diameter, into the right ventricular outflow tract increased pulmonary vascular resistance from 383 ± 87 to 730 ± 150 dyne · sec cm–5 (p < 0.05) and decreased forward CO from 1,850 ± 260 to 1,570 ± 230 ml/min (p < 0.05). Following this injection, counterpulsation again restored the pulmonic incisura, raised the PADP from 9.3 ± 1.4 to 16.0 ± 1.8 mm Hg (p < 0.01), lowered the PAPP from 25.0 ± 2.5 to 18.2 ± 2.5 mm Hg (p < 0.01), and raised the forward CO from 1,570 ± 230 to 1,720 ± 220 ml/min (p < 0.01). These findings indicate that (1) the pulmonic valve balloon can serve as a temporary substitute for the pulmonic valve, and (2) the canine heart tolerates the combination of acute pulmonic regurgitation and pulmonary vascular obstruction less well than it tolerates regurgitation alone.






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