HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wolvek, S. Search for Related Content PubMed PubMed Citation Articles by Wolvek, S.

Ann Thorac Surg 1995;59:1041
© 1995 The Society of Thoracic Surgeons

---

Correspondence

Intraaortic Balloon Rupture: A Possible Means of Prevention

Cardiac Assist Division, Datascope Corp, 15 Law Dr, Fairfield,Nj 07004

To the Editor:

I congratulate Dr Silberman and his colleagues at the Shaare Zedek Medical Center in Jerusalem for their recent letter [1] in which they commented on the relationship between plaque abrasion and penetration of intraaortic balloons and patient aorta size. As intraaortic balloon designers and manufacturers, Datascope has long recognized this relationship [2] and therefore has made available to the medical community three sizes of adult intraaortic balloons: 50 mL, 40 mL, and 34 mL. This makes it possible for the physician to select a properly sized balloon for a specific patient and enables him or her to position the balloon for the greatest intraaortic balloon pump efficacy and safety. With a balloon size matched to the patient, the tip of the balloon can be placed correctly 2 cm distal to the subclavian artery while keeping the proximal portion of the balloon membrane within the descending thoracic aorta and out of the tapering abdominal aorta with its heavier plaque concentrations.

Our own experience has made it quite obvious that improper patient/balloon sizing has contributed to plaque penetrations of balloons in the smaller patient, especially in the smaller female patient. A recent university hospital study of 59 cases correlates eight instances of intraaortic balloon failure to patient size and sex in 1990 [3]. In that year the 40-mL balloon was used in all patients. The average height of the patients in whom the 40-mL balloon failed was 1.62 m. Four of the 5 female patients were less than 1.60 m in height. Plaque abrasion and ultimate penetration accounted for all of these balloon failures.

Although only 37.4% of the intraaortic balloon patients in another study [4] were female, female patients accounted for 62.5% of the failed intraaortic balloon population. On average, the failed intraaortic balloon patients were 6 years older and 3 cm shorter than those in whom balloon leaks did not develop. Cox and colleagues [4] reported the mean height of the failed balloon patients was 1.65 m, with a high rate of intraaortic balloon leaks in patients less than 1.63 m tall. A new policy was instituted that encouraged the use of the 34-mL balloon in those patients less than 1.63 m tall and the leak rate was reduced by more than 75%. Clearly, as Dr Silberman and his colleagues have pointed out, there is a causality between improper patient balloon sizing and the incidence of plaque penetration.

References

1. Silberman S, Merin O, Fink D, Bitran D. Intraaortic balloon rupture: a possible means of prevention [Letter]. Ann Thorac Surg 1994;58:915–6.
2. Wolvek S. The hostile environment of the aging human aorta and the small patient-implications for the intra-aortic balloon. Perfusion 1994;9:87–94.[Abstract/Free Full Text]
3. Hollingsed MJ, Wolvek S, Graeber GM. High risk predictability of intra-aortic balloon perforation. Proceedings of the American Academy of Cardiovascular Perfusion, 1994.
4. Cox PM, Kellett M, Goran S, Mortaon J, Wolvek S. Plaque abrasion and intra-aortic balloon leak, Main Medical Center. Chest 1992;102(Suppl):201.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wolvek, S. Search for Related Content PubMed PubMed Citation Articles by Wolvek, S.