Pulmonary edema interventional therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Intra-aortic balloon pump can be used to achieve hemodynamic stabilization in the patient before definitive therapyIt consists of a cylindrical balloon that sits in the aorta and counterpulsates. That is, it actively deflates in systole increasing forward blood flow by reducing afterload, and actively inflates in diastole increasing blood flow to the coronary arteries.

• Can be used to achieve hemodynamic stabilization in the patient before definitive therapy^[1]
• The intra-aortic balloon pump decreases afterload

• Procedure:
  • The intra-aortic balloon pump is inserted percutaneously through the femoral artery
  • The distal end of the pump is placed distal to the aortic knob and the origin of the left subclavian artery
  • For inflation of the balloon helium is used
  • Inflation of the balloon should occur in early diastole, just after the aortic valve closes
  • Deflation of balloon should occur in early systole, just before the aortic valve opens
• Proper inflation results in an assisted peak diastolic pressure higher than the unassisted peak systolic arterial pressure
• Proper deflation leads to assisted aortic end-diastolic pressure of approximately 10mm Hg lower than the unassisted end-diastolic pressure

Absolute contraindications for intra-aortic balloon pumping include:

• Dissecting aortic aneurysm
• Severe aortic regurgitation
• Large arteriovenous shunt
• Severe coagulopathy

Relative contraindications include:

• Severe peripheral vascular disease
• Recent thrombolytic therapy
• Bleeding diathesis
• Descending aortic
• Peripheral vascular grafts

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