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The response of mechanical performance, coronary blood flow and myocardial oxygen consumption of the normal and failing dog heart to intraaortic balloon pulsation

Hämodynamik, Koronardurchblutung und myokardialer Sauerstoffverbrauch des normalen und insuffizienten Hundeherzens unter intraaortaler Ballonpulsation

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Summary

Circulatory hemodynamics, coronary blood flow and myocardial oxygen consumption were studied in 10 open chest dogs in chloralose-urethan anesthesia during intraaortic balloon-pulsation (IABP).

In the normal heart (10 dogs) 10 min IABP resulted in a significant decrease of left ventricular mean systolic pressure for 13% (p<0.001) of dp/dtmax for 5% (NS) and of tension time index for 15% (p<0.001), whereas stroke volume and mean arterial pressure were unchanged. Coronary blood flow followed the alterations of arterial pressure with a decline of systolic and an increase of diastolic left circumflex coronary flow in the presence of unaltered mean coronary blood flow during diastolic augmentation. Myocardial oxygen consumption was reduced for 8% on the average as an effect of the unloading of the left ventricle by IABP.

Cardiogenic shock with hypotension, low stroke volume, cardiac output and coronary blood flow was simulated by serial ligation of coronary arteries. In contrast to the normotensive circulatory state IABP effected in this shock state an increase of left ventricular mean systolic pressure for 19%, mean arterial pressure for 31% (p<0.05) and mean left circumflex coronary blood flow for 37% (p<0.02) after 30 min. Myocardial oxygen consumption increased modestly for 15% (NS) after 10 min IABP compared to the shock state.

The different results in the sufficient and insufficient heart can be explained by the response of the baroreceptors in various pressure ranges to the phaseshift of the arterial pulse.

Zusammenfassung

An 10 Hunden wurden die linksventrikuläre Hämodynamik, Koronardurchblutung und der Sauerstoffverbrauch des Herzens während intraaortaler Ballonpulsation (IABP) untersucht.

Beim suffizienten Herzen (10 Hunde) führte 10 min IABP zu einem signifikanten Abfall des mittleren systolischen Druckes im linken Ventrikel von 13% (p<0,001), von dp/dtmax um 5% (NS) und des „tension time index” um 15% (p<0,001), während Schlagvolumen und mittlerer arterieller Druck unverändert blieben. Die Koronardurchblutung wurde parallel zum arteriellen Druck verändert: Während der systolische Fluß im Ramus circumflexus der linken Kranzarterie abfiel und der diastolische Fluß anstieg, blieb die mittlere Koronardurchblutung unverändert. Als Folge der systolischen Druckentlastung des linken Ventrikels fiel der myokardiale Sauerstoffverbrauch um 8%.

Ein Schockzustand mit erniedrigtem arteriellem Blutdruck, Herzminutenvolumen und Koronardurchblutung wurde durch Serienligatur von Koronararterienästen herbeigeführt. Im Gegensatz zum normotonen Kreislaufzustand führte 30 min IABP beim kardiogenen Schock zu einem Anstieg des mittleren systolischen Druckes im linken Ventrikel von 19%, des mittleren arteriellen Druckes von 31% (p<0,05) und der mittleren Koronardurchblutung von 37% (p<0,02). Dabei stieg der myokardiale Sauerstoffverbrauch um 15% (NS).

Die unterschiedlichen Auswirkungen der IABP auf die Hämodynamik und Koronardurchblutung des linken Ventrikels lassen sich erklären aufgrund der Reaktion der Barorezeptoren, der Veränderungen der Pulsform während IABP in verschiedenen Druckbereichen.

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  1. W. Bleifeld

    Present address: Department of Internal Medicine I, Rheinisch-Westfälische Technische Hochschule Aachen, Goethestraße 27-29, D-5100, Aachen

Authors and Affiliations

  1. Department of Internal Medicine I, Rheinisch-Westfälische Technische Hochschule Aachen, Goethestraße 27-29, D-5100, Aachen

    G. Franken, J. Meyer & W. -D. Bussmann

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With 9 flgures and 3 tables

With support of the Deutsche Forschungsgemeinschaft SFB 109

Parts of this manuscript are from the thesis ofG. Franken, M.D.

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Bleifeld, W., Franken, G., Meyer, J. et al. The response of mechanical performance, coronary blood flow and myocardial oxygen consumption of the normal and failing dog heart to intraaortic balloon pulsation. Basic Res Cardiol 69, 379–401 (1974). https://doi.org/10.1007/BF01905943

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