By: ABDULRAHMAN ALSALMIBy: ABDULRAHMAN ALSALMI

INTRA AORTIC BALLOON PUMPINTRA AORTIC BALLOON PUMP

CHIEF CARDIAC PERFUSIONISTCHIEF CARDIAC PERFUSIONIST

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• The Perfusion department has different The Perfusion department has different machines for different functions:machines for different functions:

– Heart lung machine . Which is used for open heart Heart lung machine . Which is used for open heart surgery . surgery .

– VAD VAD

– ECMO ECMO

– CPSCPS

– IAPBIAPB

Intra Aortic Balloon PumpIntra Aortic Balloon Pump

• Intra Aortic Balloon Pump is a cardiac assist Intra Aortic Balloon Pump is a cardiac assist device which provides temporary circulatory device which provides temporary circulatory support . support .

• It supports the heart’s left ventricle by increasing It supports the heart’s left ventricle by increasing coronary perfusion while reducing left ventricular coronary perfusion while reducing left ventricular work.work.

• Coronary perfusion is increased by augmenting Coronary perfusion is increased by augmenting ( increasing ) blood pressure during the diastolic ( increasing ) blood pressure during the diastolic phase of the cardiac cycle.phase of the cardiac cycle.

Countrepulsation is the active process of mechanically Countrepulsation is the active process of mechanically displacing intra aortic blood displacing intra aortic blood by inflating and by inflating and deflating opposite to the heart’s activity. This is deflating opposite to the heart’s activity. This is were it gets the name were it gets the name ..

The IAB System is comprised basically of two entities:The IAB System is comprised basically of two entities:

1.1. Balloon.Balloon.

2.2. Console.Console.

The intra aortic balloon comes in various sizes and The intra aortic balloon comes in various sizes and designs. However, they all function to displace designs. However, they all function to displace blood from the aorta.blood from the aorta.

The balloon functions by inflating and deflating with The balloon functions by inflating and deflating with specific driving gas.specific driving gas.

• The various balloon use either carbon dioxide or The various balloon use either carbon dioxide or Helium as the inflating gas.Helium as the inflating gas.

• Atmospheric air can also be used to inflate the Atmospheric air can also be used to inflate the balloon , but is rarely used .balloon , but is rarely used .

• There are specific reasons for using carbon There are specific reasons for using carbon dioxide and helium .dioxide and helium .

• Carbon dioxide is eighteen times more soluble in Carbon dioxide is eighteen times more soluble in blood than air and fourty times more soluble than blood than air and fourty times more soluble than helium . helium .

1. The bidirectional balloon .1. The bidirectional balloon .

2. The unidirectional balloon .2. The unidirectional balloon .

Arrow Arrow ACAT1+ACAT1+

• There are three There are three manufactured ( IABP ) manufactured ( IABP ) console .console .– 1. Arrow 1. Arrow (Bard, (Bard,

Kontron, Cardiac Assisst-Kontron, Cardiac Assisst-BSC )BSC )

– 2. Datascope2. Datascope– 3. Smec3. Smec

Datascope

Placement of IABPlacement of IAB

Inflate During Diastole

Deflate During Systole

Increase Coronary Perfusion Decrease Afterload

• Diagrammatic representation of average timing of Diagrammatic representation of average timing of electrical and mechanical events on both sides of the electrical and mechanical events on both sides of the heart during atrial and ventricular systole in normal heart during atrial and ventricular systole in normal subjects .(1) Onset of right atrial contraction,(2) onset subjects .(1) Onset of right atrial contraction,(2) onset of left atrial contraction , (3) onset of left ventricular of left atrial contraction , (3) onset of left ventricular contraction, (4) onset of right ventricular contraction, contraction, (4) onset of right ventricular contraction, (5) onset of right ventricular ejection , (6) onset of left (5) onset of right ventricular ejection , (6) onset of left ventricular ejection , (7) end of left ventricular ejection , ventricular ejection , (7) end of left ventricular ejection , (8)end of right ventricular ejection . Striped areas (8)end of right ventricular ejection . Striped areas represent ventricular isometric contraction .represent ventricular isometric contraction .

1.Refractory ventricular failure .1.Refractory ventricular failure .

2.Cardiogenic shock .2.Cardiogenic shock .

3.Unstable angina .3.Unstable angina .

4.Impending infarction .4.Impending infarction .

5.Mechanical complication due to a cute 5.Mechanical complication due to a cute myocardial infarction ,i.e, VSD , MV myocardial infarction ,i.e, VSD , MV regurgitation or papillary muscle rupture .regurgitation or papillary muscle rupture .

6.Septic shock .6.Septic shock .

7.Weaning from cardiopulmonary by pass .7.Weaning from cardiopulmonary by pass .8.Support and stabilization during coronary 8.Support and stabilization during coronary

angiography and angioplasty .angiography and angioplasty .9.Intra operative pulsatile flow generation .9.Intra operative pulsatile flow generation .10.Prior to Heart Transplant.10.Prior to Heart Transplant.

1.1. Sever aortic insufficiency .Sever aortic insufficiency .

2.2. Abdominal or aortic aneurysm .Abdominal or aortic aneurysm .

3.3. Sever calcific aortic – iliac disease or Sever calcific aortic – iliac disease or peripheral vascular disease . peripheral vascular disease .