WordNet

become inflated; "The sails ballooned" (同)inflate, billow
large tough nonrigid bag filled with gas or heated air
small thin inflatable rubber bag with narrow neck
ride in a hot-air balloon; "He tried to balloon around the earth but storms forced him to land in China"
flying in a balloon

PrepTutorEJDIC

『気球』,軽気球 / (おもちゃの)風船 / (気球のように)ふくれる《+『out』(『up』)》 / (気球のように)ふくれた
気球操縦競技

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/13 14:41:32」(JST)

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An intra-aortic balloon pump

The Intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery. It consists of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery^[1] and counterpulsates. That is, it actively deflates in systole, increasing forward blood flow by reducing afterload through a vacuum effect. It actively inflates in diastole, increasing blood flow to the coronary arteries via retrograde flow. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.^[2] ^[3] ^[4]

A computer-controlled mechanism inflates the balloon with helium from a cylinder during diastole, usually linked to either an electrocardiogram (ECG) or a pressure transducer at the distal tip of the catheter; some IABPs, such as the Datascope System 98XT, allow asynchronous counterpulsation at a set rate, though this setting is rarely used. Helium is used because its low viscosity allows it to travel quickly through the long connecting tubes, and has a lower risk than air of causing an embolism should the balloon rupture.

History

The IABP device was pioneered at Grace Sinai Hospital in Detroit during the early 1960s by Dr. Adrian Kantrowitz and his team.^[3]

The first publication of intra-aortic balloon counter-pulsation appeared in the American Heart Journal of May 1962; 63: 669-675 by S. Moulopoulos, S. Topaz and W. Kolff.

The device was developed for use in heart surgery by Dr. David Bregman in 1976 at NewYork-Presbyterian Hospital in New York City.^[5]

The first clinical implant was performed at Maimonides Medical Center, Brooklyn, N.Y. in Oct., 1967. The patient, a 48 year old woman, was in cardiogenic shock and unresponsive to traditional therapy. An IABP was inserted by a cut down on the left femoral artery. Pumping was performed for approximately 6 hours. Shock reversed and the patient was discharged.

The size of the original balloon was 15 French but eventually 9 and 8 French balloons were developed.^[6] A second operation removed the balloon. Since 1979 the placement of the balloon has been modified using the Seldinger technique.^[6]^[7]

Indications

The following situations may benefit from this device.^[2]^[3]^[4]

Cardiogenic shock when used alone as treatment for myocardial infarction. 9-22% survive the first year.
Reversible intracardial mechanical defects complicating infarction, i.e. acute mitral regurgitation and septal perforation.
Unstable angina pectoris benefits from counterpulsation.
Post cardiothoracic surgery—most common and useful is counterpulsation in weaning patients from cardiopulmonary bypass after continued perioperative injury to myocardial tissue.
Preoperative use is suggested for high-risk patients such as those with unstable angina with stenosis greater than 70% of main coronary artery, in ventricular dysfunction with an ejection fraction less than 35%.
Percutaneous coronary angioplasty
In high risk coronary artery bypass graft surgery where cardiopulmonary bypass time was shortened, as well as during intubation period and hospital stay.^[8]
Thrombolytic therapy of acute myocardial infarction.^[6]

Contraindications

Aortic pressure curve in the presence of an intra-aortic balloon pump

Absolute contraindication

The following conditions will always exclude patients for treatment:^[2] ^[3] ^[4]

Severe aortic valve insufficiency
Aortic dissection
Severe aortoiliac occlusive disease

Relative contraindication

The following conditions make IABP therapy inadvisable except under pressing circumstances:^[2]

Prosthetic vascular grafts in the aorta
Aortic aneurysm
Aortofemoral grafts

Complications

Since the device is placed in the femoral artery and aorta it could provoke ischemia, and compartment syndrome. The leg is at highest risk of becoming ischemic if the femoral artery it is supplied by becomes obstructed. Placing the balloon too distal from the arcus aortae may induce occlusion of the renal artery and subsequent renal failure. Other possible complications are cerebral embolism during insertion, infection, dissection of the aorta or iliac artery, perforation of the artery and hemorrhage in the mediastinum. Mechanical failure of the balloon itself is also a risk which entails vascular surgery to remove under that circumstance. After balloon removal there is also a risk of 'embolic shower' from micro clots that have formed on the surface of the balloon, and can lead to peripheral thrombosis, myocardial ischemia, hemodynamic decompensation, and late pseudoaneurysm.^[2] ^[3] ^[4]

References

^ "Intra-aortic Balloon Pump". Texas Heart Institute.
^ ^a ^b ^c ^d ^e Intensive Care Medicine by Irwin and Rippe
^ ^a ^b ^c ^d ^e Intra Aortic Balloon Pump (IABP) Counterpulsation mirror with better quality by P. J Overwalder, M.D., Department of Surgery, Division of Cardiac Surgery, University Hospital Graz, The Internet Journal of Thoracic and Cardiovascular Surgery. 1999. Volume 2 Number 2.
^ ^a ^b ^c ^d Intra-aortic balloon pumping Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
^ "NewYork-Presbyterian Heart 'Firsts'", available at http://www.nyp.org/about/heart-firsts.html
^ ^a ^b ^c http://www.rjmatthewsmd.com/Definitions/IABP_Counterpulsation.htm Intra Aortic Balloon Pump (IABP) Counterpulsation by P. J Overwalder, M.D.
^ Kantrowitz, A., Tjonneland, S., Freed, P.S., Phillips, S.J., Butner, A.N., Sherman, J.L., Jr.: Initial clinical experience with intra-aortic balloon pumping in cardiogenic shock. JAMA, 1968; 203(2):113-8
^ Usage of Intra-Aortic Balloon Pump in High Risk Coronary Artery Bypass Graft Surgery by K. Jai Shankar

External links

Intra-italheartj.org/pdf_files/20050080.pdf Images in cardiovascular medicine The missing intra-aortic balloon pump catheter by Pasquale Totaro, Nello Degno, John Smith, Vincenzo Argano, Cardiac Surgery Department, Regional Cardiac Center, Morriston Hospital, Swansea, UK, Ital Heart J 2005; 6 (4): 361-362)

UpToDate Contents

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1. 大動脈内バルーンポンプカウンターパルセーション intraaortic balloon pump counterpulsation
2. 急性心筋梗塞を合併する心原性ショックの予後および治療 prognosis and treatment of cardiogenic shock complicating acute myocardial infarction
3. 循環補助装置：心肺補助装置および短期左室補助装置 circulatory assist devices cardiopulmonary assist device and short term left ventricular assist devices
4. 最新の診療アップデート practice changing updates
5. ST上昇型心筋梗塞後の冠動脈バイパス術 coronary artery bypass graft surgery after acute st elevation myocardial infarction

English Journal

Drug reaction with eosinophilia and systemic symptoms syndrome associated myocarditis: a survival experience after extracorporeal membrane oxygenation support.

Lo MH, Huang CF, Chang LS, Kuo HC, Chien SJ, Lin IC, Lin KM, Lin YJ.SourceDepartment of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Journal of clinical pharmacy and therapeutics.J Clin Pharm Ther.2013 Apr;38(2):172-4. doi: 10.1111/jcpt.12025. Epub 2012 Nov 22.
WHAT IS KNOWN AND OBJECTIVE: Myocarditis that develops because of the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening disease. We report a case of DRESS-associated myocarditis with cardiac failure that required extracorporeal membrane oxygenation (ECMO) f
PMID 23173909

A retrospective clinical study of transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in China.

Wang S, Luo M, Sun H, Song Y, Yin C, Wang L, Hui R, Hu S.SourceDepartment of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. wsymd@sina.com
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.Eur J Cardiothorac Surg.2013 Mar;43(3):534-40. doi: 10.1093/ejcts/ezs332. Epub 2012 Jul 3.
OBJECTIVES: The aim was to assess the early and mid-term clinical effects of transaortic extended septal myectomy (TAESM) on obstructive hypertrophic cardiomyopathy (HCM) in China.METHODS: Ninety-three consecutive patients [57 men; mean age 45.8 ± 13.4 (11-74) years] with obstructive HCM underwent
PMID 22761504

Long-Term Results of Dialysis Patients with Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting.

Sezai A, Nakata KI, Hata M, Yoshitake I, Wakui S, Hata H, Shiono M.SourceThe Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.Ann Thorac Cardiovasc Surg.2013 Feb 15. [Epub ahead of print]
Purpose: Recently, coronary atrial bypass grafting (CABG) for dialysis patients increase, but the mortality is still high. Additionally, many patients show major adverse cardiovascular and cerebrovascular event (MACCE) after discharge and long-term results are not satisfactory. Methods: Ninety patie
PMID 23411841

Japanese Journal

その他の治療法大動脈バルーンパンピング(IABP) (冠動脈疾患(上)診断と治療の進歩) -- (冠動脈疾患における治療学の進歩)

森井功
日本臨床 69(-) (1006), 461-464, 2011-09
NAID 40018986214

心筋梗塞の最新の治療について--発症の現場から急性期治療まで (特集心筋梗塞から身を守る--発作が起こる前と起こってからできること)

若槻哲三
四国医学雑誌 67(3・4), 123-126, 2011-08-25
… Acute treatment with a catheter hasadvanced : from conventional balloon angioplasty to the development of devices／procedures forcoronary stent implantation, topical thrombus aspiration, and peripheral protection. … In accordance with the circumstances, DC shock, transient pacemakerinsertion, intra-aortic balloon pumping（IABP）, and the application of percutaneous cardiopulmonarysupport（PCPS）must be promptly performed. …
NAID 40018975216