Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-19T04:41:42.464Z Has data issue: false hasContentIssue false
  • English
  • Français

Obstructing balloon catheter for the induction of systolic hypertension in the pulmonary ventricle—an acute hemodynamic study in the piglet

Published online by Cambridge University Press:  19 August 2008

Robert Krzeski ,
Hiroshi Katayama ,
Philipp Bonhoeffer ,
Carol L. Lucas ,
Walker A. Long ,
Lucio Parenzan  and
G. William Henry
Robert Krzeski
Affiliation:
From the Departments of Pediatrics, The University of North Carolina, Chapel Hill
Hiroshi Katayama*
Affiliation:
From the Departments of Pediatrics, The University of North Carolina, Chapel Hill
Philipp Bonhoeffer
Affiliation:
Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo
Carol L. Lucas
Affiliation:
From the Department of Biomedical Engineering, The University of North Carolina, Chapel Hill
Walker A. Long
Affiliation:
From the Departments of Pediatrics, The University of North Carolina, Chapel Hill Department of Cardiology, Wellcome Research Laboratories, Research Triangle Park
Lucio Parenzan
Affiliation:
Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo
G. William Henry
Affiliation:
From the Departments of Pediatrics, The University of North Carolina, Chapel Hill
*
Dr. Robert Krzeski, Department of Pediatrics, The University of North Carolina, CB 7220, 311 Burnett-Womack 229H, Chapel Hill, NC 27599USA. Tel. 919-966-4601; Fax. 919-966-6892.
Get access Rights & Permissions [Opens in a new window]

Abstract

The use of an obstructing balloon catheter positioned in the outflow tract of the pulmonary ventricle may be an alternative method for the adaptation of the left ventricle to an increased afterload prior to an arterial switch procedure in patients with complete transposition requiring a two-stage approach. We tested this approach in an acute hemodynamic study in a piglet model. Seven piglets were anesthetized with halothane and ventilated at FiO2 1.0. Through a median sternotomy, the great vessels were exposed. The right ventricular pressure and the aortic blood pressure were recorded using microtip manometers, cardiac output was measured by an electromagnetic flow probe on the ascending aorta. A 6F or 7F Berman angiographic catheter was placed in the lumen of the pulmonary artery and the balloon inflated to decrease cardiac output no more than 30%. The hemodynamic changes observed after balloon inflation included an 100% increase in systolic right ventricular pressure (control vs balloon inflation (mean±SE) 20.4 ± 1.5 mm Hg vs 46.6 ± 4 mm Hg, p<0.001), a slight reduction in systolic aortic pressure (75.5 ± 3.8 mm Hg vs 65.0 ± 5.8 mm Hg; p<0.05), and a reduction in cardiac output by 30% (1.1 ± 0.081/min vs 0.8 ±0.08 1/min, p<0.01). The systolic right ventricular to aortic pressure ratio was increased from 0.27 ± 0.02 to 0.69 ± 0.08, p<0.001. This study shows that a balloon catheter may be useful in creating systolic hypertension in the pulmonary ventricle in patients with complete transposition requiring a two-stage approach.

Keywords

Cathetercomplete transpositionarterial switch procedurepulmonary artery banding
Type
Preliminary Reports
Information
Cardiology in the Young , Volume 2 , Issue 1 , January 1992 , pp. 89 - 94
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jonas, RA, Giglia, TM, Sanders, SP, Wernovsky, G, Nadal-Ginard, B, Mayer, JE, Castañeda, AR. Rapid two stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period. Circulation 1989; 80 (Suppl I): I 203–208.Google ScholarPubMed
2.Jonas, RA. Update on the rapid two-stage arterial switch procedure. Cardiol Young 1991; 1: 99–100.CrossRefGoogle ScholarPubMed
3.Izumo, S, Lompre, AM, Matsuoka, R, Koren, G, Schwartz, K, Nadal-Ginard, B, Mahdavi, V. Myosin heavy chain messenger RNA and protein isoform transitions during cardiac hypertro phy. J Clin Invert 1987; 79: 970–977.CrossRefGoogle Scholar
4.Izumo, S, Nadal-Ginard, B, Mahdavi, V. Protooncogene induction and reprogramming of cardiac gene expression produced by pressure overload. Pro Nad Acad Sci USA 1988; 85: 339–343.CrossRefGoogle ScholarPubMed
5.Bonhoeffer, P, Henry, GW, Katayama, H, Krzeski, R, Carminati, M, Crupi, G, Parenzan, L. Preparation of the “pulmonary ventricle” for arterial switch by adjustable intravascular balloon outflow obstruction–an experimental approach in a lamb model. Cardiol Young 1992; 2: 85–88.CrossRefGoogle Scholar
6.Castañeda, AR, Trusler, GA, Paul, MH, Blackstone, EH, Kirklin, JW. The early results of treatment of simple transposition in the current era. J Thorac Cardiovasc Surg 1988; 95: 14–28.CrossRefGoogle ScholarPubMed
7.Quaegebeur, JM,Rohmer, J,Ottenkamp, J,Buis, T, Kirklin, JW, Blackstone, EH, Brom, AG. The arterial switch operation: an eight-year experience. J Thorac Cardiovasc Surg 1986; 92: 361–384.CrossRefGoogle ScholarPubMed
8.Backer, CL, Ilbawi, MN, Ohtake, S, DeLeon, SY, Muster, AJ, Paul, MH, DW, Benson Jr, Idriss, FS. Transposition of the great arteries: A comparison of results of the Mustard procedure versus the arterial switch. Ann Thorac Surg 1989; 48: 10–14.CrossRefGoogle ScholarPubMed
9.Wernovsky, G, Hougen, TJ, Walsh, EP, Sholler, GF, Colan, SD, Sanders, SP, Parness, IA, Keane, JF, Mayer, JE, Jonas, RA, Castañeda, AR, Lang, P. Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum: clinical, hemodynamic, echocardiographic, and electrophysiologic data. Circulation 1988; 77: 1333–1344.CrossRefGoogle ScholarPubMed
10.Losay, J, Planche, C, Gerardin, B, Lacour-Gayet, F, Bruniaux, J, Kachaner, J. Midterm surgical results of arterial switch opera tion for transposition of the great arteries with intact septum. Circulation 1990; 82 (Suppl IV): IV-146–IV-150.Google Scholar
11.Merrill, WH, Stewart, JR, Hammon, JW, Johns, JA, HW, Bender Jr. The Senning operation for complete transposition: mid term physiologic, electrophysiologic, and functional results. Cardiol Young 1991; 1: 80–83.CrossRefGoogle ScholarPubMed
12.Merlo, M, De Tommasi, SM, Brunelli, F, Abbruzzese, PA, Crupi, G, Ghidoni, I, Casari, A, Piti, A, Mamprin, F, Parenzan, L. Long-term results after atrial correction of complete transposition of the great arteries. Ann Thorac Surg 1991; 51: 227–231.CrossRefGoogle ScholarPubMed
13.Bink-Boelkens, MTE, Bergstra, A, Cromme-Dijkhuis, AH, Eygelaar, A, Landsman, MJ, Mooyaart, EL. The asymptomatic child a long time after the Mustard operation for transposition of the great arteries. Ann Thorac Surg 1989; 47: 45–50.CrossRefGoogle Scholar
14.Hayes, CJ, Gersony, WM. Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study. J Am Coll Cardiol 1986; 7: 133–137.CrossRefGoogle ScholarPubMed
15.Yacoub, MH, Radley-Smith, R, Maclaurin, R. Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum. Lancet 1977; 1: 1275–1278.CrossRefGoogle ScholarPubMed
16.Nakazawa, M,Oyama, K, Imai, Y, Nojima, K, Aotsuka, H, Satomi, G, Kurosawa, H, Takao, A. Criteria for two-staged arterial switch operation for simple transposition of great arteries. Circulation 1988; 78: 124–131.CrossRefGoogle ScholarPubMed
17.Lange, PE, Nurnberg, JH, Sievers, HH, Onnasch, DGH, Bernhard, A, Heintzen, PH. Response of the right ventricle to progressive pressure loading in pigs. Basic Res Cardiol 1985; 80: 436–444.CrossRefGoogle ScholarPubMed
18.Yasui, H, Kado, H, Yonenaga, K, Hisahara, M, Ando, H, Iwao, H, Fukuda, S, Mizoguchi, Y, Sunagawa, H. Arterial switch operation for transposition of the great arteries, with special reference to left ventricular function. J Thorac Cardiovasc Surg 1989; 98 : 601–610.CrossRefGoogle ScholarPubMed
19.Keane, JF, Ellison, RC, Rudd, M, Nadas, AS. Pulmonary blood flow and left ventricular volumes in transposition of the great arteries and intact ventricular septum. Br Heart J 1973; 35: 521–526.CrossRefGoogle ScholarPubMed
20.Ilbawi, MN, Idriss, FS, DeLeon, SY, Muster, AJ, Gidding, SG, Duffy, CE, Paul, MH. Preparation of the left ventricle for anatomical correction in patients with simple transposition of the great arteries. J Thorac Cardiovasc Surg 1987; 94: 87–94.CrossRefGoogle ScholarPubMed
21.Danford, DA, Huhta, JC, Gutgesell, HP. Left ventricular wall stress and thickness in complete transposition of the great arteries: implications for surgical intervention. J Thorac Cardiovasc Surg 1985; 89: 610–615.CrossRefGoogle ScholarPubMed
22.Lange, PE, Sievers, HH, Onnasch, DGH, Yacoub, MH, Bernhard, A, Heintzen, PH. Up to 7years of follow-up after two-stage anatomical correction of simple transposition of the great arteries. Circulation 1986; 74 (Suppl I): I-47–I-52.Google Scholar
23.Tooyama, K, Satomi, G, Nakazawa, M, Seguchi, M, Mori, K, Takao, A, Imai, Y. Changes in left ventricular dimensions after pulmonary artery banding and Jatene operation in children with complete transposition of the great arteries: echocardiographic study. Jpn Heart J 1988; 29: 421–427.CrossRefGoogle ScholarPubMed
24.Yonenaga, K, Yasui, H, Kado, H, Ando, H, Nakamura, Y, Fusazaki, N, Ishikawa, S, Mizoguchi, Y, Sunagawa, H, Iwao, H. Evaluation of left ventricular function after Jatene's operation for transposition of the great arteries: influence of age at repair. Nippon Kyobu Geka Gakkai Zasshi 1990; 38: 227–233. [in Japanese]Google ScholarPubMed
25.Yamaguchi, M, Hosokawa, Y, Imai, Y, Kurosawa, H, Yasui, H, Yagihara, T, Okamoto, F, Wakaki, N. Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J Thorac Cardiovasc Surg 1990; 100: 261–269.CrossRefGoogle ScholarPubMed