[HSF] RV failure management strategies

[Jbflegejr at aol.com]

I have used counterpulsation in the pulmonary artery a few times when RV 
failure prevented weaning from CPB with several successes. This was described by 
Craig Miller, and I reported the first successful  case in the ANNALS THORACIC 
SURGERY 1984;37:167-68. a 20mm graft is sutured end to side on the main PA, 
essentially a diverticulum, and the IAB inserted into the graft with the end in 
the PA. I used this successfully in one case, acute Inferior MI with 
biventricular failure, in conjunction with intra-aortic balloon (two pumps). Obviously 
this can only provide assistance to the RV just like aortic counterpulsation 
only provides assistance for the LV. In some patients assistance of either RV 
or LV or both can mean survival from an otherwise fatal situation. John Flege