[HSF] aortic root reimplantation and Rv dysfx

[Jbflegejr at aol.com]

Pulmonary artery counterpulsation may be used. A 20mm graft is sewn to the 
main pulmonary artery which is essentially a diverticulum or pumping chamber. An 
intraortic balloon is inserted into the graft with the end in the pulmonary 
artery and counterpulsation applied just like to an intraortic balloon. This 
was first described by Craig Miller who used in without success and the first 
success was reported by me. 
(Flege JB, Jr., Wright CB, Reisinger TJ. Successful balloon counterpulsation 
for right ventricular failure. Ann Thorac Surg 1984;37:167-8.) (Miller's paper 
is cited in the references.) I have used it successfully for two patients 
with mitral stenosis and severe pulmonary hypertension having MVR and one patient 
with biventricular failure resulting from extensive acute inferior RV and LV 
infarction without pulmonary hypertension who required an intraortic balloon 
as well. None of the three could be weaned from CPB even with industrial dosage 
of ionotropes and all were dependent on the balloon support for two or three 
days. I reopened the sternum to remove the balloon and grafts. All three made 
good recoveries. I have used this support several other times without success 
in equally desperate circumstances. John Flege



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