Cases reported "Aortic Valve Stenosis"

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1/4. Intra-aortic balloon pump associated with dynamic left ventricular outflow tract obstruction after valve replacement for aortic stenosis.

    An unstable patient with critical aortic stenosis had an intra-aortic balloon pump placed preoperatively for hemodynamic support and alleviation of symptoms. After separation from cardiopulmonary bypass following aortic valve replacement, the patient was hypotensive with increased pulmonary artery pressures. Transesophageal echocardiography revealed left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve and severe mitral regurgitation. This pathophysiology was present when ventricular systole was preceded by balloon counterpulsation, but was absent during unassisted systole. This case report demonstrates a potentially significant untoward effect of intra-aortic balloon pump augmentation after aortic valve replacement for aortic stenosis. The timely diagnosis of this iatrogenic condition in the operating room permitted the prompt implementation of appropriate management strategies and avoided unnecessary surgical intervention.
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ranking = 1
keywords = counterpulsation
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2/4. Successful use of intra-aortic balloon counterpulsation in the treatment of refractory intraoperative cardiogenic shock.

    Intra-aortic balloon counterpulsation (IABC) has been used successfully in the treatment of shock following myocardial infarction. This report describes eight patients who developed medically refractory cardiogenic shock following cessation of cardiopulmonary bypass and who were treated with IABC. None of the eight became balloon dependent and seven of eight (87.5%) left the hospital doing well. The treatment of refractory intra-operative cardiogenic shock represents a new and additional indication for IABC.
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ranking = 5
keywords = counterpulsation
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3/4. Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect.

    Pre-infarction angina, in the absence of coronary artery disease, was found in a 62 year-old man with severe calcific aortic stenosis. After application of intraaortic balloon pump counter-pulsation, the condition was stabilized, and coronary arteriograms were safely carried out. Interestingly, an elevated right atrial and right ventricular end-diastolic pressure with an associated Bernheim's effect was demonstrated by cardiac catheterization. The hemodynamics of the right heart returned to normal after surgical correction of the aortic stenosis. The clinical indications for intra-aortic balloon pump counterpulsation in this setting are discussed.
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ranking = 1
keywords = counterpulsation
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4/4. Intraaortic balloon counterpulsation as a temporary support measure in decompensated critical aortic stenosis.

    Intraaortic balloon counterpulsation was instituted in two adult patients whose condition was rapidly deteriorating because of critical decompensated valvular aortic stenosis. The acute hemodynamic effect of counterpulsation in these patients was compared with the effect of counterpulsation in three control patients with unstable angina and no aortic valve disease. Augmentation of aortic diastolic pressure was similar in both groups; however, in contrast to the patients with unstable angina, the patients with aortic stenosis had no decrease in left ventricular systolic pressure. counterpulsation resulted in an increase in the transvalvular pressure gradient, which was associated with a slight increase in stroke volume. In both patients with aortic stenosis, the institution of counterpulsation resulted in marked clinical improvement, which facilitated successful valve replacement surgery. The benefit from counterpulsation in critically decompensated aortic stenosis appears to be derived almost entirely from augmentation of the diastolic coronary filling gradient. The improvement that results from counterpulsation suggests that ischemia is the major cause of decompensation.
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ranking = 10
keywords = counterpulsation
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