Osamu Kawaguchi, MD, Walter E. Pae, MD, FACS, Bill B

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Ventriculoarterial coupling with intra-aortic balloon pump in acute ischemic heart failure Osamu Kawaguchi, MD, Walter E. Pae, MD, FACS, Bill B. Daily, MD, PhD, William S. Pierce, MD, FACS The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 1, Pages 164-171 (January 1999) DOI: 10.1016/S0022-5223(99)70482-4 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Experimental preparation. SVC, Superior venae cavae; AO, aorta; PA, pulmonary artery; RA, right atrium; LA, left atrium; IVC, inferior venae cavae; LVP-Fluid, a catheter for fluid-filled LV pressure; LVP-Millar, a manometer-tipped catheter for LV pressure. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 A, Schematic diagram of the pressure-volume relationship. EDPVR, End-diastolic pressure-volume relationship; PVA, pressure-volume area; PE, potential energy. B, Schematic diagram of the end-systolic ventricular and arterial elastance. The slope of the arterial end-systolic pressure-volume relationship (ESPVR; line A) is Ea with the volume intercept of end-diastolic volume. Line B represents the ventricular ESPVR, with the volume intercept of V0. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Pressure-volume relationships in the control and heart failure runs. A, Pressure-volume loop shifted to the left with the reduction of the slope of the end-systolic pressure-volume relationship and the increases in volume intercept after microsphere injection. Open circles and triangles represent end-systolic pressure-volume data points during inferior vena cava occlusion. B, Pressure-volume loops of the control run. Closed squares represent the pressure-volume loop without IABP; circles represent the pressure-volume loop with IABP. C, Heart failure run. Open circles and squares represent the end-systolic and end-diastolic pressure-volume data. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Left ventricular mechanics and ventriculoarterial coupling. Circles and squares indicate the individual data. Comparison of left ventricular mechanics and ventriculoarterial coupling with IABP. Means ± SD indicated. C, Control; C-I, control with IABP; HF, heart failure; HF-I, heart failure with IABP. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 Schematic diagram of changes in pressure-volume loops with IABP. IABP induced changes in Ea (arrows). Shadowed areas represent the pressure-volume area preserved when the pressure-volume loop changed by IABP. Reduction of the pressure-volume area is larger with the preload reduction (shaded area). ESPVR, End-systolic pressure-volume relationship; EDPVR, end-diastolic pressure-volume relationship. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 6 Changes in the optimality of the afterload with IABP after heart failure as a function of the ventriculoarterial ratio, Ea/Emax. The optimality of the afterload becomes unity when Ea/Emax is unity. When Ea/Emax changes from 3.0 to 2.4, the optimality increases from 0.75 to 0.83. The open square indicates the average data for the heart failure with IABP. The open circle indicates the average data for the heart failure. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 164-171DOI: (10.1016/S0022-5223(99)70482-4) Copyright © 1999 Mosby, Inc. Terms and Conditions