Left ventricular ballooning

Adjust left ventricular balloon volume to produce an initial LV end-diastolic pressure (LVEDP) of 10 mmHg. Keep this balloon volume constant throughout the experiment. 

Takizawa M, Kobayakawa N, Uozumi H, Yonemura S, Kodama T, Fukusima K, Takeuchi H, Kaneko Y, Kaneko T, Fujita K, Honma Y, Aoyagi T. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol 2007 114(1) el5-7. 

Drug withdrawal Transient left ventricular ballooning syndrome (takotsubo cardiomyopathy) occurs mostly in post-menopausal women in response to stressful events and beta-blockers are used to treat it. Abrupt withdrawal of beta-blockade can result in a hyperadrenergic syndrome that can lead to takotsubo cardiomyopathy, even in the absence of a stressful precipitating event [14 ]. 

Van Belle E, Abolmaali K, Bauters C, McFadden ER Lablanche JM, Bertrand ME. Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic patients. J Am Coll Cardiol 1999 34 476-485. 

The left ventricular (LV) end-diastolic pressure is set at 10 mm Hg, utilizing a water-filled balloon-tipped catheter attached to a pressure transducer. Baseline hemodynamic measurements are recorded on a strip-chart recorder (Hewlett-Packard 7754A) for a 10-min stabilization period. 

Place a thin-walled latex balloon in the left ventricle via the left atrium, and connect it to a pressure transducer to measure left ventricular developed pressure (LVDP) (systolic-diastolic) and the electronically derived dp/dt. 

Figure 5. A, Schematic of a Largerdortf perfused rat heart model. Retrograde perfusion is established through the aorta. Perfusate oxygenated with 95% O, and 5% CO, is circulated by a peristaltic pump and the flow can be adjusted. Left ventricular pressure is monitored Ihrough a balloon which is inserted into the empty left ventricle. Heart rhythm is controlled by pacing.

Transient left-ventricular apical ballooning (Tako-Tsubo syndrome)... 

Ibanez B, Navarro F, Farre J et al. Tako-Tsubo transient left ventricular apical ballooning is associated with a left anterior descending coronary artery with a long course along the apical diaphragmatic surface of the left ventricle. Rev Esp Cardiol 2004 57 209. 

Previtali M, Repetto A, Scuteri L. Dobutamine induced severe midventricular obstruction and mitral regurgitation in left ventricular apical ballooning syndrome. Heart 2005 91(3) 353. 

Invasive hemodynamic monitoring usually is performed with a flow-directed pulmonary artery (PA) or Swan-Ganz catheter placed percutaneously through a central vein and advanced through the right side of the heart and into the PA. Inflation of a balloon proximal to the end port allows the catheter to wedge, yielding the PAOP, which estimates the pulmonary venous (left atrial) pressure and, in the absence of intracardiac shunt or mitral valve or pulmonary disease, left ventricular diastolic pressure. Additionally, cardiac output may be measured and systemic vascular resistance (SVR) calculated. Normal values for hemodynamic parameters are listed in Table 14—12. 

Pulmonary artery occlusion pressure—It is usually determined by a balloon-tipped Swan-Ganz catheter that is advanced into a distal branch of the pulmonary artery. Inflation of the balloon at the catheter tip occludes the pulmonary artery and allows measurement of the left atrial pressure which reflects the left ventricular diastolic pressure. Therefore, it is a measure of the left ventricular preload. 

Fig 9 5 Coronary sinus venography showing stenosis at the middle part of the main vessel (left anterior oblique in precluding left ventricular (LV) lead advancement. Angioplasty balloon inflation (b). Over-the-wire implantation of the LV lead in a lateral branch of the coronary sinus (c)... 

In some cases, identification of a lateral venons branch in which to place a left ventricular lead is not immediately visualized. Most commonly, this is because either an insufficient mount of dye retrogradely filled aU venous branches due to poor balloon occlusion, the balloon itself occlnded the proximal aspect of an eligible lateral vessel, or another more proximal branch was not visualized due to distal balloon or angiographic catheter placement. In these cases, withdrawing the sheath to the ostium of the coronary sinns and performing a hand injection at this location will often identify a vessel snpplying the lateral wall when none was previously seen. 

Cardiovascular Tako-Tsubo syndrome is transient left ventricular apical ballooning, very similar to acute myocardial infarction. 

Indirect effects of drugs on catecholamines have ako resulted in takotsubo syndrome. In one case there was transient typical ballooning of the left ventricular apex during systole following the use of cocaine, thought to have been due to inhibition of catecholamine reuptake [22ft]. A 43-year-old woman who took an overdose of venlafaxine, an inhibitor of serotonin and noradrenaline reuptake, developed a takotsubo cardiomyopathy and there was an increase in urinary normetadrenaline (normetanephrine) concentration [23 ]. 

Catecholamines do not improve function in the apical ballooning syndrome and may make it worse. In 11 patients cm infusion of low-dose dobutamine did not improve the akinetic wcdl motion, despite the hypercontractile basal left ventricular wcdl, and despite the fact that the syndrome is reversible [29 ]. In other cases, takotsubo syndrome was worsened by infusion of catecholamines (in one case adrenaline, dobutamine, and noradrenaline and in another dopamine) and improved when the catecholamines were withdrawn [30, 31 ] beta-blockade was beneficial... 

Varieties There are three main types left ventricular apical ballooning (classical takotsubo cardiomyopathy), an inverted or reverse variant (basal akinesb with a hyperdynamic apex, abo called the artichoke heart ), and a midventricular variant. 

Reversible severe left ventricular systolic dysfunction with apical ballooning has abo been reported during dobutamine stress echocardiography [45, 46, 47, 48, 49, 50, 51, 52, 53, 54 ] and abo in one case after recovery from stress echocardiography [55 ]. In one case it occurred in a patient with previous orthotopic heart transplantation [56 ]. In another case it occurred in a patient who had had a subarachnoid haemorrhage [57 ], in which sympathetic nervous system activity b increased and in which acute myocardial infarction can abo occur. 

Sanchez-Recalde A, Iborra C, Costero O, Moreno R, Lopez de Sa E, Sobrlno JA, Lopez-Sendon JL. Isolated left ventricular basal ballooning in young women inverted takotsubo pattern related to catecholamine-toxicity. Am J Cardiol 2007 100(9) 1496-7. 

Arora S, Alfayoumi F, Srinivasan V. Transient left ventricular apical ballooning after cocaine use is catecholamine cardio-toxicity the pathologic link Mayo Clin Proc 2006 81(6) 829-32. 

Fujiwara S, Takeishi Y, Isoyama S, Aono G, Takizawa K, Honda H, Otomo T, Mitsuoka M, Itoh Y, Terashima M, Kubota I, Meguro T. Responsiveness to dobutamine stimulation in patients with left ventricular apical ballooning syndrome. Am J Cardiol 2007 100(10) 1600-3. 

Reuss CS, Lester SJ, Hurst RT, Askew JW, Nager P, Lusk J, Altemose GT, Tajik AS. Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women. Am J Cardiol 2007 99(10) 1451-3. 

Kumar A, Jenkins LA, Perez-Verdia A, Roongsritong C. Transient left ventricular apical ballooning during dobutamine myocardial perfusion imaging. Int J Cardiol... 

Cherian J, Kothari S, Angelis D, Atef A, Downey B, Kirkpatrick Jr. J. Atypical takotsubo cardiomyopathy dobutamine-precipitated apical ballooning with left ventricular outflow tract obstruction. Tex Heart Inst J 2008 35(1) 73-5. 

Sonmez O, Duman C, Duzenli MA, Tokac M. Special attention for elderly women atypical left ventricular apical ballooning syndrome induced by dobutamine stress test a case report. J Am Geriatr Soc 2009 57(9) 1735-6. 

Jefic D, Koul D, Boguszewski A, Martini W. Transient left ventricular apical ballooning syndrome caused by abrupt metoprolol withdrawal. Int J Cardiol 2008 131 e35-7. 

Figure 1. Diagram of a perfused heart in the NMR spectrometer with accessory instrumentation. (A) Arrangement of perfusate bath, peristaltic pump, perfusate flow lines with normal (110 cm) and ischemic overflows, pressure transducer with oscilloscope, and pacing stimulator. The vacuum line is for perfusate removal. (B) Expanded view of the perfused heart in the NMR sample tube. The perfusate cannula is positioned in the aorta above the aortic valve. Isovo-lumic left ventricular pressure was measured with a fluid-filled balloon and the hearts were paced with electrodes sewn on the surface of the right ventricle. From Hollis et al. (1978).

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