Safety and efficacy of inferior vena caval occlusion to rapidly alter ventricular loading conditions in idiopathic dilated cardiomyopathy |
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| Authors: | D Van Fossen M E Fontana D V Unverferth S Walker A J Kolibash T M Bashore |
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| Affiliation: | 1. From the Ohio State University Hospitals, Division of Cardiology, Columbus, Ohio, USA;2. Duke University, Division of Cardiology, Durham, North Carolina, USA;1. Department of Chemistry, University of Sistan and Baluchestan, Zahedan, Iran;2. Biomaterials Group, Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, Iran;1. Center for Research Engineering and Applied Sciences, Autonomous State University of Morelos (CIICAp-UAEM), Av. Univ. 1001, Col. Chamilpa, Cuernavaca, Morelos 62209, Mexico;2. Physics Institute, National Autonomous University of Mexico (IF-UNAM), Distrito Federal C.P. 04510, México;3. Department of Electronics, Bhaskaracharya College of Applied Sciences, University of Delhi, Delhi 110075, India;4. Department of Physics, Bhaskaracharya College of Applied Sciences, University of Delhi, Delhi 110075, India;1. Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, USA;2. Department of Mechanical Engineering, Michigan State University, Lansing, MI 48824, USA;3. School of Materials Science and Engineering, Shandong University, Jinan 250061, China;4. Production Service Management Inc. (PSMi), Saline, MI, USA;5. Key Laboratory of High Efficiency and Clean Mechanical Manufacture of MOE/Key National Demonstration Center for Experimental Mechanical Engineering Education, Jinan 250061, China;1. Graduate School of Engineering, The University of Tokyo, Komaba 4-6-1, Meguro 153-8505, Tokyo, Japan;2. Institute of Industrial Science, The University of Tokyo, Komaba 4-6-1, Meguro 153-8505, Tokyo, Japan |
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| Abstract: | To investigate the safety and efficacy of inferior vena caval (IVC) balloon occlusion for preload alteration in humans, 13 patients with dilated cardiomyopathy were studied before and during repeated (total of 78) IVC occlusions. Left and right ventricular (LV and RV) micromanometer pressures were simultaneously measured and M-mode and 2-D echocardiograms were recorded at end expiration. Complications were limited to abdominal discomfort in 2 patients. With IVC occlusion, RV collapse fluoroscopically shifted the heart toward midline and ventricular septal motion was frequently disordered. Significant (p = 0.001) changes occurred in RV and LV systolic peak pressures (from 19 +/- 6 to 12 +/- 5 mm Hg and from 129 +/- 34 to 109 +/- 25 mm Hg, respectively). LV and RV end-diastolic pressures also decreased significantly (from 18 +/- 7 to 6 +/- 6 mm Hg and from 5 +/- 3 to 2 +/- 2 mm Hg, respectively) (both p less than or equal to 0.0055). Similarly, LV end-diastolic diameter decreased 13% (from 61 +/- 11 to 53 +/- 12 mm, p = 0.0002). Mean heart rate did not change significantly (from 76 +/- 19 to 78 +/- 21 beats/min). Thus, IVC balloon occlusion provides a safe method of repeatedly altering loading conditions in humans. This approach allows for acquisition of important information regarding cardiac chamber dynamics while minimizing the effects of reflex mechanisms and avoiding use of pharmacologic agents. |
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