Influence of aortic elastic properties on pulse pressure changes induced by rapid ventricular pacing

Abstract Giant basilar apex aneurysms are associated with significant therapeutic challenges.1–6 Multiple techniques exist to treat giant basilar apex aneurysms, including direct clipping, stent-assisted coil embolization, and proximal occlusion with bypass revascularization.7–9 Hypothermic circulatory arrest was a useful adjunct for surgical repair of these aneurysms but has been abandoned because of associated risks.10,11 Rapid ventricular pacing can achieve similar aneurysm softening with minimal risks and assist in clip occlusion. This case illustrates clip occlusion of a giant, partially thrombosed, previously stent-coiled basilar apex aneurysm in a 15-yr-old boy with progressive cranial neuropathies and sensorimotor impairment. Although a wire was placed preoperatively for ventricular pacing, it was not needed during the procedure. Patient consent was obtained. A right-sided orbitozygomatic craniotomy transcavernous approach with anterior and posterior clinoidectomies was performed. The basilar quadrification was dissected, and proximal control was obtained. After aneurysm trapping, the aneurysm was incised and thrombectomized using an ultrasonic aspirator. Back-bleeding from the aneurysm was anticipated, and ventricular pacing was ready, but back-bleeding was minimal. With the coil mass left in place, stacked, fenestrated clips were applied in a tandem fashion to occlude the aneurysm neck. Indocyanine green videoangiography confirmed occlusion of the aneurysm and patency of parent and branch arteries. The patient was at a neurological baseline after the operation, with improvement in motor skills and cognition at 3-mo follow-up. This case demonstrates the use of trans-sylvian-transcavernous exposure, rapid ventricular pacing, and thrombectomy amid previous coils and stents to clip a giant, thrombotic basilar apex aneurysm. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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Impairment in aortic elastic properties and mechanics of carotid artery system in patients with Takayasu's arteritis

La Presse Médicale ◽

10.1016/j.lpm.2013.02.156 ◽

2013 ◽

Vol 42 (4) ◽

pp. 718

Author(s):

F. Alibaz-Oner ◽

S. Yurdakul ◽

S. Aytekin ◽

H. Direskeneli

Keyword(s):

Carotid Artery ◽

Elastic Properties ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis ◽

Aortic Elastic Properties

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Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1964 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Ninomiya ◽

M Ishida ◽

K Tosaka ◽

N Kanehama ◽

Y Ishikawa ◽

...

Keyword(s):

Aortic Valve ◽

Cardiopulmonary Arrest ◽

Ventricular Pacing ◽

Balloon Aortic Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Aortic Valvuloplasty ◽

Prolonged Hypotension ◽

Rapid Ventricular Pacing ◽

Inoue Balloon ◽

Valve Implantation

Abstract Background Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation. Purpose The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation. Methods From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV. Result Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002). Conclusion Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI. Funding Acknowledgement Type of funding source: None

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Beta-adrenergic receptor-G protein-adenylate cyclase complex in experimental canine congestive heart failure produced by rapid ventricular pacing.

Circulation Research ◽

10.1161/01.res.69.6.1546 ◽

1991 ◽

Vol 69 (6) ◽

pp. 1546-1556 ◽

Cited By ~ 63

Author(s):

K P Marzo ◽

M J Frey ◽

J R Wilson ◽

B T Liang ◽

D R Manning ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Adenylate Cyclase ◽

G Protein ◽

Adrenergic Receptor ◽

Ventricular Pacing ◽

Beta Adrenergic Receptor ◽

Beta Adrenergic ◽

Rapid Ventricular Pacing ◽

Experimental Canine

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Characterization of baroreflex impairment in conscious dogs with pacing-induced heart failure

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1993.265.5.r1132 ◽

1993 ◽

Vol 265 (5) ◽

pp. R1132-R1140 ◽

Cited By ~ 14

Author(s):

N. B. Olivier ◽

R. B. Stephenson

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Cardiac Output ◽

Peripheral Resistance ◽

Open Loop ◽

Ventricular Pacing ◽

Baroreflex Control ◽

Rapid Ventricular Pacing ◽

Reflex Control

Open-loop baroreflex responses were evaluated in eight conscious dogs before and during congestive heart failure to determine the effects of failure on baroreflex control of blood pressure, heart rate, cardiac output, and total peripheral resistance. Heart failure was induced by rapid ventricular pacing. Baroreflex function was determined by calculation of the range and gain of the open-loop stimulus-response relationships for the effect of carotid sinus pressure on blood pressure, heart rate, cardiac output, and total peripheral resistance. The range and gain of blood pressure responses were substantially reduced as early as 3 days after induction of heart failure (161 +/- 6 to 99 +/- 8 mmHg and -2.7 +/- 0.3 to -1.5 +/- 0.1, respectively) and remained depressed for the 21 days of heart failure. This depression in baroreflex control of blood pressure was associated with similar depressions in reflex range and gain for heart rate (125 +/- 9 to 78 +/- 11 beats/min and -2.05 +/- 0.2 to -1.16 +/- 0.2 beats/min, respectively) and cardiac output (1.74 +/- 0.2 to 0.46 +/- 0.2 l/min and -0.81 +/- 0.02 to -0.027 +/- 0.008 l/min, respectively). The group-averaged range and gain for reflex control of vascular resistance were not altered by heart failure. In three dogs, discontinuation of rapid ventricular pacing led to resolution of heart failure within 7 days and partial restoration of the range and gain of reflex control of blood pressure. We conclude that heart failure reversibly depresses baroreflex control of blood pressure principally through a concurrent reduction in reflex control of cardiac output, whereas reflex control of vascular resistance is not consistently affected.

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