Prevention of Possible Embolus Following Intra Aortic Balloon Counterpulsation (IABP) Insertion by Transesophageal Echocardiography ( TEE )

Severe atherosclerosis of the descending aorta is directly related to atheroembolic events. Transesophageal echocardiography (TEE) is a sensitive technique for evaluating such atheroma plaques of the thoracic aorta which may predict the risk of emboli. We describe a patient with severe intraluminal aortic atherosclerotic plaques detected by TEE while positioning an Intraaortic Balloon Counterpulsation ( IABP ) during coronary artery by-pass grafting. IABP was re-positioned to prevent an emboli formation with the aid of TEE. TEE should be use to visualize descending aorta prior to IABP insertion. INTODUCTION function and who presented an intramural aortic atherosclerotic debris detected by transesophageal The use of Intraaortic Balloon Pump (IABP) has been echocardiography in the thoracic aorta during coronary well established and has been an effective treatment in by pass surgery following IABP positioning. TEE helped perioperative support of surgical patients with severe left us to reposition of IABP and possibly prevent an emboli ventricular dysfunction. More recently, it works as a due to IABP operation. circulatory support during the high-risk coronary angioplasty procedures. It has been estimated that 2-12% Case report : A 78 year-old male patient without diabetes of cardiac surgery patients require IABP support during was admitted for elective coronary artery bypass grafting perioperative period. Although most ischemic for unstable angina with angiographic evidence of severe complications are owing to impairment of arterial inflow, coronary artery disease. Coronary artery catheterization severe atherosclerotic diseases of the descending thoracic revealed stenosis in all three coronary vessels, left aorta may produce embolization of atherosclerotic material ventricular Ejection Fraction (EF) of 30% with apical that can cause toe ischemia and eventually require akinesis, and mild mitral regurgitation. Anesthesia was amputation.Embolus may also reach the renal and visceral induced with standart protocol. Cardiopulmonary by-pass arteries to produce ischemia of these organs. The was achieved via aorta-atrial cannulation and the patient presence of aortic atherosclerosis can be determined by was cooled down to 32°C. Three vessel by-pass grafting echocardiography and if present, insertion through the was performed during ischemic arrest achieved with axillary artery considered . hypothermic blood cadioplegia. Since the weaning from (1)