IABP – radio-opaque marker – close up on CXR

This is a magnification of the CXR demonstrating the IAB against the background of the heart.

The contrast & briteness were significantly altered to easily identify the inflated balloon.

cxr-iab mag

 

cxr-iab mag - marker

above : the radio-opaque marker is identified by the 2 red arrows against the background of the heart.

cxr-iab mag 002

above : the inflated balloon is outlines by the arrows.

IABP – radio-opaque marker

The IABP can be visualized in this radiograph below.

Look for the gas density (= black) in the CXR in the form of a balloon  (aligned vertically ) in the descending Ao.

In a CXR, patent alveoli = black ; atelectasis = white.

Other gas filled structures will also appear black :

> stomach, esophagus, ETT cuff.

> IABP (during inflation >> with Helium).

 

cxr-iab

 

cxr-iab radioopaque marker

pictured above, radio-opaque marker at the tip of the IAB.

Ideal position : 2cm below the top of the  Aortic arch.

 

IABP – intra-aortic balloon pump – the device

The IABP is a common device seen often in the CTICU, CCU, or not so frequently in other ICUs.

iabp-infl vs defl

Above, the balloon that is in inflated vs. deflated position.

It resides in the Descending Aorta (proper positioning to be discussed later).

iabp - dvc

Above : the IABP console.

iabp - dvc scrm

Above : the IABP control.

iabp - radiogr

IABP inserted percutaneously via femoral artery and residing in the descending Aorta.

IABP – mechanism of action (MoA)

coronary art iabp deflate 001

The heart should have an ample supply of blood for proper functioning.

Normally, the heart receives its blood supply opposite to the body’s supply.

This interesting paradox occurs because during systole, the body cannot squeeze

blood into itself via the coronary arteries.

Systole : the heart squeezes, thereby allowing :

supply of 80% of all organ systems requisite blood supply.

supply of 20% of the heart’s requisite blood supply.

Diastole : the heart relaxes, thereby allowing :

supply of 80% of the heart’s requisite blood supply.

supply of 20% of all organ systems requisite blood supply.

The day that the cardiac blood supply is compromised, is the beginning of cardiac demise.

If the insult (AMI – acute myocardial infarction) is addressed early, an IABP may allow

for recovery of the insulted myocardium.

Red = rich blood supply to the myocardium.

Pink = weak blood supply to the myocardium.

Green = blockage in the coronary arteries compromising the myocardial blood supply.

 

coronary art iabp deflate 002

Once the IABP is inserted and situated in the proper position, during systole, the heart is provided

with some of its requisite (20%) blood supply.

coronary art iabp deflate 003

Upon balloon inflation, the blood is sent cephalad (towards the head) and because the Aortic valve is closed, the blood

is forcibly driven deep into the myocardium via the  coronary arteries.

The augmented coronary blood pressure is much higher than it is normally.