Early detection of the tip position and complication of the intra-aortic balloon pump catheter by perioperative transesophageal echocardiography.

BACKGROUND. Intraoperative verification of the precise balloon position of intra-aortic balloon pump(IABP) is necessary and important. We introduced transesophageal echocardiogram (TEE) as one of our routine intraoperative image monitor to accomplish this identification fluently, conveniently and also precisely. METHODS. 56 patients who needed the hemodynamic support when weaning the cardiopulmonary bypass were introduced to receive IABP and the balloon position was verified by TEE. To confirm the accurate location, the position of balloon tip was rechecked with postoperative portable chest x-ray. RESULTS. The balloon tip was attempted to locate in the proximal descending aorta, which was verified via TEE to be successful in 98.1% of patients by postoperative chest x-ray. Five (8.9%) patients failed to pass the balloon catheter at the first time due to high arterial resistance. One iatrogenic aortic dissection (1.8%) and one case in the wrong lumen (1.8%) were detected by TEE. No early death was contributed to IABP insertion. CONCLUSIONS. The application of TEE in the perioperative period helps not only detect IABP complication early but also verify of balloon catheter position quickly. It can replace the conventional role of fluorography.