Selective Coronary and Left Ventricular Cineangiography during Intraaortic Balloon Pumping for Cardiogenic Shock

Eleven patients underwent selective coronary and left ventricular cineangiography during intraaortic balloon pumping for acute myocardial infarction and cardiogenic shock. Studies were performed when the clinical and hemodynamic trend predicted in-hospital death. Angiograms were reviewed by dividing the left ventricle into six segments, each with its characteristic coronary perfusion. No patient with avascular and akinetic segments survived with or without surgery. One patient with residual perfusion of all segments showed massive necrosis at operation that eventually led to his death. In four patients the findings of residual contraction and perfusion of most segments suggested reversible ventricular dysfunction. Three of these underwent coronary surgery with two excellent survivors.