There’s always a good reason to review the physiology and reasons for placement of an Intra Aortic Balloon Pump (IABP).  We come across these a couple of times a month in our cardiac patients.  They’re a great temporary measure to stabilizing and treating the patient.

Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in Perioperative Cardiovascular Practice: An Evidence-Based Review for the Cardiovascular Anesthesiologist. JCVA, February 2017. Volume 31, Issue 1, Pages 309–320.

From JCVA, Feb 2017.

One of the best explanations that I have ever seen for the IABP is from Dr. Rishi Kumar.  He’s a board certified anesthesiologist and is ICU fellowship trained and is pursuing a cardiac anesthesia fellowship as well.  This lovely human is no joke.  I’ve read his blog and his instagram posts, and he’s a wonderful teacher and mentor to those he reaches.  Please click his link for an entry regarding IABPs on his blog.

RKMD.com: Intra-Aortic Balloon Pump, Arterial Line, and EKG Waveforms. April 2018.




TEE for placement of IABP

Anesthesia & Analgesia, July 2011. Vol 113, No. 1.

  • Want the tip 1-2 cm from left subclavian artery (LSCA)
  • X-plane aortic arch down to descending aorta to see the left subclavian artery
  • Visible during systole when the IABP balloon is deflated

Good visualization of the LSCA

A Novel Technique for Intra-aortic Balloon Positioning in the Intensive Care Unit.  J Extra Corpor Technol. 2012 Sep; 44(3): 160–162.


MitraClip and TEE for MR


European Heart Journal – Cardiovascular Imaging (2013) 14, 935–949.  Peri-interventional echo assessment for the MitraClip procedure. 

Everest Clinical Trial results PPT

Open Heart 2014;1:e000056. Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome.

ASE Echo 2016: Percutaneous approaches to MR. UofMichigan PPT.

2015: The role of 3D TEE in the MitraClip procedure – UofColorado PPT

Abbott TTE checklist for MitraClip

EuroValve Congress 2015: MR in the MitraClip Era

2012: Echo in mitral valve intervention. 


Abbott MitraClip device and delivery system package insert

Neth Heart J (2017) 25:125–130. MitraClip step by step; how to simplify the procedure.



Transseptal Puncture technique with TEE

JACC Cardiovascular Imaging: July 2012. Role of echo in percutaneous mitral valve interventions. 

MitraClip Cases with TEE: Mayo Clinic.

Minimally invasive mitral valve surgery from an anesthesiologist’s perspective. #cardiac #mitral #tee #minimallyinvasive #robot #anesthesia #meded

Surgically, more and more cases are performed through tiny incisions for minimal scarring.  Don’t let that underestimate the size of the procedure.  For example, mitral valve surgery is still a common procedure that involves a sternotomy (“cracking the chest”) and stopping the heart — it’s a big procedure.  However, surgeons have become adept at making smaller incisions while still undergoing the big procedure.

Innovations; 2011: Vol 6, No. 2.  Minimally invasive vs. Conventional open mitral valve surgery: A meta-analysis and systematic review.

Robotic mitral valve repair: anatomic considerations

Journal of Heart Valve Disease: August 2006. 2D Echo measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair

Annals of Cardiothoracic Surgery: 2013;2(6): 796-802. Value of TEE guidance in minimally invasive mitral valve surgery.

Multimedia-Manual of Cardiothoracic Surgery: Vol 2009; Issue 0122. Minimally invasive mitral valve surgery via right minithoracotomy

Cardiac Anesthesia: Principles and Clinical Practice; Chapter 25: Anesthesia for minimally invasive cardiac surgery.

Mitral Valve Repair Center: Post-Repair TEE Assessment.

Medtronic: Echo and surgical techniques for retrograde cardioplegia-coronary sinus cannulation during minimally invasive cardiac valve surgery.

OA Anaesthetics; 2014 Feb 25;2(1):3. Anaesthetics considerations for robotic-assisted cardiac surgery.

A modified anaesthesia protocol for patients undergoing minimally invasive cardiac surgery by thoracotomy – a single center experience.

HSR Proceedings in Intensive Care and Cardiovascular Anesthesia; 2013. Current concepts for minimally invasive mitral valve repair.

2014 Clinical vignette from the surgical prospective

Chauhan S, Sukesan S. Anesthesia for robotic cardiac surgery: An amalgam of technology and skill. Ann Card Anaesth [serial online] 2010 [cited 2016 Apr 12];13:169-75. Available from: http://www.annals.in/text.asp?2010/13/2/169/62947