Intra-aortic balloon pump associated with dynamic left ventricular outflowtract obstruction after valve replacement for aortic stenosis

An unstable patient with critical aortic stenosis had an intra-aortic ballo on pump placed preoperatively for hemodynamic support and alleviation of sy mptoms. After separation from cardiopulmonary bypass following aortic valve replacement, the patient was hypotensive with increased pulmonary artery p ressures. Transesophageal echocardiography revealed left ventricular outflo w tract obstruction associated with systolic anterior motion of the mitral valve and severe mitral regurgitation. This pathophysiology was present whe n ventricular systole was preceded by balloon counterpulsation, but was abs ent during unassisted systole, This case report demonstrates a potentially significant untoward effect of intra-aortic balloon pump augmentation after aortic valve replacement for aortic stenosis. The timely diagnosis of this iatrogenic condition in the operating room permitted the prompt implementa tion of appropriate management strategies and avoided unnecessary surgical intervention.