Images in cardiovascular medicine. Augmentation of coronary blood flow with intra-aortic balloon pump counter-pulsation.

Intra-Aortic Balloon Pump Counter-Pulsation To the Editor: The imaging of coronary flow1 during intra-aortic balloon pumping is important and might be used to adjust the timing of balloon deflation better. In the series of figures shown by Ryan and Foster,1 with intra-aortic balloon pumping assisting every second beat, there was no consistent reduction of systolic pressure in the intervening unassisted beat, which suggests that balloon deflation may have been premature.2 Further, in the assisted beat, coronary flow, although having a higher peak, appeared to be of shorter duration than in the unassisted beat. Have the authors considered the possibility that their technique may help optimize balloon deflation by ensuring maintenance of coronary perfusion throughout the diastolic period?