To the Editor.
—Iqbal and Liebson, in a recent issue of the Archives (1981;141:247-249), have reported the value of the simultaneous use of dobutamine hydrochloride along with counterpulsation and claimed this to be the first reported case of right ventricular failure in which simultaneous use of counterpulsation and an inotropic agent (dobutamine) resulted in a substantial improvement in cardiac output and hemodynamics. The use of intra-aortic balloon counterpulsation in isolated right-sided heart failure had already been reported by Kopman and Ramirez-Inawat.1The hemodynamic data reported by Iqbal and Liebson indicated that both the right and left ventricles were in failure (right and left ventricular enddiastolic pressures, 17 mm Hg). Thus, the hemodynamic improvement would have been caused by a decrease in left ventricular afterload, volume, and wall tension.The beneficial effect of counterpulsation in right-sided heart failure is probably caused by an increase in coronary perfusion pressure and, consequently,
Kopman EA. Ventricular Failure. Arch Intern Med. 1981;141(11):1558. doi:10.1001/archinte.1981.00340120166048