Balloon Pulmonary Valvuloplasty in Children
Balloon Pulmonary Valvuloplasty in Children Commentary: Balloon Pulmonary Valvuloplasty in Children - P. Syamasundar Rao, MD Congenital pulmonary valve stenosis comprises 7.5% to 9% of all congenital heart defects. In the past, surgical valvotomy was the treatment of choice; however, more recently, balloon valvuloplasty has gained acceptance as the first option in the management of congenital pulmonary valve ...
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Mitral Stenosis and Percutaneous Mitral Valvuloplasty (Part 2)
,118 and Ben Farhat et al.120 Retrospectively comparing PMV and open mitral commissurotomy (OMC) in pregnant women with mitral stenosis (MS), Souza et al. Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Percutaneous mitral balloon valvotomy in patients with calcific mitral stenosis: Immediate and long-term outcome.
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Short- and Intermediate-Term Follow-up Results of Percutaneous Transluminal Balloon Valvuloplasty in Adolescents and Young Adults with Congenital Pulmonary Valve Stenosis
Percutaneous pulmonary balloon valvuloplasty (PBV) is a well-established treatment alternative to surgery in many cardiology centers. We described our experience with PBV in 25 adolescent and young adult patients with isolated pulmonary valve stenosis (PVS). Among 20 successful PBVs, there was a significant immediate decrease in right ventricular systolic pressure from 116.9 ± 32.4 mmHg to 60.5 ± 18.7 mmHg (p < 0.0001) and a decrease in transpulmonary valve pressure gradient from 93.5 ± 32.8 mmHg to 33.5 ± 9.7 mmHg (p < 0.0001) was noted. The follow-up period was 1?5 years (mean = 3.2 ± 1.2 years), during which patients were periodically assessed by Doppler echocardiogram. During follow-up, the transpulmonary valve pressure gradient further decreased from 33.5 ± 9.7 mmHg to 18.6 ± 3.4 mmHg (p < 0.0001) mainly due to regression of infundibular hypertrophy. Thus, the study showed excellent short-term and intermediate-term results of PBV.
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Evaluation of a Simplified Transseptal Mitral Valvuloplasty Technique Using Over-the-Wire Single Balloons and Complementary Femoral and Jugular Venous Approaches in 1,407 Consecutive Patients
The over-the-wire double balloon technique (DBT) of balloon mitral valvuloplasty (BMV) has been decreasingly used in recent years because of its relative complexity and potential for left ventricular perforation. We attempted to make over-the-wire BMV simpler and safer by developing: (a) a single balloon technique (SBT) using a rapidly inflating, over-the-wire, cylindrical balloon having abrupt distal taper and short blunt tip to prevent left ventricular perforation, and (b) an alternative jugular approach to reduce technical difficulty in patients with cardiac anatomic distortion. SBT-BMV was evaluated over seven years in 1,407 consecutive patients (femoral approach: 1,277 patients, jugular approach: 130 patients), and compared with 954 patients who underwent DBT-BMV earlier at the same center. Results of SBT-BMV were comparable to those of DBT-BMV: optimal outcomes (91.0% versus 87.8%), fluoroscopy time (12.4 ± 6.8 minutes versus 17.6 ± 7.2 minutes), significant right heart oxygen step-up (4.8% versus 10.7%), and major complication rates (3.7% versus 5.6%) were significantly better with SBT-BMV; whereas mean post-BMV mitral valve area (1.92 ± 0.31 cm2 versus 2.03 ± 0.42 cm2), and post-BMV hemodynamic parameters were inferior with SBT-BMV. Balloon-related left ventricular perforation did not occur in SBT-BMV. Fluoroscopy time in jugular approach SBT-BMV (9.0 ± 4.2 minutes) was significantly lower than in the femoral approach SBT-BMV (12.4 ± 6.8 minutes) despite cardiac anatomic distortion. SBT-BMV reduced procedural costs considerably. SBT-BMV was effective, safe, technically simple and economical; it was comparable to, and overcame several limitations of DBT-BMV.
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Concurrent Percutaneous Valvuloplasty of Mitral and Tricuspid Valve Stenoses
ABSTRACT: We report the results of two cases of concurrent double valvuloplasty with a metallic valvulotome and an Inoue balloon for mitral and tricuspid stenoses, respectively. The mitral valve area (MVA) increased from 0.6 cm2 and 0.7 cm2 to 1.8 cm2 and 2.1 cm2, respectively; while the tricuspid valve area (TVA) increased from 0.8 cm2 and 1.1 cm2 to 3.0 cm2 and 3.2 cm2. Clinical and echocardiographic follow-up showed that the valvular opening remained satisfactory in both cases. Concurrent valvuloplasty of mitral and tricuspid valve stenoses is an effective and safe alternative to surgical commissurotomy in selected cases.
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Transcatheter Treatment of Lutembacher Syndrome: Combined Balloon Mitral Valvuloplasty and Percutaneous Atrial Septal Defect Closure
Lutembacher syndrome is a rare combination of atrial septal defect (ASD) and rheumatic mitral stenosis. There is a long history of surgical correction for both diseases, but more recently percutaneous balloon mitral valvuloplasty and device closure for atrial septal defect have been described. We report a case in which Inoue balloon mitral valvuloplasty and atrial septal closure with an Amplatzer septal occluder was preformed successfully, and review the literature.
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The Use of Percutaneous Suture-Mediated Closure for the Management of 14 French Femoral Venous Access
Background. Little has been reported regarding the utility or outcomes of femoral venous vascular closure using arterial suture closure devices. We describe results using a pre-closure approach with a 6 French (Fr) Perclose Closer S device in patients who underwent antegrade aortic valvuloplasty using 14 Fr percutaneous femoral venous access catheters. Methods. Forty-five patients underwent antegrade aortic valvuloplasty and suture-mediated closure with a 6 Fr Perclose? device. A 6 Fr Closer S suture device was preloaded into the femoral vein after 6 Fr sheath access, prior to insertion of a 14 Fr venous sheath. Upon completion of the procedure, the 14 Fr femoral venous sheath was removed through the existing sutures. Results. Of 45 patients (mean age 82.4 years; 17 males), immediate hemostasis was achieved with percutaneous suture closure in 43 (95.6%). Only 2 failures occurred which were subsequently successfully treated with manual compression. No late access site bleeding occurred from sutured sites. In all other patients, hemostasis using a 6 Fr Perclose suture-mediated device was successful and immediate. There was no need for transfusion, no clinical venous thrombosis, and no infections occurred at the access site. Two hospital deaths were documented from causes unrelated to suture-mediated closure. Conclusions. In conjunction with 14-Fr size percutaneous sheaths during antegrade aortic valvuloplasty, percutaneous suture-mediated closure is a highly effective method for achieving hemostasis. This has simplified postprocedural management in terms of early mobilization and diminished late access site bleeding. J INVASIVE CARDIOL 2006;18:299?302
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Current Results of Balloon Aortic Valvuloplasty in High-Risk Patients
ABSTRACT: In this report, we describe our experience with a contemporary series of patients with severe aortic stenosis (AS) undergoing balloon aortic valvuloplasty (BAV) who were not deemed to be surgical candidates. Demographic, hemodynamic and procedural data, operative risk (EuroSCORE) and long-term follow up were collected. Eighty consecutive patients with severe symptomatic AS underwent 104 BAV procedures as a single center and were followed for a mean of 3 ± 2 years. Thirteen patients underwent 2 BAV procedures, 2 patients underwent 3 BAV procedures and 1 patient underwent 5 BAV procedures. Mean age was 81 ± 10 years, and 23% were > 90 years of age. Cardiogenic shock was present in 20% and the ejection fraction was < 30% in 38% of the patients. The mean EuroSCORE was 16 ± 5, and 98% had a high-risk EuroSCORE. There were no procedural deaths and 9 (9%) total vascular complications. In-hospital, 1-, 2- and 3-year mortality rates were 6%, 44%, 62% and 71%, respectively. Seventeen patients (21%) underwent repeat BAV procedures and had long-term mortality similar to those undergoing a single BAV procedure. Contemporary BAV has acceptable short- and long-term results and can effectively be used for patients deemed unsuitable surgical candidates and those at highest operative risk, such as patients with cardiogenic shock.
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Outcome of Percutaneous Mitral Balloon Valvuloplasty: Comparison of the Inoue and Retrograde Non-Transseptal Techniques. A Single-Center Experience
Introduction. The transseptal Inoue (IN) and to a lesser extent retrograde non-transseptal (RNT) techniques are established procedures for percutaneous mitral balloon valvuloplasty (PBMV) in patients with mitral stenosis. However, a head to head comparison of these two techniques, especially from a single center, has not yet been reported. Methods. Seventy-two consecutive patients (n = 35 IN and n = 37 RNT) underwent PMBV in our clinic from October 1993 to December 1999. All baseline and procedural characteristics were compared, as well as immediate and long-term outcomes (mean follow-up, 42 ± 12 months) of the patients. Results. Baseline characteristics were similar in the two groups. A successful immediate result was achieved in 91% of IN patients and 89% of RNT patients. After the PMBV, mitral valve area (MVA) increased from 1.04 ± 0.16 cm2 to 1.6 ± 0.3 cm2 and from 1.06 ± 0.23 cm2 to 1.55 ± 0.3 cm2 in the IN group and RNT group, respectively (p = NS). There was a higher percentage of mild mitral regurgitation (MR) after the RNT technique (p = 0.03). Mean fluoroscopy time was 31 ± 16 minutes in the IN group and 39 ± 11 minutes in the RNT group (p = 0.02). After discharge, major adverse cardiac events (MACE: mitral valve replacement, repeat PMBV) occurred in 3 patients (8%) patients in the IN group and 5 patients (13.5%) in the RNT group (p = NS). Follow-up echocardiographic evaluation revealed no significant changes regarding MVA in either group. Conclusions. The IN and RNT techniques are comparable regarding the achieved MVA, with slightly more frequent MR post-RNT PBMV. IN requires significantly less fluoroscopy time. MACE and event-free survival rates at follow-up were similar in the two groups.
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First Human Case Description of TandemHeart?-Assisted High-Risk Percutaneous Balloon Aortic Valvuloplasty Using Bivalirudin Anticoagulation
ABSTRACT: TandemHeart? is a recently-introduced percutaneous left ventricular assist device that can be used for hemodynamic support during high-risk interventional procedures in severely compromised patients. Angioplasty and stent placement in patients with coronary artery disease and high-risk coronary anatomy including the left main coronary artery have been described using this device. We report the first human case description of a high-risk percutaneous balloon aortic valvuloplasty for critical bicuspid aortic stenosis using the TandemHeart for periprocedural hemodynamic support. Also not previously reported is the use of bivaluridin as the periprocedural antithrombin agent during and after high-risk aortic valvuloplasty.
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
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 Newest Perspectives on Drug-Eluting Stents
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
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 Create a Successful Vena Cava Filter Practice
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
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Release Date: December 8, 2006