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Biomedical subjects

Z Lababidi

Publications and source records attributed to Z Lababidi.

At least 19 recordsLinked to original sources
PubMed1990

Balloon pulmonary valvuloplasty: results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry.

Eight hundred twenty-two balloon pulmonary valvuloplasties were reported to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Before and after systolic outflow gradients were recorded in 784 valvuloplasties, and the gradient decreased from 71 +/- 33 to 28 +/- 21 mm Hg. The sites of residual obstructions could be ascertained in 196 patients. In these, the total systolic outflow gradients decreased from 85 +/- 41 mm Hg to 33 +/- 27 mm Hg. Of this total residual gradient, 16 +/- 15 mm Hg was transvalvar and 18 +/- 24 mm Hg was infundibular. The degree to which infundibular obstruction subsequently resolved was not determined in this study. The procedure was less effective in reducing outflow gradients in patients with dysplastic valves with or without Noonan's syndrome. There were 5 major complications (0.6%), including 2 deaths (0.2%), a cardiac perforation with tamponade (0.1%) and 2 tricuspid insufficiencies (0.2%). There were 11 minor complications (1.3%) and 21 incidents (2.6%). The incidence of major complications, minor complications and incidents was inversely related to age; it was substantially higher in infants and, in particular, neonates. Balloon pulmonary valvuloplasty is a safe and effective method of lowering pulmonary outflow gradients in infants, children and adults. Small transvalvar and varied infundibular gradients commonly are present at the end of the procedure. Assessing the full effect of the procedure requires intermediate-term follow-up and assessing the duration of relief requires long-term follow-up.

Adult↗
PubMed1989

Bronchopulmonary sequestration.

Bronchopulmonary sequestration is an area of lung parenchyma that is devoid of normal connection to the trachebronchial tree. Arterial supply is from an aberrant systemic artery, usually a branch of the aorta. There are two broad types of bronchopulmonary sequestration: intralobar and extralobar. The former shares a common pleura with the lung while the latter is separated by its own pleura. Definitive therapy requires pulmonary resection.

Bronchopulmonary Sequestration↗
PubMed1988

[Percutaneous transluminal balloon dilatation of discrete membranous subvalvular aortic stenosis].

Discrete membranous subaortic stenosis (DMSS) which is localized immediately subvalvular and can be differentiated from fibromuscular stenosis of the left ventricular outflow tract, represents theoretically a well-suited lesion for uncomplicated balloon dilatation. The practical use of balloon dilatation for treatment of DMSS has been reported by two groups [6, 10]. In this overview, we will report our experience with balloon dilatation of DMSS in six children. Between June, 1986 and June, 1987, balloon dilatation of DMSS was carried out in six male children ranging in age from four to ten years (Table 2). In one child, coarctation of the aorta had been present and was previously treated successfully with balloon dilatation. In two children, the aortic valve was thickened with or without stenosis. All children had mild aortic regurgitation. After transvenous right heart catheterization and transarterial left heart catheterization including levocardiography and supraaortic angiography, 50 units of heparin per kilogram of body weight were administered and a guidewire advanced to the left ventricle for positioning of the balloon catheter in the left ventricular outflow tract. The choice of balloon diameter was based on measurement of the angiographically-determined aortic ring diameter (Table 1). Pressure measurements were obtained by means of a diagnostic catheter after the dilatation. No complications were observed either during or immediately after the intervention. After the dilatation, all children were discharged from the hospital to go home. Pressure in the left ventricle was reduced from 225 +/- 55 to 116 +/- 29 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Stenosis, Subvalvular↗
PubMed1988

[Percutaneous transvenous antegrade balloon angioplasty in aortic isthmus stenosis].

Balloon angioplasty of native or postoperative coarctation of the aorta has been recommended as an alternative method to surgical treatment. On use of the retrograde approach via the femoral artery, after introduction of the catheter into a vessel of narrow lumen, not infrequently, injury or obstruction was observed. This overview summarizes our experience primarily on use of antegrade balloon angioplasty for coarctation of the aorta, the first description of which was published as a case report in 1986. Between December, 1985, and September, 1987, balloon angioplasty was carried out for native coarctation of the aorta in seven neonates, age two to 30 days. Concomitant cardiovascular anomalies included ventricular septal defect in five, patent ductus arteriosus in five, mitral valve atresia in two and transposition of the great arteries with and without double outlet right ventricle in two (Table 1). Prior to balloon angioplasty for coarctation, in four neonates therapeutic balloon atrial septostomy had been performed. For balloon angioplasty, via the right femoral vein, an end-hole catheter was advanced into the right ventricle. In five neonates, the catheter could be advanced into the ascending aorta directly from the right ventricle or through a ventricular septal defect. In the two other neonates, the catheter was advanced via the foramen ovale and the mitral valve into the left ventricle and the ascending aorta. Pressure was measured by the end-hole catheter as well as in the femoral artery after direct puncture.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Coarctation↗
PubMed1987

Transluminal balloon dilatation for discrete subaortic stenosis.

Ten children, 10 weeks to 18 years old, with discrete subaortic stenosis (DSS) underwent transluminal balloon dilatation of the subaortic obstruction. The DSS was visualized by 2-dimensional echocardiography and cineangiography. Six patients had a thin discrete "membrane" immediately below the aortic valve (group I) and 4 patients had a thicker fibromuscular ring about 1 cm below the aortic valve (group II). In group I, the mean gradient decreased from 82 +/- 49 mm Hg (range 35 to 164) to 22 +/- 15 mm Hg (range 5 to 40); in group II, it decreased from 155 +/- 18 mm Hg (range 132 to 177) to 85 +/- 44 mm Hg (range 60 to 150). Three patients had follow-up cardiac catheterization 1 year later. Their mean gradient soon after the procedure was 37 +/- 23 mm Hg. On follow-up, it was still 37 +/- 19 mm Hg, indicating persistence of relief of the obstruction. Because of the high residual gradient in group II, 3 patients had surgical relief of the obstruction. The degree of aortic regurgitation present before the dilatation in all 10 patients did not change after the procedure. The mechanism of relief of the obstruction was by tearing of the subaortic membrane. Our data suggest that relief of subaortic obstruction is more favorable in the thin, membranous DSS.

Adolescent↗
PubMed1987

Morphologic effects of percutaneous balloon pulmonary valvuloplasty.

Five patients with pulmonary valve stenosis and other cardiac anomalies had elective operative repair after percutaneous balloon pulmonary valvuloplasty. Four had reduction in pulmonary valve gradients from 67 +/- 9 mm Hg to 39 +/- 9 mm Hg (P less than .01), whereas one patient with a dysplastic pulmonary valve did not. Operative evaluation of the pulmonary valves revealed the morphologic effects of the balloon forces on the stenotic valves to be commissure splitting in one patient, cusp tear in one patient, and a combination of commissure splitting and cusp avulsion in two patients. There were no deaths. Patients with combined infundibular and pulmonary valve stenosis have a high potential for cusp avulsion due to fixation of the balloon in the infundibulum and retraction of the balloon into the ventricle during systole. Echocardiography, cardiac catheterization pressure gradients, and cineangiography should be used to assess infundibular stenosis and avoid percutaneous balloon angioplasty in patients who have combined pulmonary valve stenosis and infundibular pulmonary stenosis.

Child, Preschool↗
PubMed1987

Operative balloon pulmonary valvuloplasty.

Closed operative pulmonary valvulotomy for relief of critical pulmonary valve stenosis can be performed effectively by intraoperative use of a balloon catheter without inflow occlusion or hemodynamic instability and with minimal blood loss. Follow-up evaluation indicates adequate growth of the valve.

Angioplasty, Balloon↗
PubMed1986

Successful balloon valvuloplasty for neonatal critical aortic stenosis.

Transluminal balloon aortic valvuloplasty was performed in two term neonates, ages 6 and 7 days, with critical aortic stenosis. Transluminal balloon coarctation angioplasty was also performed in the second neonate. The neonates presented in congestive heart failure and underwent unsuccessful treatment with digoxin, furosemide, and careful fluid management before balloon dilatation. In the first patient, the gradient across the aortic valve was reduced from 75 mm Hg before balloon aortic valvuloplasty to 34 mm Hg after the procedure. The second neonate showed clinical improvement after both dilatation procedures. In both patients, follow-up clinical and Doppler echocardiography findings suggest persistent improvement 5 months after the procedure.

Aortic Valve Insufficiency↗
PubMed1984

Percutaneous balloon aortic valvuloplasty: results in 23 patients.

Percutaneous balloon aortic valvuloplasty (BAV) was performed in 23 consecutive patients with valvular aortic stenosis with no associated cardiac defects. The patients were 2 to 17 years old and were referred from 12 hospitals in 4 states. The balloon was positioned across the aortic valve and inflated to pressures of 80, 100, then 120 psi. Each inflation lasted 5 to 10 seconds. The arterial and venous catheters were connected together outside the groin to avoid excessive increase in left ventricular pressure during total aortic valve occlusion with the inflated balloon. Peak systolic aortic valve pressure gradient and cardiac output were measured before and 15 minutes after BAV. There was no significant change in cardiac output, but all patients had a lessened gradient. The gradient before BAV was 113 +/- 48 mm Hg, decreasing to 32 +/- 15 mm Hg after BAV (p less than 0.01). The left ventricular peak systolic pressure decreased from 221 +/- 54 to 149 +/- 21 mm Hg (p less than 0.01). No aortic regurgitation was noted in 13 patients and very mild aortic regurgitation was noted in 10 patients after BAV. The balloons were 10 to 20 mm in diameter, chosen at least 1 mm smaller than the diameter of the aortic valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. Six patients had repeat cardiac catheterization studies 3 to 9 months after BAV. In none was there a significant change in peak systolic aortic valve pressure gradient or cardiac output compared with the study immediately after valvuloplasty.

Adolescent↗
PubMed1984

Assessment of percutaneous balloon pulmonary and aortic valvuloplasty.

Percutaneous balloon pulmonary or aortic valvuloplasty was performed in 66 consecutive patients with no deaths. The transvalvular pressure gradient was reduced from 85 +/- 35 to 30 +/- 15 mm Hg (p less than 0.01) in 39 patients with congenital pulmonary valve stenosis and from 108 +/- 46 to 32 +/- 16 mm Hg (p less than 0.01) in 27 patients with congenital aortic valve stenosis. Subsequent mild aortic regurgitation occurred in seven patients and moderate regurgitation occurred in one patient. Operative evaluation of seven patients with pulmonary valve stenosis who had additional cardiac anomalies revealed the mechanisms of valve opening to be commissural splitting, cusp tear, or avulsion of the cusp from the anulus. Operative evaluation of two patients with residual high aortic valve gradients revealed minor degrees of commissural splitting. Although further evaluation is required to determine the long-term effects, early evaluation indicates that percutaneous balloon valvuloplasty may be useful in the definitive treatment of isolated pulmonary valve stenosis in some patients and of palliative value in others. The procedure is considered palliative in patients with aortic valve stenosis.

Adolescent↗
PubMed1983

Percutaneous balloon pulmonary valvuloplasty.

Percutaneous balloon pulmonary valvuloplasty (BPV) was performed in 18 consecutive patients with valvular pulmonary stenosis (PS) with no associated cardiac defects. The patients were 11 months to 19 years of age. The balloon was positioned across the pulmonary valve and inflated to pressures of 80, 100, and 120 pounds/square inch (psi). Each inflation lasted approximately 10 seconds. Peak systolic pulmonary valve gradient (delta P) and cardiac output were measured before and 15 minutes after BPV. There was no change in cardiac output, but all patients had an improved delta P. The prevalvuloplasty delta P was 81 +/- 31 mm Hg, decreasing to 23 +/- 11 mm Hg after BPV (p less than 0.01). The right ventricular peak systolic pressure decreased from 106 +/- 31 to 50 +/- 12 mm Hg (p less than 0.01). No pulmonary regurgitation was noted after BPV. The balloons were 12 or 15 mm in diameter, chosen according to the diameter of the pulmonary valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. BPV also was performed in a patient with tetralogy of Fallot. Subsequent total repair provided an opportunity to observe the mechanism of the dilatation. Evidence of a small tear alongside the anterior valve raphe was noted. BPV induced a significant decrease in delta P and may offer an alternative method for treating PS.

Adolescent↗