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PubMed1959

Pulmonary stenosis.

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Cardiac Surgical Procedures↗
PubMed1988

Valvuloplasty with trefoil and bifoil balloons and the long sheath technique.

The experimental and early clinical experience with percutaneous valvuloplasty using trefoil and bifoil balloon catheters (Schneider Shiley) and a long introducer sheath with a new back-up wire are reported. The trefoil balloon consists of three and the bifoil balloon of two angioplasty balloons mounted in parallel on a single catheter. Inflated, they form a rosette allowing for some blood flow through the spaces between the individual balloons. These small balloons are more pressure tolerant than one large balloon. The hemodynamic advantage of these balloons compared to single balloons could be demonstrated in animal experiments (healthy valves and surgically created stenoses). In 31 consecutive patients with trefoil-bifoil balloon valvuloplasty, there was no inhospital mortality. The results of trefoil valvuloplasty in twelve patients with pulmonary stenosis compared favorably to those of patients treated with single balloons. There were no technical failures or complications. There were two unsatisfactory results (severely dysplastic valve). In the aortic valve, the results with calcified stenoses were satisfactory at first but disappointing during follow-up. There were no technical failures but one of nine patients suffered an embolic myocardial infarction. In the mitral valve, there were two failures (one deficient equipment, one stroke during balloon positioning). In one case, insufficient balloon size led to an inadequate result. One patient needed surgical drainage for a pericardial tamponade. In two patients, mitral regurgitation was significantly increased. A 17F long sheath was developed to further facilitate balloon valvuloplasty. It guides the balloon catheter across the valve (and across the septum in case of the mitral valve), stabilizes it during inflation, and serves as a second pressure line to continuously monitor the transvalvular pressure gradient. It prevents bleeding at the puncture site during the intervention and presumably reduces the trauma to the artery. Because of its thrombogenic potential, heparinization of the patients is essential. The largest balloon accepted by the sheath is a 2 X 19 bifoil balloon which was the reason to use a bifoil balloon in some mitral valves. Trefoil balloons put in place through a long sheath provide some theoretical advantages over conventional single balloons introduced over guidewires that need to be evaluated by larger clinical studies. Although they do not prevent circulatory collapse during initial inflation in tight stenoses, they permit transvalvular flow when fully unfolded.

Aged↗
PubMed1998

[A case report: right ventricular outflow tract (RVOT) reconstruction using homograft for RVOT restenosis after Jatene's procedure of transposition of the great arteries (TGA)].

A 7-year-old boy was admitted for RVOT restenosis. The patient was born following an unremarkable pregnancy and delivery. He was carried out Jatene's procedure for TGA at 23rd day after birth. At 19 month of age, he was removed pulmonary stenosis using patch angioplasty with mono cusp. When he was 6 year of age, the onset of edem, ascites and hepatomegaly were pointed out. At 7 year of age, he was admitted for edema, hypoproteinemia and protein loosing enteropatchy. After he was treated medical therapy, cardiac catheterization showed markedly right atrial and right ventricular hypertension and ventricular septal defect (VSD). Cine angiography suggested the right ventricular outflow tract stenosis, pulmonary valve and tricuspid valve insufficiency. On August 1, 1996, the patient underwent surgical repair: direct closure of VSD, aortic homograft (20mm) replacement for RVOT stenosis and tricuspid valve annuloplasty by DeVega's procedure. Postoperative course was uneventful. At 23rd postoperative day, cardiac catheterization and cine angiography showed no problems. He was not treated with anticoagulation.

Aorta↗
PubMed1989

Therapeutic cardiac catheterization for pulmonary valve and pulmonary artery stenosis.

At C.S. Mott Children's Hospital, percutaneous balloon angioplasty for pulmonary valve or pulmonary artery stenosis accounts for approximately 40 per cent of all therapeutic transcatheter procedures performed in our laboratory. Percutaneous balloon valvuloplasty offers a highly successful nonsurgical approach to the treatment of children with isolated congenital valvar pulmonary stenosis. In these children, balloon valvuloplasty generally reduces the peak systolic pressure gradient by more than 50 per cent and should be considered the treatment of choice. Balloon angioplasty provides substantial anatomic and hemodynamic benefit in approximately 50 to 60 per cent of children with peripheral pulmonary artery stenosis. It is most often successful in treating naturally occurring pulmonary artery stenoses in children with tetralogy of Fallot. Since the surgical alternatives are difficult and often unsuccessful, balloon angioplasty offers a valuable form of treatment for many children with significant pulmonary artery stenosis or hypoplasia.

Adolescent↗
PubMed1986

Transcatheter treatment of pulmonary stenosis and coarctation of the aorta: experience with percutaneous balloon dilatation.

Twenty two children (age range 4 months-20 years) with pulmonary valve stenosis and ten children (age range 1 month-11 years) with coarctation of the aorta underwent balloon dilatation in the 29 month period between October 1983 and February 1986. Number 5-9 French catheters with 5-20 mm balloons were used according to the size of the angiographically measured pulmonary valve annulus or coarcted segment and the aorta proximal to coarctation. The peak inflation pressure used in the balloons varied from 2-5 atm (202-505 kN/m2) for pulmonary valve stenosis and 4-8 atm (404-808 kN/m2) for coarctation, and inflation lasted 8-15 s. At least four balloon dilatations were performed in every case. After balloon dilatation the mean (SD) peak systolic pressure gradient across the pulmonary valve fell from 98 (39) to 33 (13) mm Hg. The cardiac index did not change. After balloon dilatation of aortic coarctation the systolic pressure in the descending aorta rose from 86.4 (17.7) to 107.8 (20) mm Hg and the peak systolic pressure difference across the coarctation fell from 44.1 (19.1) to 8.5 (8.5) mm Hg. The diameter of the angiographically measured coarcted segment increased, the Doppler estimate of the pressure difference across the coarctation decreased, and the femoral pulses improved. There were no important complications. Long term follow up results for balloon dilatation of pulmonary valve stenosis were excellent. Similar follow up was not available for patients after dilatation of aortic coarctation. Percutaneous balloon dilatation for pulmonary stenosis and coarctation of the aorta is a safe and effective alternative to operation. It is the treatment of choice for pulmonary valve stenosis and it may become so for coarctation of the aorta in young children if long term results are favourable.

Adolescent↗