Transluminal balloon valvuloplasty was used to treat congenital pulmonary valve stenosis in 20 patients. Follow-up cardiac catheterization was performed in 11 patients at intervals of from 2 to 12 months after the procedure. Peak One patient with pulmonary atresia and a hypoplastic right ventricle underwent a Brock procedure during the neonatal period. At 1 year of age she had evidence of persistent right ventricular outflow tract obstruction. Technique of valvuloplasty. The method of valvuloplasty was the same for each patient, regardless of age. Both groins were prepared and draped. A No. 7F sheath was introduced percutaneously into the right femoral vein. A No. 5F sheath was introduced into the left femoral vein, and a Teflon arterial cannula was introduced into the left femoral artery. Heparin (100 units/kg) was administered intravenously. Cardiac output was measured by the thermal dilution technique. Femoral arterial, right ventricular, and pulmonary arterial pressures were recorded.A No. 7F balloon-tipped wedge pressure catheter was advanced from the right femoral vein to the left pulmonary artery. An 0.035 inch diameter (200 cm length) angioplasty J guidewire* was introduced through the catheter and positioned with the J well into the left lower lobe pulmonary artery. The No. 7F catheter and introducing sheath were removed, leaving the guidewire in place in the left pulmonary artery. While the catheter was being withdrawn care was taken to avoid advancing excess guidewire, so that the wire course would remain straight and there would be no looping of the wire in the heart. The right femoral vein was dilated with a No. 9F dilator.Selection of the appropriate balloon size was based on measurement of the dimension of the valve anulus, as determined from the cineangiogram. The magnification factor of the cineangiogram was determined by comparing the angiographically determined diameter of the catheter to its actual diameter. The actual dimension of the valve anulus was thus equal to:
Hourigan SK, Anders RA, Mitchell SE, Schwarz KB, Lau H, Karnsakul W. Chronic diarrhea, ascites, and protein‐losing enteropathy in an infant with hepatic venous outflow obstruction after liver transplantation.
Abstract: An 18‐month‐old female status post‐orthotopic liver transplant for biliary atresia presented nine months after transplant with severe diarrhea and intolerance of feeds. She was found to have a PLE as evidenced by a low serum albumin and a persistent elevation of fecal A1AT. Investigation eventually revealed that the cause of the PLE was a stricture at the anastomosis site between the hepatic vein and inferior cava, supported by resolution of the PLE after venoplasty of the stricture. The patient has subsequently required several repeat venoplasties for recurrence of her symptoms correlating with recurrence of the stricture. This is a very rare presentation of hepatic venous outflow obstruction. Moreover, normal duplex ultrasound imaging of liver vasculature and her unusual presentation led to a delay in her diagnosis highlighting the need for an increased index of suspicion.
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