Percutaneous balloon pulmonary valvuloplasty: A modified over-the-wire Inoue balloon technique for difficult right ventricular anatomy

Abstract

Percutaneous balloon pulmonary valvuloplasty (BPV) is the mainstay of treatment for significant pulmonary stenosis with doming leaflets. Various techniques have been described in the literature including the use of Inoue Percutaneous Transseptal Mitral Commissurotomy (PTMC) catheter with standard 0.025″ guidewire. But if right ventricular anatomy is not suitable, 0.025″ guidewire doesn't provide enough support to track the Inoue PTMC catheter. Here, we report a case of successful BPV using a novel technique of slenderizing the Inoue Percutaneous Transseptal Mitral Commissurotomy (PTMC) catheter over an Amplatz superstiff 0.035″ guidewire. This technique may be useful during BPV in difficult right ventricular inflow and outflow tract anatomy in patients with congenital pulmonary valve stenosis.

Percutaneous balloon pulmonary valvuloplasty (PBPV) of extreme pulmonary valve stenosis by the use of Accura balloon

“…At this time, procedure can be repeated depending on the need without disengaging the catheter. Slenderisation and modification of the standard technique, that is, using superstiff Amplatz guidewire instead of stainless steel LA wire is similar to as reported by Patel et al 5 but they had used Inoue balloon. Inoue and Accura balloons are although fundamentally similar, their pressure and volume relationship are different.…”

Use of dobutamine stress echocardiography for periprocedural evaluation of a case of critical valvular pulmonary stenosis with delayed presentation

“…[5] The graded dilatation of PS reduces chances of pulmonary edema. [6] In our case, we did not use incremental dilation up to 140% because of very good result from pliable valve without almost any infundibular stenosis. Sometimes, the resulted pulmonary edema from rapid increase in pulmonary blood flow and unprepared LV may need positive pressure ventilation for a week or so.…”

First-in-Human Percutaneous Balloon Pulmonary Valvuloplasty Under Echocardiographic Guidance Only

“…All patients successfully underwent PBPV with echocardiography guidance and without radiation and contrast agent ( [1][2][3][4][5] However, traditional PBPV was performed under guidance of fluoroscopy with avoid less use of contrast agents. Although this procedure can be performed with limited fluoroscopic exposure and non-ionic contrast administration nowadays, 5 potential injury still cannot be ignored especially for physicians often performing intervention procedures and patients with renal dysfunction.…”

“…First reported by Kan et al in 1982, balloon dilation now is considered as main therapy for PS causing only minor trauma and obviating the need for cardiopulmonary bypass . However, traditional PBPV was performed under guidance of fluoroscopy with avoid less use of contrast agents.…”

“…From March 2013 to December 2014, 34 PS patients (general characteristics of patients see Table ) were recruited to undergo PBPV under echocardiography guidance at Fuwai Hospital, Beijing, China. Patients were eligible for inclusion based on acknowledged criteria of suitability for balloon angioplasty determined by transthoracic echocardiography (TTE) study: (1) patients aged ≥3 years; (2) isolated PS without subvalvular or supravalvular stenosis, severe valve dysplasia, or other conditions requiring open‐heart surgery; and (3) transvalvular pressure gradient ≥40 mm Hg.…”