Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis.

Abstract

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 While the catheter was being withdrawn care was taken to avoid advancing excess guidewire, so that the wire course would remain straight and there would be no looping of the wire in the heart.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:

Angioplasty for coarctation of the aorta: long-term results.

“…Our early observations with balloon angioplasty for unoperated coarctation of the aorta were encouraging and similar to the findings of thers. 4 Always of concern, however, occurred in one patient immediately after balloon coarctation angioplasty was particularly disturbing.27…”

Balloon Valvuloplasty in 30 Dogs with Pulmonic Stenosis: Effect of Valve Morphology and Annular Size on Initial and 1‐Year Outcome

“…Other than valvular anatomy, 17,18,20,21 predictors of successful outcome postvalvuloplasty are age 21 and balloon-to-valve hinge-point diameter ratio. 22 Valvuloplasty was performed in cases of moderate or severe PS.The aims of this study were (1) to evaluate the long-term effect of valvuloplasty on the symptomatology and pulmonic valve pressure gradient, and (2) to identify factors that may influence outcome, such as annulus diameter and valve morphology. …”

“…13 To confirm such anomalies, especially in predisposed breeds, [14][15][16] left-sided angiocardiography must be performed. [13][14][15][16] Pulmonary balloon valvuloplasty has become the treatment of choice for PS in humans [17][18][19][20][21][22] and in dogs 23-27 since it was 1st described in human literature in 1982. 28 The ''typical'' form of PS in humans 10,21 and the type 1 PS described by Patterson et al 7,8 are best treated by this method.…”

Changes in myocardial repolarization in patients undergoing balloon valvuloplasty for congenital pulmonary stenosis: evidence for contraction-excitation feedback in humans.

“…1 2 The present study focuses on the electrocardiographic and electrophysiologic changes that develop in patients undergoing balloon valvuloplasty for congenital pulmonary stenosis. The purpose of this study was to demonstrate that changes in ventricular repolarization consistent with contraction-excitation feedback mechanisms occur in man.…”

“…In patients undergoing balloon dilatation of stenotic valves, three mechanical states are present: (1) before valvuloplasty, at which time pulmonary stenosis asso-70 ciated with increased right ventricular afterload is present, (2) after valvuloplasty of the stenotic valve, associated with decreased afterload and right ventricular pressure generation, and (3) during balloon occlusion of the right ventricular outflow tract and pulmonary valve, at which time maximal afterload and right ventricular pressure generation are noted and tensions approach those seen under isovolumetric conditions. Contraction-excitation feedback theory predicts that the time course of ventricular repolarization will be influenced by the mechanical loading conditions.…”