Balloon Valvoplasty Research Articles

COMBINED SEVERE AORTIC AND PULMONARY VALVULAR STENOSIS IN A CHILD AND ITS MANAGEMENT: A CASE REPORT

Combined congenital aortic and pulmonary valvular stenosis is a rare congenital heart defect. Prevalence of severe combined valvular stenosis of aortic and pulmonary valve accounts about 0.01% and also has association with many syndromes. This combination presents unusual diagnostic as well as management problems. Apart from a few case reports, there is little in the literature on the combined stenosis of both semilunar valves and its management. We present this rare combination in a 9 year old boy which was promptly managed with the balloon valvoplasty without any complications in the same setting under local anesthesia with sedation.

Pattern of Intervention in Congenital Heart Disease: Single Centre Analysis of Cases over Five Years in Bangladesh

Introduction: In Bangladesh, 25/1000 cases of neonates are born with mild to severe type of congenital heart disease. Significant numbers of cases from new born to adult age group are reporting to OPD clinics with broad spectrum of congenital and grown up untreated heart diseases. This study will cover pattern of diseases among cases selected for cardiac catheterization and intervention in study group in a cardiac hospital with limited facility for children.
 Objectives: To analyze all the cases who had cardiac catheterization and intervention in said period and to see the outcome.
 Materials and Methods: It is a retrospective study conducted in a cardiac hospital from December 2014 to December 2019. All cases of cardiac catheterization and interventions were included in the study. Pattern of diseases, interventions, management and outcomes were analyzed.
 Results: Out of 1179 cases, 44.87% were male and 55.13% were female. Two hundred fifty four cases(21.54%) were in 0-1 year age group, 44.02% were in >01-05 year age group, 18.66% cases were in > 5 to 10 year , 8.48% cases were in >10 to 20 years, 4.83% cases were in> 20 to 30 years and 2.46% cases were in more than 30 year age group. Among trans-catheter closure patent ductus arteriosus (PDA) was the commonest type of intervention (44.68%), followed by atrial septal defect (ASD) (25.20%), ventricular septal defect (VSD) (11.83%) and balloon valvoplasty (BVP) for pulmonary stenosis (11.63%). Neonatal interventions were minimum as the coronary care unit used as post cathward had limited facility for neonatal care. PDA stenting was performed in 0.81% cases and BAS in 0.91% cases. Many patients underwent more than one intervention at a time; most common was ASD device closure and pulmonary valvoplasty. Cardiac Catheterization studies were minimum in this series and most of the cath study cases were VSD or/with other combinations (4.48%). Among infants (254), PDA device closure was the commonest intervention (64.56%) followed balloon valvoplasty for PS (15.35%) and balloon dilation of Coarctation on aorta (7.87%). Among implants, most commonly used were 8/6 mm (14.59%) Amplatzer Duct occluder (ADO), 6/4 ADOII, MF-Konar (9.79%) device and most common balloon used for valve or vessel dilation was 10x3 mm Tyshak II (3.26%). Only one mortality was noticed in a case of double intervention of critical Aortic and pulmonary valve stenosis.
 Conclusion: Commonest and established interventions were performed in this study other than few life saving interventions in neonates and outcome was excellent. Skilled team of pediatric cardiologist and technician in catheterization laboratory can bring success at the end of the day in spite of challenges.
 Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 3-9

TCT-800 Immediate and long-term predictor score of success after percutaneous mitral balloon valvoplasty

TCT-800 Immediate and long-term predictor score of success after percutaneous mitral balloon valvoplasty

The Ross Operation in Children and Young Adults: 12-Year Results and Trends From the UK National Database.

To determine UK national trends and results of the Ross operation in relation to all aortic valve interventions. Examination of the UK Congenital Central Cardiac Audit Database for all aortic valve procedures performed between 2000 and 2011 in children (0-16 years) and young adults (16-30 years). A total of 2,206 aortic valve procedures were performed in children and 1,824 in young adults, the proportions in the two groups being: Ross operation (19% vs 15%, respectively), surgical valvoplasty (9.5% vs 4%), surgical valvotomy (9.5% vs 1%), aortic valve replacement (AVR; 11% vs 55%), aortic root replacement (4% vs 18%), and balloon valvoplasty (47% vs 7%). The 30-day and 1-year survival after Ross is 99.3% and 98.7%, respectively, in the last four years achieving 100%. In children, the proportion of balloon valvoplasty increased from an average of 43% in 2000 to 2006 to 53% in 2007 to 2011, whereas the Ross operation decreased from 22% to 16% (P < .001). In young adults, the figures are an increase from 49% to 58% for AVR compared to a decrease from 23% to 9% for Ross (P < .001). Our own single-center series of 91 patients also shows standard results for early- and long-term survival and freedom from reoperation, but gradually fewer Ross operations performed. The year-on-year changes show a significant decreasing trend locally and nationally. Despite an excellent track record, the Ross operation is performed less frequently in the United Kingdom. This report is a first step in comparing treatment modalities at national level.

Right and left ventricular mechanics and interaction late after balloon valvoplasty for pulmonary stenosis.

This study sought to explore right (RV) and left ventricular (LV) mechanics and ventricular-ventricular interaction in adolescents and young adults late after percutaneous balloon pulmonary valvoplasty (PBPV) for valvar pulmonary stenosis (PS). Potential late effects of PS despite PBPV on cardiac mechanics have not been well defined. Thirty-one patients aged 20.2 ± 7.6 years were studied at 18 ± 6 years after PBPV. Ventricular myocardial deformation was determined using speckle tracking echocardiography, while RV and LV volumes and ejection fraction as well as LV systolic dyssynchrony index were assessed by three-dimensional echocardiography. The results were compared with those of 30 controls. Pulmonary regurgitation, mostly trivial to mild, was present in 90% (28/31) of patients. Compared with controls, patients had significantly greater RV end-diastolic (P < 0.001), RV end-systolic (P < 0.001), and LV end-systolic (P = 0.04) volumes as well as lower LV ejection fraction (P < 0.001). For deformation, patients had significantly reduced RV longitudinal systolic strain (P = 0.004), decreased LV circumferential systolic strain (P < 0.001), and strain rate (P = 0.001) as well as greater LV mechanical dyssynchrony (P < 0.001). In patients, RV end-diastolic and end-systolic volumes correlated with LV circumferential strain (r = -0.47, P = 0.008 and r = -0.36, P = 0.049, respectively) and dyssynchrony (r = 0.53, P = 0.002 and r = 0.49, P = 0.005, respectively). Patients who had PBPV at age ≤1 year had ventricular deformation indices similar to those who had interventions beyond 1 year. Impaired RV and LV mechanics and adverse ventricular-ventricular interaction occur in adolescents and young adults late after balloon valvoplasty for isolated valvar PS.

Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvoplasty of severe pulmonary stenosis in adolescents

Background The fundamental abnormality of restrictive right ventricle (RV) physiology is reduced RV compliance as a result of chronic increase in pressure overload. In this study, we test the hypothesis that the persistence of Restrictive RV physiology after balloon pulmonary valvoplasty (BPV) is related to RV fibrosis assessed by Gadolinium-DTPA delayed-enhancement magnetic resonance imaging (de-MRI).

Aortic Root Aneurysm After Balloon Valvoplasty: Evaluation with CT Angiography

A 15-year-old was admitted in 2001 for aortic valve balloon dilatation. He was readmitted in 2005 complaining of fatigue. Echocardiography showed severe aortic regurgitation. Computed tomography revealed aneurysm of aorta near the orifice of the left main coronary artery. He underwent uneventful Ross procedure combined with aneurysmectomy.

Mitral insufficiency after percutaneous balloon valvuloplasty in mitral stenosis. Incidence and progression

Percutaneous balloon valvoplasty of the mitral valve was performed in 126 patients (24 men, 102 women; mean age 55.0 +/- 12.1 years) with mitral stenosis. The mean transmitral valve gradient fell from 12.4 +/- 6.1 to 6.0 +/- 3.2 mmHg, while the valve opening area increased from 1.0 +/- 0.2 to 1.55 +/- 0.3 cm2. After percutaneous balloon valvoplasty 36 patients still had no mitral regurgitation, while the grade of mitral regurgitation remained the same in 47 (grade I: n = 35; grade I: n = 12). Mitral regurgitation, previously not present, occurred in 25 patients, but was severe in only three (grade III: n = 1; grade IV: n = 2). Previously present mitral regurgitation increased in 18 of 65 patients, in four to grade III, in one to grade IV. In three patients acute grade IV mitral regurgitation resulted from a tear in a leaflet of a fibrotic valve which was not or only slightly calcified, requiring emergency surgery. Followup observations over 16.9 (1-60) months showed no change in most patients, but three developed mitral regurgitation. The latter underwent elective surgery, as did one patient with acute mitral regurgitation. Thus a total of seven patients (5.6%) required surgery for mitral regurgitation after percutaneous balloon valvoplasty.

Axillary artery approach for balloon valvoplasty in young infants with severe aortic valve stenosis: Medium‐term results

To assess the feasibility and results of trans-axillary approach for balloon aortic valvoplasty (BAV) in early infancy. Severe aortic valve stenosis (SAVS) is rare but serious condition in infancy, which may be promptly treated either by surgical aortic valvotomy or BAV. BAV is usually performed via the femoral artery route, which is associated with significant vascular complications and long procedure times. BAV via the trans-axillary approach was performed on twenty-seven sequential infants with SAVS presenting to a single tertiary referral center over an 11-year period. Maximum inflated balloon size was less than or equal to the aortic valve diameter. Twenty-seven infants aged 1-77 days underwent BAV. Weight at time of procedure was 2.0-4.42 kgs. The median procedure and screening times were 82 and 7.9 minutes, respectively. Mean instantaneous Doppler gradient across the aortic valve reduced from 68 +/- 33 to 37 +/- 14 mmHg ( p < 0.0001). Three infants developed at least moderate aortic regurgitation. Right arm pulse volume was decreased in 12 infants; 5 received an intravenous heparin infusion. Longer-term follow-up demonstrated reduced or absent peripheral pulse in 5 infants. Transection of the axillary artery occurred in one infant requiring emergency microvascular repair. There was one post-procedural and one late death due to non-cardiac causes. In early infancy balloon aortic valvoplasty via the axillary artery approach for severe aortic stenosis is an acceptable and safe alternative to the femoral arterial approach and results in short procedure and screening times. Longer-term vascular follow-up is required. (c) 2006 Wiley-Liss, Inc.

Current options, and long-term results for interventional treatment of pulmonary valvar stenosis

dilation of the pulmonary valve with a balloonhas become widely accepted as the treatmentof choice for individuals with congenital pulmonaryvalvar stenosis. This technique is safe and effective inpatients of all ages. Currently, balloon valvoplasty isused for a wide spectrum of obstructive pulmonary val-var pathology, including valvar stenosis, dysplasia andatresia. In this review, we will address the history,indications, technique, immediate and long-term out-comes, as well as future outlook, of percutaneous bal-loon valvoplasty for the wide spectrum of congenitalpulmonary valvar disease.

Abstracts for British Paediatric Cardiac Association Annual Meeting: St John’s College, Cambridge, 15–16 December 2003: Results in the mid-term of an axillary artery approach for balloon valvoplasty of severe aortic valvar stenosis in early infancy

Abstracts for British Paediatric Cardiac Association Annual Meeting: St John’s College, Cambridge, 15–16 December 2003: Results in the mid-term of an axillary artery approach for balloon valvoplasty of severe aortic valvar stenosis in early infancy

Pulmonary regurgitation after percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis in childhood

A retrospective study was undertaken to determine the degree of pulmonary regurgitation following percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis. Percutaneous balloon valvoplasty is the recognised treatment of choice in pulmonary valvar stenosis with effective relief of gradient. Few studies have reviewed the degree of pulmonary regurgitation after the balloon valvoplasty. We reviewed all patients with isolated pulmonary valvar stenosis undergoing percutaneous balloon valvoplasty at a tertiary centre between December 1984 and August 1996. Those with an associated haemodynamically insignificant atrial septal defect or patent oval foramen were also included. Their medical records, echocardiograms and angiograms were studied. Colour flow Doppler was used as a semi-quantitative way of assessing the pulmonary incompetence. Over the period of review, 57 procedures had been performed in 49 patients. The median age at the time of the procedure was 1.08 years, with a range from 0.01 to 13.3 years. The median period of follow-up was 5.64 years, with a range from 3.00 to 14.26 years. Immediately following the dilation of the pulmonary valve, the peak-to-peak instantaneous systolic pressure gradient was significantly reduced. Seven patients required a second dilation of the valve. Their median age at the first valvoplasty, at 0.49 year, was significantly lower than those who required only one procedure, at a median of 1.50 years. Following the valvoplasty, mild pulmonary incompetence was noted in 26 out of 42 patients the day after the procedure, but only 7% had moderate incompetence. On follow-up, there was an increase in the number of patients with moderate to severe pulmonary incompetence, from 7% to 29%. Those patients in whom the procedure was performed at a younger age had more significant pulmonary incompetence. Neither the initial gradient across the pulmonary valve, nor the size of the balloon used, were related with statistical significance to the subsequent development of pulmonary incompetence. The majority of the patients with congenital isolated pulmonary valvar stenosis had only a mild increase in the degree of pulmonary incompetence following a single pulmonary valvoplasty. Patients who required the procedure early in life were more likely to develop significant pulmonary incompetence. The ratio of the size of the balloon to the diameter of the valve did not significantly affect the outcome. We suggest that those patients who had more severe stenosis because of a more abnormal pulmonary valve, and hence required early intervention, were more likely to develop greater pulmonary incompetence after the valvoplasty.

Usefulness of laser-assisted valvotomy with balloon valvoplasty for pulmonary valve atresia with intact ventricular septum

Usefulness of laser-assisted valvotomy with balloon valvoplasty for pulmonary valve atresia with intact ventricular septum

Usefulness of laser-assisted valvotomy with balloon valvoplasty for pulmonary valve atresia with intact ventricular septum

Usefulness of laser-assisted valvotomy with balloon valvoplasty for pulmonary valve atresia with intact ventricular septum

Anterograde balloon valvuloplasty for the treatment of neonatal critical valvar aortic stenosis.

We report our experience with anterograde balloon valvuloplasty in 17 neonates treated between November 1996 and June 2001 for critical aortic stenosis. Patients with hypoplastic left heart syndrome were excluded. Anterograde balloon valvoplasty of the aortic valve was possible in all 17 patients. The mean peak systolic gradient prior to cardiac catheterization was 73 mm Hg (range, 30-117 mm Hg) and decreased to 37 mm Hg (range, 21-60 mm Hg) after the dilation. Aortic regurgitation after balloon valvoplasty was absent or mild in 14/17 patients, moderate in 2 patients, and severe in 1 patient. There was no mortality or echocardiographic evidence for aortic cusp perforation or mitral regurgitation associated with the procedure. Redilation was necessary in 3/17 patients. Two patients are awaiting elective Ross operation. One patient with endocardial fibroelastosis died at 11 months of age. Anterograde balloon valvoplasty can be safely and effectively performed to palliate neonates with critical aortic valve stenosis.

Transcatheter closure of defects within the oval fossa using the Amplatzer Septal Occluder.

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 +/- 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

Balloon valvoplasty in infants with tetralogy of Fallot: effects on oxygen saturation and growth of the pulmonary arteries.

Balloon valvoplasty was undertaken in 27 patients with tetralogy of Fallot for first-stage palliation. Indications were arterial saturation of oxygen < 80%, hypoxic spells and duct-dependant pulmonary perfusion. The dilation was performed following diagnostic heart catheterization. Saturations improved from 75% +/- 8.5 before valvoplasty to 85% +/- 8.4 after the procedure, and worsened little to 83% +/- 9.6 at follow-up after 3.4 months. The pulmonary valvar orifice was hypoplastic in most patients (Z = -3.3 +/- 1.2), and did not change after the procedure. The cross-sectional area of the pulmonary arteries was diminished initially, reflected by a Nakata index of 186 +/- 95 mm2/m2. After valvoplasty, we found widening of the vessels (Nakata index 225 +/- 100 mm2/m2). At follow-up no further growth of the arteries was observed (Nakata index 209 +/- 109 mm2/m2). The procedure was complicated by hypoxic spells in three patients which were controlled by intravenous propranolol, and deep venous thrombosis in four patients. Our data demonstrate that balloon valvoplasty is feasible for initial palliation in patients with tetralogy of Fallot. It does not, however, produce growth of the pulmonary arteries or of the pulmonary valve.

Percutaneous mitral valvotomy with a metal dilatator

Since its introduction by Inoue in 1983, 1 Inoue K Owaki T Nakanura T Kitamura F Miyamoto N Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984; 87: 394-402 PubMed Google Scholar percutaneous balloon valvoplasty of the mitral valve (PMV) has become a common treatment for mitral stenosis. The cost of the balloon catheters used is a limitation to its application in countries with low financial resources. Many centres in developing countries reuse balloon catheters, although they are meant to be disposable, with potential hazards of imperfect sterilisation and decreased performance.

Natural history of congenital aortic valvar stenosis: an echo and Doppler cardiographic study

AbstratThe availability of echo Doppler cardiography enables monitoring of the natural course of congenital aortic valvar stenosis more adequately than before. Between 1986 and 1993, 129 children with such stenosis were examined echocardiographically, 83 of them over a prolonged period with repeated studies of at least one per year. The pressure gradient between the left ventricle and ascending aorta, as well as the left ventricular wall thickness, were measured. When the pressure gradient detected increased to more than 60 mmHg, the patients were treated by balloon valvoplasty or surgical valvotomy. The last examination prior to intervention was taken as the final measurement.We found a significant increase (≥10 mmHg) in the measured pressure gradient in 40 of the 83 patients (48%). The onset of severe stenosis was not observed at a specific age, rather the stenosis was found suddenly to increase in severity at any age. The gradients measured in children younger than 2 years of age, however, increased twice as rapidly as those measured in the older children. A high gradient was not always accompanied by evidence of left ventricular hypertrophy.Based on our findings, we suggest that, since a sudden increase in severity of aortic valvar stenosis might be expected, the pressure gradient should be measured once every 6 months in children younger than 2 years of age and once a year after that age

Laser valvotomy with balloon valvoplasty for pulmonary atresia with intact ventricular septum: five years' experience.

OBJECTIVE: To assess immediate and medium term results of transcatheter laser valvotomy with balloon valvoplasty in selected infants with pulmonary atresia and intact ventricular septum. DESIGN: Prospective study. SETTING: Tertiary...