Balloon Valvoplasty Research Articles

Perforation of the heart in a newborn with critical valvar pulmonary stenosis during balloon valvoplasty

We describe the perforation of the right ventricular outflow tract with a 0.021 inch wire in a newborn infant with critical pulmonary valvar stenosis in an attempt to balloon dilatation of the pulmonary valve. The complication was diagnosed by contrast injection into the pericardium. The infant was followed with sector scan echocardiography and recovered completely from that injury. The dilatation was successfully repeated a few days later with the use of a soft tipped wire to cross the pulmonary valve.

Follow-up after percutaneous balloon valvoplasty for noncalcific aortic stenosis

This study evaluates the follow-up data from the first 25 patients with noncalcific aortic stenosis who underwent percutaneous balloon aortic valvuloplasty (PBAV) at our center between September 1986 and December 1988.

Efficacy of aortic balloon valvoplasty: direct measurement of orificial area in a model with pulsatile flow

The efficacy of balloon valvoplasty of calcific aortic stenosis remains controversial. We studied, therefore, 5 human aortic valves obtained at necropsy in a positive-displacement pulse duplicator which delivered stroke volumes of 40–100 ml with a quasiphysiological waveform of flow. All valves had three leaflets without commissural fusion and were preserved in antibiotic solution before study. Orificial area was planimetered from videotape of opening of the valve and varied with flow in all cases. Valvoplasty with a 20 mm diameter balloon had no effect on the orifice of the normal valve but increased the orifice of 2 mildly calcified valves from 0.70–1.77 cm 2 (range) at baseline to 1.06–1.95 cm 2. In 2 valves with severe calcification of the leaflets, the orifice was increased from 0.31–0.82 cm 2 to 0.73–1.07 cm 2. Dual balloon valvoplasty achieved a variable but small further increase in orificial area. No valve showed tears of the leaflets or fracture of calcific deposits after valvoplasty. We conclude that balloon valvoplasty can acutely increase orificial area, independently of any change in stroke volume. In valves without commissural fusion, its mechanism appears to be an increase in the pliability of the leaflets which does not require macroscopic fracture of calcific deposits.

Restenosis is a common feature of the angiographic follow-up after balloon valvoplasty of calcified aortic stenoses

Balloon dilatation of calcified aortic stenosis was attempted in 12 patients, 6 men and 6 women, aged 38–82 years. Two patients underwent emergency surgery because of myocardial injury or pericardial tamponade. One patient with severe depressed left ventricular function in whom the procedure was attempted in cardiogenic shock died during the procedure. One patient experienced severe aortic insufficiency after dilatation. The remaining pressure gradient was higher than 50 mm Hg in another patient. Seven dilatations were considered to be successful with a remaining pressure gradient below 50 mm Hg and a mean gradient reduction of 53 mm Hg. In one of these 7 patients, who suffered from severe heart failure, valvoplasty had been carried out to make aortic valve replacement possible. The operation was performed 2 weeks later without complications. Five of 6 patients treated medically after successful valvoplasty had restenosis within 3 to 12 months. One of them exhibited a good result at 3 months but severe restenosis after one year. It is concluded that balloon valvoplasty of calcified aortic stenosis cannot be considered an alternative to surgery. If, however, left ventricular function improves after successful valvoplasty, valve replacement will then carry less risk.

Percutaneous transluminal balloon pulmonary valvoplasty — long-term results

Thirty-two patients with isolated valvar pulmonary stenosis (21 male; 11 female, age range 4 to 53 years, mean 14 years) underwent cardiac catheterization and balloon valvoplasty. Right ventricular systolic pressure before valvoplasty ranged from 65 to 210 mm Hg (mean 120.2 ± 44.8 mm Hg). It fell to 24–200 mm Hg (mean 73.1 ± 42.4 mm Hg) immediately after dilation. Peak systolic gradient across the pulmonary valve before valvoplasty ranged from 42 to 193 mm Hg (mean 98 ± 45.3 mm Hg) and decreased significantly to 5 to 182 mm Hg (mean 52.7 ± 43.1 mm Hg) immediately after dilation. At repeat cardiac catheterization in 21 patients 3 to 6 months after valvoplasty, a further significant fall of gradient was noted in 15 patients with no change in the remaining six patients. The right ventricular systolic pressure ranged from 30 to 100 mm Hg (mean 55.1 ± 23.8 mm Hg) while the transpulmonary gradient varied from 12 t0 84 mm Hg (mean 34 ± 23.8 mm Hg). In the four patients evaluated 1 to 1 1 2 years after valvoplasty, the gradient further reduced in 2 patients and was unchanged in the remaining two patients. Patients with isolated valvar pulmonary stenosis can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.

Balloon valvoplasty in calcific aortic stenosis: a therapeutic alternative

Percutaneous balloon valvoplasty was used to treat calcific aortic stenosis in 3 women aged 73, 67, and 61 years, respectively. We approached through the left brachial artery in the first case and the right femoral artery in the other two. An 18 mm balloon was used in all cases, the systolic gradient being reduced from 50, 180 and 48 to 7, 50 and 35 mm Hg, respectively. A mild and transitory systemic embolization was observed in one case. Aortic regurgitation was not present in two patients either before or after valvoplasty. In the other case, a grade 1 6 murmur indicative of regurgitation prior to the procedure increased to a grade 2 6 afterwards. A small and localized aortic dissection was present in one case but disappeared in the control angiography performed 11 days later.

The pathology of balloon pulmonary valvoplasty

The pulmonary valve was examined following balloon dilation of pulmonary valve stenosis in six children. Stenosis was due to commissural fusion in two. In these patients, cineangiography showed that the valve was slightly thickened and “domed” during systole. Balloon valvoplasty produced complete separation of fused commissure in one and partial separation in the other. Commissural splitting is likely to be the most common mechanism of relief of pulmonary stenosis by balloon dilation. Incomplete separation could account for the partial reduction of the gradient in most children treated with this technique. Four children had pulmonary valve dysplasia. Balloon valvoplasty did not produce haemodynamic improvement or morphological changes that were identifiable at the time of surgical correction. Tearing of pulmonary valve tissue and avulsion of pulmonary cusps were not seen in this series.

Continuous wave Doppler assessment of patients subjected to pulmonary balloon valvoplasty

To evaluate the role of Doppler ultrasound in accurately quantitating patients with valvar pulmonary stenosis, we studied 30 patients (20 patients undergoing balloon pulmonary valvoplasty before and after the procedure, and 10 patients who had previously undergone pulmonary balloon valvoplasty) by Doppler echocardiography and cardiac catheterization. The peak systolic gradient was calculated by the two methods within 24 hours of each other. The maximal velocity of blood flow was obtained by non-imaging, continous wave Doppler ultrasound examination performed from various parasternal and subcostal positions and the valve gradient was calculated using a modified Bernoulli's equation. Transpulmonary peak systolic gradient calculated by Doppler examination ranged from 9 to 159 mm Hg (mean 54.8±34.5 mm Hg) and correlated well with values obtained at cardiac catheterization ( r = 0.94, P < 0.001). Thus our study shows that accurate quantification of pulmonary valve stenosis can be reliably undertaken non-invasively utilizing Doppler echocardiography.

Pulmonary artery tear following balloon valvoplasty in Fallot's tetralogy

A 3-year-old girl with Fallot's tetralogy underwent balloon pulmonary valvoplasty without any obvious complications. Elective total correction was performed 15 months later. At operation, a well-healed longitudinal tear measuring 2 cm was noted in the posterior wall of the main pulmonary artery 1 cm from the pulmonary valve extending into the right pulmonary artery.

Doppler ultrasound in the prediction of transvalvar pressure gradients in patients with valvar pulmonary stenosis

Good correlation between Doppler-derived and catheterization-measured pulmonary valvar pressure gradients has previously been reported. The purpose of this paper was to present two groups of patients who did not show such correlation, namely those with very severe stenosis and those measured immediately following balloon pulmonary valvoplasty. Twenty-two patients, aged 4 months to 20 years, in whom Doppler and catheterization pressure gradients were measured within 24 hours of each other were included in the study. There were 35 pairs of such data. The correlation coefficient for the entire group was 0.61 which improved to 0.91 when the five patients with severe stenosis (gradients of 94 to 190 mm Hg) and one patient with severe right ventricular infundibular stenosis immediately following balloon valvoplasty were excluded from analysis. Although the possibility exists, technical aspects of Doppler recording did not appear to be causing this lack of correlation. Cone-shaped spray formation rather than a focused jet in patients with extremely severe pulmonary stenosis may be postulated to be responsible for poor prediction by Doppler of catheterization gradient. Once these two groups of patients are excluded, there is excellent correlation between Doppler and catheterization gradients in patients with pulmonic stenosis.

Pulmonary balloon valvoplasty in late adult life

A case of severe valvar pulmonary stenosis in a 60-year-old woman is described. Percutaneous balloon valvoplasty was performed without complication and reduced the right ventricular outflow pressure gradient from 95 mm Hg to 25 mm Hg. Balloon valvoplasty is an effective alternative to surgical valvotomy in adults as well as children.

Comparison between Total Echo Score and Total Commissural Morphology Score for the Outcome and Complication of Balloon and Surgical Closed Mitral Commissurotomy

Background: Now a days mitral balloon valvoplasty(PTMC) is an alternative to closed surgical mitral commissurotomy (CMC) for the treatment of selectcd patients with rheumatic mitral stenosis. To compare between the total echo score (Wilkin’s score) total echocardiographic commissural morphology score (TC) for outcome and as a predictors of complications of both procedures. Method: We carried out a prospective well matched comparative observational study on 123 patients of symptomatic mitral and three patients were rejected due to procedural complications and technical failure. Result: Age ranges were 12 55 years, mean (±SD) age was 28.83+9.33 years. Out of 120 patients, 41 (34.2%) were male and 79 (65.8%) were female. Before procedure, 29 (48.3 %) and 32 (53.3 %) patients were in NYHA class III.Total Wilkins score was in the range of 4 10. Mean (±SD) of total Wilkins score were 6.43+1.53 and 6.30+1.33. Good commissural morphology (score 0 1) were present in 38 (63.5%) and 36 (60%) and bad commissural morphology (score 2 3) were present in 22 (26.7 %) and. 24 (40 %) in both groups respectively. Mitral valve area increased from a mean (±SD) of 0.80±0.16 and 0.79±0.15 to 1.94 ±0.24 and 1.92 + 0.26cm2. in PTMC and CMC groups respectively. Transmitral mean and peak pressure gradient also decreased significantly in both the individual procedures but no statistically significant difference between the procedures. NYHA class improved by class 1 or more in most patients in both groups. There were 2 (3.33 %) cases of cardiac temponade due cardiac perforation in PTMC group, of which one need repair and CMC and another was managed conservatively. There were also 3 (5 %) patients in PTMC and I (1. 66 %) patient in CMC developed peripheral thromboembolism and one patient (1.66%) developed arteriovenous fistula in PTMC group. Mitral regurgitation grade III, developed in 3 (5%) patients and one patient (1.66%) in PTMC and CMC respectively having no statistical significance. Conclusion: Total Wilkin’s score and total commissural morphology score were found to be most important preprocedural variable associcated with the outcome and as a predictors of post procedural complications Keywords: PTMC, CMC, Mitral stenosis, Rheumatic heart diseaseDOI: http://dx.doi.org/10.3329/cardio.v1i1.8202 Cardiovasc. j. 2008; 1(1) : 34-43