Balloon Valvuloplasty Research Articles

CRT-700.53 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

CRT-700.53 Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

Anesthetic management of a child with Cornelia de Lange Syndrome undergoing open heart surgery: A case report

BACKGROUNDCornelia de Lange syndrome (CdLS) is a congenital multisystemic genetic disorder. The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years. However, they still more frequently undergo cardiac surgery. There are some challenges for clinicians when faced with CdLS patients. We present the perioperative management of a child with CdLS undergoing open-heart surgery. CASE SUMMARYSevere pulmonic and subpulmonic valvular stenosis, enlargement of the right side of the heart, mild tricuspid regurgitation, atrial septal defect, and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis, developmental delay, and malnutrition. Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve, therefore it was decided to perform an open surgical repair. Following a successful and uncomplicated intraoperative course, the patient was extubated on postoperative day 5, and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10, respectively. Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed, and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32. The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems. CONCLUSIONThis is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.

Propofol‐dexmedetomidine continuous infusion in a dog with pulmonic stenosis undergoing balloon valvuloplasty

AbstractA 6‐month‐old, 4 kg, male pomeranian, was referred for investigations of a heart murmur found during a routine clinical examination. A severe valvular pulmonic stenosis was diagnosed and medical management with atenolol was started. One month later, the dog underwent percutaneous balloon valvuloplasty. Anaesthesia was maintained with propofol‐dexmedetomidine continuous infusion, and a minimally invasive cardiac output monitor was used to assess haemodynamic variations. Intraoperatively, lidocaine was started because the frequency of the premature ventricular complexes increased before ballooning. A reduction in pressure gradient across the pulmonic valve was achieved. No other intraoperative complications were recorded. Recovery from general anaesthesia was uneventful, and the dog was discharged from the hospital 26 hours following the procedure.

SEVERE MITRAL REGURGITATION AFTER PMBV? COMPARISON BETWEEN INOUE AND MULTI-TRACK TECHNIQUES

Objectives: To compare the frequency of severe mitral regurgitation after percutaneous mitral balloon valvuloplasty (PMBV) via Inoue balloon and multi-track balloon technique in our population. Methodology: In this retrospective observational study which was conducted at a tertiary care cardiac center of Karachi, Pakistan between 2015 and 2020 on Hospital registry of PMBV patients. Data were categorized in to two groups, Inoue balloon or multi-track balloon technique. Post procedure echocardiographic and catheterization parameters and in-hospital outcomes and complications, including severe MR, were compared between two groups. Results: Out of 470 PMBV procedures, 286 (60.9%) were performed with multi-track and 184 (39.1%) with Inoue balloon. Improvement in mitral value area was significantly higher with multi-track as compared to Inoue balloon (0.66±0.31 cm2 vs. 0.56±0.29 cm2; p<0.001). Severe MR was not significant, 3.5% (10/286) vs. 4.3% (8/184); p=0.639 for multi-track and Inoue balloon. One patient in Inoue balloon group and two patients in multi-track group required emergency valve surgery. Stroke was observed in two patients of multi-track group and two patients from the same group developed tamponade. No in-hospital mortality was observed. Conclusion: Post-procedure severe MR is a significant and frequent complication. Rate of post procedure severe MR are similar for PMBV via Inoue balloon and multi-track balloon. Both methods are equally effective with equal success rate.

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Objectives: Factors influencing results of balloon valvuloplasty (BVP) of pulmonary valve stenosis (PS) in children are investigated. Background: BVP has become the standard of care for PS, medium-term results are not uniform and depend on various preconditions. Methods: We analysed the medium-term results of BVP of PS in children in an observational, single centre study. Need for additional procedure was defined as outcome after initial BVP. Results: We included 143 children (83 female) at a median (IQR) age of 2.6 (0.26–9.24) months and body weight of 5 (3.4–8) kg at BVP with a follow–up of 5.04 (1.6–10.2) years. We used balloon size of 10 (9–14) mm and maximal balloon pressure of 4 (3.5–10) atm, resulting in balloon–to–pulmonary annulus ratio of 1.28 (1.2–1.4). Systolic pressure gradient of PS was reduced with BVP (43.5 mmHg vs. 14.0 mmHg, p < 0.001) and confirmed by echocardiography (68.0 mmHg vs. 25.0 mmHg, p < 0.001) day 1 post procedure. Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients (74.2%). Early additional procedure was necessary in 14 patients (9.8%) after 0.2 (0.1–0.7) years due to residual PS (n = 13) and infective endocarditis (n = 1). Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient, but not genetic syndrome. During further follow–up of 5.04 (1.6–10.2) years no further additional procedures were needed. Conclusions: Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results, even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.

Percutaneous Pulmonary Valvuloplasty by JOMIVA Balloon in Adults: Long Term Retrospective Study from a Tertiary Care Hospital of Eastern India

Introduction: Isolated pulmonary valve stenosis with intact ventricular septum constitutes the third most common congenital heart disease apart from Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD). Percutaneous balloon pulmonary valvuloplasty is an effective therapeutic alternative procedure of choice in severe valvular PS. Conventionally, the Mansfield balloon is being used worldwide for pulmonary valvuloplasty. Joseph Mitral Valvuloplasty (JOMIVA) balloon offers advantages of longer size, lower cost and its familiarity to use this balloon for mitral valvuloplasty in this institution since long. Aim: To assess the immediate and long-term results of Joseph Mitral Valvuloplasty (JOMIVA)balloon for Pulmonary valvuloplasty in isolated severe Pulmonary Stenosis (PS). Materials and Methods: This was a long term retrospective study conducted at the Cardiology Department of SCB Medical college and Hospital, Cuttack, Odisha, India, where pulmonary valvuloplasty was performed using single JOMIVA balloon in 21 adults and adolescent patients. Clinical and Echocardiography (Echo) Doppler evaluation for restenosis and Pulmonary Regurgitation (PR) were assessed. All the cases were followedup serially in Outpatient Department (OPD) for 12 years in retrospect manner. Results: Data of total 21 participants (15 males and 6 females; mean age was 18.3±6.8 years) were analysed in the study. After pulmonary valvuloplasty, the median transvalvular gradient significantly decreased from 115 mmHg (interquartile range (IQR) 101-128 mmHg) to 46 mmHg (IQR 37-51 mmHg) (p-value&lt;0.0001). Also, the right ventricular systolic pressure reduced significantly from 136 mmHg (IQR 122-148 mmHg) to 67 mmHg (IQR 57-71 mmHg) (p-value&lt;0.0001). Catheterization Laboratory (Cath Lab) complications were transient and selflimiting. Mild to moderate (PR) was noted in all cases i.e., Grade I in 12 cases (57.1%) and Grade II in 9 cases (42.8%) which showed evidence of regression on follow-up. Neither significant restenosis nor significant PR (Grade III /IV) was observed during follow-up period of 12 years. Conclusion: Percutaneous valvuloplasty using JOMIVA Balloon, in case of severe valvular PS in adults, is a cost-effective procedure. It has excellent immediate results, and long-term incremental benefits was observed in this 12-year follow-up study

Balloon valvuloplasty as percutaneous intervention for pulmonary stenosis: Experience from a tertiary care center

Balloon valvuloplasty as percutaneous intervention for pulmonary stenosis: Experience from a tertiary care center

Predictors of Procedural Success and Durable Outcomes in Percutaneous Mitral Balloon Valvuloplasty: Not Just the Wilkins Score

Global migration means rheumatic heart disease (RHD) and mitral stenosis (MS) remain important issues in Western health systems. Percutaneous mitral balloon valvuloplasty (PMBV) is a durable treatment strategy relying on suitable leaflet characteristics adjudged by a Wilkins score. Commissural calcification alone has been thought as reliable as Wilkins score. Timing PMBV is also important. Falling left atrial ejection fraction (LAEF) has been theorised to predict future MS intervention. This study compared Wilkins score and commissural calcification as predictors of procedural success and durability; and, observed if LAEF improved post-valvuloplasty.

Comparison of Post-Procedural and 30-day Post-Implantation Transcatheter Aortic Valve Replacement Gradients with and without pre-implantation Balloon Valvuloplasty: A Real-World Analysis of Early Results using a Novel Balloon Expandable Transcatheter Aortic Valve

Objectives: This study describes a real-world experience of implanting a novel balloon expandable transcatheter aortic valve replacement (TAVR) compared to devices commonly used in clinical practice. As a secondary objective, the effect of balloon angioplasty (BAV) before TAVR on the transvalvular gradient 1 and 30 days after implantation was evaluated. Background: For most commercial TAVR valves, the 30-day average mean aortic valve gradients have been reported. Our experience with the Lotus Valve System had indicated higher immediate post-implant gradients than those in the literature. We sought to evaluate both these valves, comparing them to other valves. Methods: We analyzed discharge and 30-day echocardiograms of Lotus valves from 7/5/2019 to 8/27/2020. In response to higher-than-expected post-implant gradients, patients from 11/4/19 to 8/27/20 underwent BAV before the valve implantation, whereas patients from 7/5/19 to 10/18/19 did not (no-BAV). We compared these samples to each other and to a random sampling of TAVR valves implanted by the same interventionalist. Results: At discharge, 27 patients received Lotus valves. The average mean aortic valve gradient was 16.7 mmHg (SD = 5.5 mmHg) for the no-BAV and 14.7 mmHg (SD = 3.7 mmHg) for the BAV (P = 0.177) cohorts. No-BAV Lotus valve mean gradients were significantly higher (P &lt; 0.001) than those of the Sapien valve (M = 12 mmHg, SD = 4.3) and CoreValve (M = 9.18 mmHg, SD = 3.96). At the 30-day assessment, the mean gradients in the no-BAV and BAV groups were similar to those in the literature (M = 11 mmHg SD 3.5; M = 12 mmHg, SD 4.1 (P = 0.287)) and those of other valves. Conclusions: The Lotus valve demonstrated higher post-implantation gradients than other valves. This effect was not attenuated by BAV. These elevated gradients were not significant at the 30-day follow-up.

Yenidoğanın Geçici Takipnesinde Reiki Kullanımı

This study was conducted to evaluate the effect of Reiki therapy on maintaining the integrity based on Levine's Conservation Model in a case treated for respiratory distress in a neonatal intensive care unit at a university hospital, and transient tachpynea of newborn. A term male baby with a birth weight of 3,000 g, who was born by cesarean section, had bradycardia after birth. The baby was ventilated with pulmonary balloon valvuloplasty and kept under observation for 2 hours. He was taken to the neonatal intensive care unit when his respiratory effort continued. Interventions, which we designed considering the protection principles in a term newborn case followed up with the diagnosis of transient tachpynea of newborn, provided us with a holistic perspective and positively stimulated the baby's internal and external adaptation. The baby and the family adapted to this process more rapidly and maintained the integrity.

Outcomes of aortic balloon valvuloplasty in newborns: A single-centre experience

Introduction: Critical or severe aortic stenosis in new-borns is a condition that requires rapid intervention. Aortic balloon valvuloplasty (ABV) is a method of choice that has been successfully performed since 1983. Aims: This study was conducted to explore the experiences of our centre. Study Design: The data of ABV performed on new-borns (n = 52) between 2007 and 2020 were retrospectively analysed to evaluate follow-up of the cases. Materials and Methods: Patients were divided into 4 groups according to procedural immediate results. Results: Left ventricular endocardial fibroelastosis and left ventricular systolic dysfunction were detected in 18 (34.6%) and 19 (36.5%) patients, respectively and there was a significant association between fibroelastosis and left ventricular dysfunction (P < 0.05). The preprocedural echocardiographic mean gradient was significantly lower in the unsuccessful group (P < 0.41). The mean hospital stay day was shorter in the group with optimal results without statistical significance (P = 0.055). Immediate inadequate results after the procedure were detected as a major risk for re-intervention. Re-intervention was required in one-fifth of the patients and the most common cause was aortic stenosis. The risk factors of mortality were found to be associated with the disease itself such as ventricular dysfunction, being critical aortic stenosis instead of procedural reasons. Conclusion: ABV is an effective method and as left ventricular dysfunction and critical aortic stenosis are risk factors of mortality, preprocedural evaluation, and quick intervention are essential.

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis.

Background:This study aimed to evaluate the acute treatment of patients with severe aortic valve stenosis in Germany.Methods and Results:Three treatment strategies in 11,027 patients acutely admitted due to aortic valve stenosis were compared from 2014 until 2018 using German nationwide records: The annual number of transcatheter aortic valve replacement (TAVR) procedures (1,294 to 1,827) and balloon valvuloplasty (BV only) procedures (170 to 233) in patients acutely admitted increased, but surgical aortic valve replacement (SAVR) procedures decreased (426 to 316). In comparison to BV only patients (mean age 81.3; EuroSCORE 23.2) SAVR patients were younger and at lower logistic EuroSCORE (mean age 66.9; EuroSCORE 9.4). Patients treated with TAVR were at comparable age and operative risk (mean age 81.3; EuroSCORE 24.4) as those patients treated with BV only. Primary outcome was in-hospital mortality. Reimbursement was considered secondary outcome. After risk adjustment using multivariable logistic and linear regression analyses, SAVR (OR 0.26 [96%CI 0.16;0.45], p < 0.001) and TAVR (OR 0.38 [0.29;0.49], p < 0.001) were associated with lower risk for mortality compared to BV only. Compared to BV only, hospitalization costs of patients undergoing SAVR were reduced by €5,578 ([95%CI €8,023; €3,133], p < 0.001). TAVR procedures were associated with higher hospitalization costs than BV only (risk-adjusted difference €4,143 [€2,330; €5,926], p < 0.001).Conclusions:BV only was associated with a substantially increased risk of in-hospital mortality in acute patients. We conclude that a definitive aortic valve replacement should be preferred as primary treatment in patients with severe aortic valve stenosis causing an acute admission.

Percutaneous Transcatheter Closure of a Stented Patent Ductus Arteriosus in a Patient With Critical Pulmonary Stenosis: A Case Series

INTRODUCTION: TStenting of the ductus is an alternative to surgical shunt in patients with critical pulmonary stenosis who remain ductal dependent following valvuloplasty. Stents close spontaneously after improvement of right ventricular function; however, in rare cases, stents fail to completely endothelialize, resulting in pulmonary overcirculation. CASE PRESENTATION: The first case was a 3-year-old who had critical pulmonary stenosis at birth, and the second case was a 3-year-old boy who at 5 months of age was managed for severe pulmonary valve stenosis. Both underwent stenting of the duct and percutaneous pulmonary balloon valvuloplasty. On follow-up, the patent ductus arteriosus (PDA) stent of both cases remained patent even after an adequate growth and improvement of the right ventricle, resulting in significant left-to-right shunting and development of increased pulmonary blood flow; hence, percutaneous transcatheter closure of the stented PDA was done. DISCUSSION: Stenting of the ductus allows significant and balanced growth of the pulmonary artery in patients with duct-dependent congenital heart diseases leading to adequate growth of the right ventricle. Persistence of patency of stent causing significant left-to-right shunting warrants closure of the PDA stent. Closure of the stent is challenging and requires a high degree of technical skill because of the difficulty to enter the partially closed stent. CONCLUSION: Percutaneous transcatheter closure of a stented PDA in patients with critical pulmonary stenosis can be a technically challenging procedure because of the difficulty to enter the stent due to the presence of intrastent endothelial proliferation. KEYWORDS: congenital heart disease, critical pulmonary stenosis, patent ductus arteriosus, transcatheter device closure, stent

Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

336 Right ventricular mechanics in patients affected by pulmonary valve stenosis, before and after percutaneous pulmonary angioplasty

Abstract Aims Pulmonary valve stenosis accounts for 6–9% of all congenital heart diseases. The main effect of this obstructive lesion is a rise in right ventricular pressure; this overload leads to multiple changes in shape, dimensions, and volume of the ventricle. The diagnosis is based on transthoracic echocardiography and invasive heart catheterization. Usually the stenosis is classified into mild, moderate, and severe based on pressure gradient between right ventricle and pulmonary artery and on the ratio between right ventricle and left ventricle systolic pressure. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages; alternatively surgical valvotomy is an option in selected cases. The aim of this study is to evaluate the mechanical changes of the right ventricle in patients undergoing balloon pulmonary valvuloplasty using transthoracic and speckle-tracking echocardiography (STE). Furthermore, we sought to investigate the correlation between haemodynamic and echocardiographic parameters to better evaluate the degree of pulmonary valve stenosis before and after treatment. Methods and results Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited at the University Hospital of Padua. All patients underwent standard transthoracic echocardiography (TTE), STE with analysis of right ventricle global longitudinal strain (RVGLS) one day before and one day after the procedure. For each patient were collected invasive parameters during the interventional procedure before and after balloon valvuloplasty. After the procedure, there was an immediate statistically significant reduction of both peak-to-peak transpulmonary gradient (Dp post) and ratio between the systolic pressure of right and left ventricle (RV/LV ratio) with a drop of 29.3 ± 14.67 mmHg and 0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (50 ± 32.23 and 31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, following the intervention it reached 29% with a statistically significant increase (P = 0.007). However, the incidence of pulmonary valve moderate and severe regurgitation remained stable after the procedure. The analysis of right ventricular function and mechanics showed a significant improvement of Fractional Area Change (FAC) immediately after the procedure (40.11% vs. 44.42%, P = 0,01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE (P = 0.60) and longitudinal strain (P = 0.31), did not improve significantly after intervention. Finally, pre-procedural invasive RV/LV ratio showed good correlation to echocardiographic transvalvular peak and mean pressure gradient (R = 0.375, P = 0.019 and R = 0.40, P = 0.012, respectively), as well as with FAC (R = 0.31, P = 0.05), TAPSE (R = 0.62, P &amp;lt; 0.001), and RVGLS (R = 0.46, P = 0.01). Conclusions Percutaneous balloon pulmonary valvuloplasty represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. Interestingly, the analysis of right ventricular mechanics on echocardiography demonstrated an immediate global systolic function improvement following afterload reduction. Conversely, longitudinal systolic function did not show improvement immediately after intervention, possibly due to the necessity of longer time to recover. Finally, invasive preprocedural RV/LV ratio demonstrated better correlation with echocardiographic evaluation of stenosis degree and right ventricular function compared to invasive peak-to-peak pressure gradient. Therefore, RV/LV ratio should be preferred for the assessment of pulmonary valve stenosis.

English Case report: Succesfully Management of Critical Pulmonary Stenosis in a 12-Month-Old Boy By percutaneous transluminal balloon valvuloplasty

Abstract&#x0D; Critical pulmonary stenosis (PS) is used in infants born with very severe narrowing valves and requires treatment soon after birth. At four months old, an A-12-month-old boy was diagnosed with critical pulmonary stenosis but still successfully managed by percutaneous transluminal balloon valvuloplasty (PTBV) with satisfactory results without serious complications. Since he was born, cyanosis was seen at his lips and fingertip, with oxygen saturation around 60% until 70%. Echocardiography showed critical pulmonary stenosis, atrial septal defect (ASD), and patent ductus arteriosus (PDA). Percutaneous transluminal balloon valvuloplasty (PTBV) is accepted as the treatment of choice for critical pulmonary valve stenosis in many centers worldwide with significant results. After PTBV, he experienced improvement condition as no cyanosis was observed and oxygen saturation was 96%. This case was our first PTBV intervention case in our hospital and gave satisfactory results, although the intervention was delayed due to our limited resources before. &#x0D; Keywords: cyanosis, critical pulmonary stenosis, percutaneous transluminal balloon valvuloplasty

Outcome and right ventricle remodelling after valve replacement for pulmonic stenosis

BackgroundComplications and need for reinterventions are frequent in patients with pulmonary valve stenosis (PVS). Pulmonary regurgitation is common, but no data are available on outcome after pulmonary valve replacement (PVR).MethodsWe...

Percutaneous Mitral Balloon Valvuloplasty: Technique and Results

Background: Percutaneous balloon mitral valvuloplasty is a procedure used to dilate the mitral valve in cases of rheumatic mitral stenosis. The catheter is inserted into the female vein to the right atrium and atrial septum. The mitral valve is then passed through the inflated balloon to facilitate effective integration of mitral adhesions, which increases the area of the mitral valve and decreases the rate of mitral stenosis. Mitral regurgitation is a potential problem, and thus balloon percutaneous mitral valvuloplasty (PBMV) is prevented in moderate to severe relapse. The Wilkins score studies mitral valve morphology and evaluation by echocardiography to assess the viability of PBMVs based on specific echocardiographic conditions.&#x0D; Conclusion: There are many factors in the immediate and long-term outcomes of patients undergoing PMV. Echo-Sc can be used in combination with other clinical and morphological predictions of PMV effects to identify patients who experience the best effects on PMV.

Pericardial tamponade during balloon pulmonary valvuloplasty in a dog

AbstractA 4‐month‐old entire male Coton de Tulear dog was referred for balloon valvuloplasty for treatment of severe valvular pulmonic stenosis. During the procedure, when attempting to pass the guide wire into the ventricle, the dog developed cardiac arrest. After initial resuscitation with chest compressions, manual ventilation, adrenaline and intravenous fluids, focused cardiac ultrasound revealed pericardial effusion and cardiac tamponade. Pericardiocentesis resolved the haemodynamic emergency. This case report should raise awareness of pericardial tamponade as a possible complication during pulmonic stenosis balloon valvuloplasty. It describes the clinical signs observed during anaesthesia as well as how to treat it with a positive outcome.

Coil Embolization of Iatrogenic Femoral Artery Pseudoaneurysm

<h3>Introduction and Objective</h3> Femoral pseudoaneurysms are not uncommon after cardiac catheterizations. Multiple methods are used to treat pseudoaneurysms including ultrasound guided thrombin injection, direct pressure, stent grafting, open surgical repair and endovascular coil embolization. We describe a patient with severe comorbidities with complicated femoral pseudoaneurysm treated with emergent coil embolization via radial access. <h3>Case Report</h3> An obese 77-year-old female with multiple comorbidities, who was deemed a prohibitive risk for cardiac surgery, was taken to the cardiac cath lab for percutaneous coronary intervention. She underwent balloon valvuloplasty of the aortic valve in addition to placement of drug-eluting stents in the left main, LAD, diagonal and circumflex arteries. This was accomplished through a 10 French sheath placed in the left common femoral artery. The groin was closed with two Perclose devices. An immediate hematoma developed in the left groin. Manual pressure was held until the patient was stable. She was then transported to the ICU. Shortly after arrival in the ICU, the patient developed hypotension. She was taken back to the cardiac cath lab where she underwent an arteriogram via the left radial artery. Contrast extravasation was noted from the left femoral artery. Several attempts to control hemorrhage with balloon occlusion were unsuccessful. Urgent vascular surgery consultation was obtained. Patient was emergently moved to the endovascular operating room. Left femoral arteriography via left radial access revealed active contrast extravasation from the femoral bifurcation into a large pseudoaneurysm cavity. A vertebral catheter was used to advance a glide wire into the pseudoaneurysm. A microcatheter was then advanced into the pseudoaneurysm cavity. The pseudoaneurysm was embolized with two detachable 6 × 12 Penumbra Ruby coils. Post embolization, there was minimal flow into the pseudoaneurysm. Duplex ultrasound performed the next day revealed minimal flow in the pseudoaneurysm cavity with a maximal flow lumen of 1 cm. This was observed and it spontaneously thrombosed. The patient ultimately recovered and returned to her baseline medical status. <h3>Discussion</h3> A variety of methods are available for the treatment of pseudoaneurysms. Traditional treatment options include ultrasound-guided manual compression, thrombin injection and open surgery. With the development and evolution of endovascular techniques, less invasive options such as stent graft coverage and coil embolization can be successfully utilized. There are few case reports of coil embolization of femoral pseudoaneurysms. In selected patients, coil embolization may be an effective alternative to surgical treatment and can be offered by the vascular surgeon.