Interventional Balloon Dilatation Research Articles

Outcomes of Early Simultaneous Removal of Ureteric Stent With Indwelling Urethral Catheter After Kidney Transplant in Pediatric Recipients: A 10-Year Review

A ureteric stent is routinely placed to minimize urological complications during kidney transplant. However, some complications may occur in association with the ureteric stent, such as urinary tract infections, and the optimal duration for stent placement is unclear. We reviewed the outcomes following early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients. We reviewed all kidney transplants from January 2009 to January 2019. The data we collated included demographics, donor and recipient characteristics, and perioperative details, including urological complications, stent-related complications, and kidney graft function. The financial cost of late stent removal was calculated. The early stent removal group was defined as 5 days, and the late removal group was about 4 to 6 weeks. The median follow-up time was 60 months (interquartile range, 31.5-91 months). There were 32 transplants in 31 patients during the study period (early vs late group = 23:9). No urine leak occurred in either group. One patient in the early group developed distal ureteric stenosis, and this condition was managed with interventional balloon dilatation. The median time for stent removal was 6 days in the early group and 39 days in the late group. There were 5 episodes of symptomatic urinary tract infections in 3 patients in the early group and 10 episodes of symptomatic urinary tract infections in 3 patients in the late group. The mean estimated glomerular filtration rate at 12 months was comparable between the 2 groups (84 ± 54 vs 64 ± 21 L/min/1.73 m²; P = .3). The average cost for each early removal was A$772.65 compared with the late group. Early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients is feasible, safe, and cost-effective.

Balloon Dilation for Obstructive Eustachian Tube Dysfunction in Children.

Determine the safety and efficacy of balloon dilation of the Eustachian tube (ET) in pediatric patients. Retrospective matched cohort study. Tertiary medical center. Pediatric patients (<18 yr) with persistent (>1.5 yr) chronic Eustachian tube dysfunction (ETD) with previous tympanostomy tube (TT) insertion versus matched controls. Balloon dilation of the cartilaginous ET (BDET) was performed using concomitant myringotomy with/without tube placement and adjunctive procedures if indicated versus controls (TT). Otitis media with effusion (OME)/retraction with need for additional tube, tympanogram, audiogram, otomicroscopy, ET mucosal inflammation/opening score, and Valsalva maneuver. Forty six ETs (26 patients), ages 7 to 17 years (mean 12.5) underwent BDET. Mean follow-up was 2.3 years (standard deviation [SD], 1.1; range, 6 mo-5 yr). Significant improvements were observed for all measures. Tympanic membranes were healthy in 9% preoperatively, 38% at 6 months, 55% at 12 months, and 93% at 36 months postoperatively. Tympanograms improved to type A in 50% at 6 months, 59% at 12 months, and 85% at 36 months. Mean scores of mucosal inflammation declined from 3.2 (±0.6) preoperatively to 2.5 (±0.7) at 6 months and 1.7 (±0.6) at 36 months postoperatively. BDET had lower risk of failure versus TT insertion (adjusted hazard ratio [HR] 0.26; 95% confidence interval [CI]: 0.10, 0.70; p = 0.007). Probability of being failure free at 2 years was 87% (95% CI: 70, 94%) after BDET and 56% (95% CI: 40, 70%) after TT insertions. BDET is a safe and possibly effective procedure in selected pediatric patients with chronic ETD.

Chinese Pediatric Organ Donation With Scheduled Cardiac Arrest After Brain Death: A Novel China Classification Beyond Maastricht

ObjectiveOrgan donation with scheduled cardiac arrest after brain death (s-DBCD) is a special category in China. This study was to evaluate the procedure of pediatric s-DBCD, graft quality, and clinical outcomes of single kidney transplantation. MethodsWe retrospectively analyzed the data of 8 Chinese pediatric donors. ResultsThe death causes of the donors (age 4–12 years) were cerebral hypoxia after cardiopulmonary resuscitation (n = 1), intracranial vascular malformation (n = 1), severe traumatic brain injury (n = 3), and brain malignancy (n = 3). The functional warm ischemia time of the grafts was 18 (13–26) minutes. Sixteen kidneys were recovered using liver-kidney en bloc procurement after in situ perfusion. All kidneys had a length >7 cm and were transplanted to 3 adolescent and 13 adult recipients. Two cases of delayed graft function occurred. The patients had a median serum creatinine level of 97 (55–123) μmol/L by the last visit. The median estimated glomerular filtration rate level was 85.4 (58–136) mL/min. Five episodes of biopsy-proven acute rejection occurred in 4 patients, which were reversed by methylprednisolone pulse therapy. Renal arterial stenosis was observed in 1 patient, which was cured by interventional balloon dilatation and stent implantation. ConclusionPediatric s-DBCD is feasible with acceptable graft quality. Single kidney transplantation with pediatric graft size >7 cm has good clinical outcomes.

Diagnosis and management of hepatic venous outflow stenosis in living donor liver transplantation

Hepatic venous outflow stenosis is a rare complication after liver transplantation,its incidence after living donor liver transplantation (LDLT) is 2％-4％.Two recipients who suffered from graft hepatic venous outflow stenosis after right lobe LDLT received conservative treatment and interventional balloon dilatation at the Chinese PLA General Hospital from June 2006 to May 2010.The results demonstrated that conservative treatment is risk-taken for hepatic venous outflow stenosis,while interventional hepatic venous radiography,balloon dilatation and metallic stent placement are effective for the diagnosis and treatment of hepatic venous outflow stenosis. Key words: Hepatic venous outflow stenosis; Hepatic vein; Living donor liver transplantation; Balloon dilatation

Meticulous Use of Techniques for Reconstruction of Multiple Renal Arteries in Live Donor Kidney Transplantation

BackgroundThe aims of this study were to provide an overview of techniques for renal artery reconstruction and to introduce a novel technique using the gonadal vein as a “Carrel patch.” Materials and MethodsFrom January 2005 to December 2011, we performed 128 live donor kidney transplantations. All donor nephrectomies used laparoscopic surgery, yielding 23 grafts with 2 and 3 with 3 renal arteries. The reconstruction technique was based on the length and caliber of the arteries. For 3 renal arteries, we used the gonadal vein as a “Carrel patch”. The gonadal vein was harvested with the ureter as a bundle during nephrectomy. The recipients were 1.5 to 71 years old (average, 43.9). ResultsAll laparoscopic donor nephrectomies were performed successfully with preservation of the multiple arteries. The reconstructions were satisfactory; all grafts functioned immediately. There was no arterial infarction on postoperative Doppler ultrasound and renal nuclear scan. Renal artery stenosis occurred in 2 cases, in which the interventional balloon dilatation was first used; 1 case required subsequent stent insertion. ConclusionIn cases of multiple renal arteries, the live donor kidney can be recovered safely by laparoscopic surgery. Our technique to reconstruct multiple renal arteries uses the gonadal vein as a “Carrel patch.” The gonadal vein is readily available during laparoscopic donor nephrectomy.

Management of venous stenosis in living donor liver transplant recipients

To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT). From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT. The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites. Intraoperative balloon placement, emergent reoperation, proper interventional balloon dilatation and stent placement can be effective as a way to manage hepatic and PV stenosis during and after LDLT.

Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in Children

The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6-41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8-13.0) years. Balloon diameter was 75-133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter > or =100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange.

The perioperative management of bile duct injuries after laparoscopic cholecystectomy

目的 探讨腹腔镜胆囊切除术后胆管损伤围手术期的处理方法.方法 分析我院1989年1月至2005年6月收治的38例腹腔镜胆囊切除术后胆管损伤的临床资料,结合随访结果总结有关围手术期处理方面的经验.结果 38例胆道重建包括胆肠吻合术29例和对端吻合及胆管修补术9例,术后均放置胆道支撑管;术后发生胆瘘5例(13.15%),切口感染4例(10.52%),腹腔积液3例(7.89%).胆道引流管3～4周内拔除31例;5～6周拔除7例.随诊6个月～15年,平均93个月,33例(86.84%)手术效果良好,5例(13.16%)术后吻合口狭窄,其中3例再次手术治愈,2例经十二指肠镜介入球囊扩张好转.结论 胆管损伤宜术中及时发现和合理的处理;胆管损伤导致严重腹腔感染应尽早探查引流择期再行胆道重建术;胆道重建术后吻合口再狭窄处理前须获得满意的影像学检查结果;是否胆管重建术后常规放置支撑管和通过介入方法行胆管扩张治疗胆道狭窄的疗效有待进一步研究。

Determination of the pressure gradient in children with coarctation of the aorta by low-field magnetic resonance imaging.

During the past few years magnetic resonance imaging (MRI) has gained increasing importance in the noninvasive examination of congenital heart defects. Practically all existing examinations have been carried out with a magnetic field strength exceeding 1 (T high-field MRI). Flow quantification is considered to be an advanced MRI application and, in the past, has been available for high-field systems only. Therefore until recently, functional examinations such as MRI tomographic flow quantification were reported exclusively for high-field MRI units. From December 1998 to December 1999, nine patients (five girls and four boys, mean age 130 plus minus 3.6 months, range 62-185 months) were investigated by means of MRI after a previous surgical repair or interventional balloon dilatation of a coarctation of the aorta (mean postinterventional time period 23 plus minus 0.4 months). The examination was carried out without sedation in an open low-field unit (Siemens Magnetom Open 0.2 T). Cardiac-triggered spin-echo sequences were used with a 3-mm to 7-mm slice thickness in an axial and a double oblique plane. The measurement of the immediate poststenotic flow velocity was done by flow-sensitive sequences developed for the study (phase-sensitive flow measurement sequences: TE, 6-12 msec; TR, 50 msec; flip angle, 60 degrees; Vmax, 200-1200 cm/sec; two acquisitions). All patients were examined on the same day with comparative echocardiographic procedures. In all cases, an excellent anatomical evaluation of the aortic arch was possible. The diameters of the residual stenosis were measured by MRI and correlated well r = 0.95; p ? 0.001; mean difference 0.44 +/- 2.47 mm) with echocardiographic results. No wall damage was observed in any of the cases studied. The pressure gradient of the stenosis calculated from the flow sequence was between 17 and 50 mmHg and corresponded well (r = 0.93; p = 0.001; mean difference 0.67 +/- 11 mmHg) with the results obtained from echocardiography. The study demonstrates that examination of the aortic arch is possible in a low-field MRI system, with its significant advantages (lower patient discomfort and more cost-effective examination). In addition, a quantitative flow measurement in low-field MRI was realized for the first time. Low-field MRI therefore seems to be a good, noninvasive method for examining patients with a poor echocardiographic representation of the aortic arch.

A new combined surgical interventional method for univentricular palliation of congenital heart defects

Total cavo-pulmonary anastomosis is frequently performed to palliate patients with a broad variety of congenital heart defects with functionally univentricular hearts precluding biventricular circulation. In patients with risk factors for primary repair a stepwise approach is frequently chosen with initial creation of an aorto-pulmonary shunt followed by a Glenn anastomosis or hemifontan procedure. Finally a total cavo-pulmonary connection is completed surgically. The aim of this feasibility study was to develop a combined surgical-interventional approach for creation of a total cavo-pulmonary anastomosis which reduces the number of surgical interventions, precludes extracorporeal circulation and intracardiac sutures, putting the patients at risk for subsequent rhythm disturbances. A Glenn anastomosis was created in 10 sheep without cardio-pulmonary bypass. The superior vena cava was banded superior to the cavo-atrial junction leaving a minimal lumen for subsequent interventional balloon dilatation and implantation of a stent graft. A 15 mm Gore-Tex tube was sutured around the inferior vena cava intrapericardially to provide resistance for subsequent interventional stent implantation. Total cavo-pulmonary anastomosis was completed interventionally by dilating the banded vena cava superior and connection of the inferior vena cava to the superior vena cava by implanting an Aneurx covered stent graft. All animals survived the combined surgical-interventional procedure. Stent deployment was possible without causing obstruction to the hepatic veins. Neither stent dislocation nor rhythm disturbances were encountered. Total cavo-pulmonary anastomosis can be achieved without intracardiac sutures and cardio-pulmonary bypass by use of a combined surgical-interventional approach using the Aneurx covered stent graft.