Percutaneous Transluminal Balloon Valvuloplasty Research Articles

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

Abstract
 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. 
 Keywords: cyanosis, critical pulmonary stenosis, percutaneous transluminal balloon valvuloplasty

The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)

The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)

Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology

Between September 1992 and February 1998, 22 consecutive patients aged 4 to 90 days with critical valvular pulmonary stenosis underwent percutaneous transluminal balloon valvuloplasty. Sixteen were cyanosed and 7 required prostaglandin infusion. The pulmonary valve was successfully crossed in all patients. Progressive dilatation was used to attain a final balloon to valve ratio between 1.2 and 1.4. Mean right ventricular systolic pressure dropped from 109 ± 26 to 34 ± 1 mm Hg. Oxygen saturation increased from 84% ± 8% to 98% ± 2%. There were 5 complications including 1 death due to valvular damage, 1 hemopericardium requiring drainage and transfusion, significant blood loss during cannulation in 2 cases, and a fractured guidewire that was retrieved in another. Repeat valvuloplasty was performed in 2 patients. Two patients required surgery; one had a dysplastic pulmonary valve with persistent pulmonary stenosis and the other had a hypoplastic right ventricle. Of the 20 patients who had valvuloplasty alone, 17 (85%) remained well with a mean peak systolic Doppler gradient of 30 ± 26 mm Hg and no pulmonary regurgitation. We concluded that valvuloplasty is likely to be the only procedure necessary for the majority of infants and neonates with critical pulmonary stenosis. However, surgery is required in cases of dysplastic pulmonary valve or hypoplastic right ventricle.

Hemodynamic findings during exercise on a bicycle ergometer following balloon valvuloplasty of pulmonary stenosis in children and adolescents

Eleven patients (4 female, 7 male), age range 3.3 to 24.8 years (mean 11.10 years) treated for isolated pulmonary stenosis underwent cardiac catheterization and percutaneous transluminal balloon valvuloplasty (PTVP). The right ventricular systolic pressure (RVSP) before valvuloplasty ranged from 31 to 127 mmHg (mean 79 mmHg) decreasing to 28 to 62 mmHg (mean 42 mmHg) immediately after the dilatation. The peak systolic gradient of the pulmonary valve (delta p RV-PA) before valvuloplasty ranged from 22 to 107 mmHg (mean 61 mmHg) and decreased to a range of 14 and 45 mmHg (mean 23 mmHg) immediately after the dilatation. Balloon valvuloplasty was performed using balloons of 13 to 31 mm in diameter. On 11 patients cardiac catheterization and Doppler echocardiography were repeated between 11 months and 5.3 years (mean 3.11 years) after the balloon valvuloplasty showed a further significant fall in the gradient of pressure. The right ventricular systolic pressure ranged from 20 to 51 mmHg (mean 31.7 mmHg) while the transpulmonary gradient varied from 3 to 24 mmHg (mean 11.6 mmHg). At the time of follow-up examination the patients were aged between 7.2 and 25.7 years (mean 15.9 years). On average the second catheterization was performed 3.11 years following the first hemodynamic study. The follow-up examination encompassed clinical examination, electrocardiogram, Doppler echocardiography, and right heart cardiac catheterization. During right heart cardiac catheterization the children exercised on a bicycle ergometer for three min at 50 or 100 W depending on their body surface area. During this exertion, pressures of the right ventricle and the pulmonary artery as well as heart rate and oxygen saturation were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative balloon valvuloplasty for critical aortic valvular stenosis in neonates

Critical aortic stenosis (AS) in the neonate represents a particularly severe form of AS where normal compensatory mechanisms are unable to maintain homeostasis, even at rest. Critical AS may be defined as aortic valve stenosis with congestive heart failure and signs of decreased systemic cardiac output. 1 When patients present in infancy with aortic valve stenosis and congestive heart failure, medical management is frequently unsuccessful. Various surgical procedures using both open and closed heart techniques have been attempted to relieve critical AS in infancy. 2–7 Percutaneous transluminal balloon valvuloplasty has been performed in patients with critical AS in infancy. 7 This procedure is technically difficult and at times impossible. The use of balloon valvuloplasty in the operating room has been described for the treatment of AS. 8,9 The technical aspects of intraoperative balloon valvuloplasty and the range of application are still being investigated. Reported complications include severe aortic regurgitation and disruption of an aortic valve cusp. This report describes the use of intraoperative balloon valvuloplasty in 4 neonates who presented with critical AS in the first week of life.

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.

Surgical implications of atrial septal defect complicating aortic balloon valvuloplasty

An 80-year-old man underwent percutaneous transluminal balloon valvuloplasty for critical aortic stenosis. The procedure was performed by the antegrade atrial transseptal approach and was complicated by a persistent atrial septal defect. Symptoms recurred 6 months later, restenosis of the aortic valve was confirmed, and the atrial septal defect yielded a substantially greater left-to-right shunt. This complication of percutaneous transluminal balloon valvuloplasty poses important problems in hemodynamic assesment and operative management of patients who undergo subsequent aortic valve replacement.

Percutaneous Transluminal Balloon Valvuloplasty and Angioplasty for Congenital Heart Disease in Infants.

Percutaneous Transluminal Balloon Valvuloplasty and Angioplasty for Congenital Heart Disease in Infants.

Percutaneous transluminal balloon valvuloplasty for congenital pulmonary valve stenosis and aortic valve stenosis

Percutaneous transluminal balloon valvuloplasty for congenital pulmonary valve stenosis and aortic valve stenosis

Mechanism of Reduction of Aortic Valvular Stenosis by Percutaneous Transluminal Balloon Valvuloplasty: Report of Five Cases and Review of Literature

Among five patients (69 to 93 years of age) in whom percutaneous transluminal balloon valvuloplasty was performed for severe aortic stenosis, fractures of cuspid calcium were observed in three, fractures and a cuspid tear in one, and no gross alterations in one. Aortic stenosis resulted from degenerative (senile) calcification of tricuspid aortic valves in two patients, calcification of congenitally bicuspid aortic valves in two, and postinflammatory (presumably rheumatic) fibrocalcific disease in one. Fractures of calcific lesions, by allowing hingelike motion along their sites, seemed to facilitate cuspid mobility and thereby provided the apparent morphologic substrate for reduction in functional stenosis. Among three cases with fused commissures (two bicuspid and one postinflammatory), however, mobility of the conjoined cusps was not achieved after valvuloplasty, despite fracture of calcific nodules in the adjacent valve pocket of one case, because the fused and calcified commissures were not split or fractured and therefore continued to act as rigid struts that impeded cuspid motion. In the current autopsy evaluation of the effects of aortic balloon valvuloplasty, greater cuspid mobility seemed to be achieved in subjects with degenerative calcific stenosis than in those with calcified bicuspid valves or distortion by postinflammatory disease.

Surgical Evaluation of Percutaneous Transluminal Balloon Angioplasty and Valvuloplasty in Congenital Cardiovascular Anomalies

Percutaneous transluminal bal loon angioplasty and valvuloplasty procedures for treatment of congeni tal cardiovascular anomalies were performed in 109 consecutive pa tients. Forty-two patients had balloon pulmonary valvuloplasty: the mean peak systolic gradient was reduced from 80 ± 35 mmHg to 23 ± 15 mmHg (p < 0.01). Thirty-seven pa tients had balloon aortic valvulo plasty : the mean gradient was re duced from 105 ± 43 mmHg to 28 ± 15 mmHg (p < 0.01). Thirty pa tients had balloon aortic coarctation angioplasty: the mean gradient was reduced from 47 ± 3.9 mmHg to 9.2 ± 1.3 mmHg (p < 0.01). Follow-ups of percutaneous balloon pulmonary valvuloplasty results in 15 patients (mean of 9.1 ± 1.2 months), of per cutaneous balloon aortic valvulo plasty in 17 patients (mean of 11.6 ± 1.9 months), and of percutaneous balloon aortic coarctation angio plasty in 14 patients (mean of 13 ± 4 months) revealed that gradients re mained significantly reduced (p < 0.01) in all groups. Elective op eration was performed upon 14 pa tients following percutaneous transluminal balloon procedures, and pulmonary valves were noted to be opened by commissural splitting, cusp tear, or cusp avulsion from the annulus. Aortic valves had commis sural splitting, and coarctation sites had intimal tears. No deaths oc curred. Percutaneous transluminal balloon valvuloplasty and angioplasty can aid in palliating selected congeni tal cardiovascular anomalies and de lay the time within which operative treatment is required.

Percutaneous transluminal balloon valvuloplasty of congenital pulmonary valve stenosis, with a special report on infants and neonates

Fifty-six percutaneous transluminal halloon valvuloplasty procedures were performed in 51 patients suffering from congenital pulmonary valve stenosis. The patients ranged in age from 1 day to 60 years (mean 6.9 years); 21 were infants <1 year of age, including 8 neonates. The peak systolic pressure gradient was >50 mm Hg (mean 81.5) in 47 cases, and <50 mm Hg (mean 34.6) in 9. Valvuloplasty enabled a reduction in the mean right ventricular peak systolic pressure from 93.1 to 51.6 mm Hg (p < 0.001), the mean transvalvular gradient from 73.4 to 27.0 mm Hg (p < 0.001) and the mean right ventricular pressure expressed as a percent of systemic pressure from 99.5 to 52.0% (p < 0.001). In infants and neonates, the mean right ventricular pressure expressed as a percent of systemic pressure decreased from 117.3 to 64.4% (p < 0.001).In 23 patients, follow-up cardiac catheterization at 1 to 17 months revealed a significant change in the right ventricular systolic pressure, which decreased from 54.0 to 46.7 mm Hg (p < 9.05), and in the peak systolic pressure gradient, which decreased from 27.3 to 22.6 mm Hg (p < 0.05). Valvuloplasty is an effective procedure in relieving pulmonary stenosis in patients of all ages, including neonates.

Percutaneous transluminal balloon valvuloplasty of adult aortic stenosis: Report of 92 cases

Percutaneous transluminal balloon valvuloplasty was attempted in 92 adult patients with severe calcific aortic stenosis. The mean age was 75 +/- 11 years (range 38 to 91) and 35 patients were more than 80 years old. Most of the patients were severely disabled; 66 were in New York Heart Association functional class III or IV, 27 had syncopal attacks and 21 had severe angina pectoris. Because of unacceptably high surgical risk or contraindication to thoracic surgery, 42 patients could not be considered for valve replacement. Other patients either were in a category of high operative risk or refused the surgical intervention. Valvuloplasty was performed by way of the femoral route (82 patients) or the brachial route (10 patients). Catheters of size 15, 18 and 20 mm were successively placed across the aortic valve and three inflations were usually done with each of them, lasting 80 seconds on average, until a decrease in peak to peak systolic pressure gradient to 40 mm Hg or less was attained, a result considered satisfactory. The inflated balloons were not totally occlusive in most cases and clinical tolerance of inflation was good. Valvuloplasty resulted in a reduction of mean systolic gradient from 75 +/- 26 to 30 +/- 13 mm Hg (p less than 0.001); the final gradient was less than 40 mm Hg in 78 patients. Mean calculated aortic valve area increased from 0.49 +/- 0.17 to 0.93 +/- 0.36 cm2 (p less than 0.001). Immediately after the procedure, ejection fraction increased from 48 +/- 16 to 51 +/- 16% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)