Single Balloon Technique Research Articles

Prior surgical mitral commissurotomy and echocardiographic score influence in mitral balloon valvuloplasty. Immediate post procedure results

Abstract Introduction Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis. Objectives: to evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV). Methods From 1987 to 2013, 526 procedures with Inoue balloon, double or single Balt balloon technique; 480 without PMC named primary MBV group (PMBVG) and 46 that have been submitted to PMC, the PMC group. The PMCG was older than PMBVG (42.7±12.4 vs 36.9±12.5 years, p=0.0030). Gender, atrial fibrilation and NYHA functional class were similar. In PMBVG and PMCG, respectively, ES were 7.2±1,4 and 7.7±1.5 points (p=0.0158) and mitral valve area (MVA) 0.94±0.21 and 1.00±0.22 cm2 (p=0.0699). Results Pre-MBV: mean pulmonary artery pressures (MPAP) were 37.8±14.2 and 37.6±14.4 mmHg, p=0.9515; mean gradient (MG) 19.6±6.9 and 18.3±6.9 mmHg, p=0.2342; MVA 0.90±0.21 and 0.93±0.19 cm2, p=0.4092, respectively, whem compare PMBVG and PMCG. Post-MBV: MPAP were 26.8±10.2 and 26.6±10.9 mmHg, p=0.9062; MG 5.4±3.5 and 6.3±4.2 mmHg, p=0.1492; MVA 2.04±0.42 and 1.92±0.41 cm2, p=0.0801, respectively. Mitral regurgitation (MR) were similar pre and post-MBV. Severe MR post-MBV in 10 patients: 8 in PMBVG and 2 in PMCG, p=0.2048. As there were not found significant diferences, the total group were divided in ES ≤8 and >8 groups: Pre-MBV: MPAP 37.5±13.9 and 39.3±16.6 mmHg, p=0.4041; MG 19.7±6.8 and 18.3±7.3 mmHg, p=0.1753; MVA 0.90±0.21 and 0.94±0.20 cm2, p=0.0090 respectively. Post-MBV: MPAP 26.7±10.1 and 28.0±10.6 mmHg, p=0.3730, MG 5.5±3.6 and 5.5±3.3 mmHg, MVA 2.06±0.42 and 1.90±0.40 cm2, p=0.0090. Conclusion The groups with and without prior mitral commissurotomy in MBV were compare and no differences were found in pre- and post-procedure, as mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Although PMCG was older, with higher ES, its hemodynamics datas were similar. Whem the entire group was divided based on echo scores, those with echo scores >8 had highse MV (p=0.0090). and smaler mitral valve areas post-valvuloplasty. The valve anatomy were more important than prior commissurotomy. Funding Acknowledgement Type of funding source: None

Single Balloon-assisted Colonoscopy for Placement of Colonic Manometry Catheters: Initial Experience in Children.

Colonic manometry is used frequently in children with long standing and difficult to manage constipation to aid in management decisions. Accurate analysis requires placement of the colonic manometry catheter in the colon without looping. This is technically difficult due to the long-standing nature of the constipation in most patients leading to sigmoid and other colonic redundancy. Single balloon colonoscopy has been successfully used in adult in cases of difficult colonoscopy. We report the first series of single balloon-assisted colonoscopy for performing difficult colonoscopy in children and placing colonic manometry catheters. Retrospective chart review was performed to identify patients undergoing the procedure. All patients had prior preparation with nasogastric golytely. Using the single balloon technique, 36 patients underwent placement of the colonic manometry catheter (ages ranging from 3 to 16 years, weights 12 to 95 kg). Catheter placement was successful in all cases with procedure times of 20 to 105 minutes. No major complications were noted. This is the first reported series of using single balloon-assisted colonoscopy to perform difficult colonoscopy in children and place colonic manometry catheters. It may have other therapeutic implications in children such as removal of polyps or placement of similar catheters.

CRT-700.47 Long-term Follow-up of Percutaneous Mitral Valvuloplasty With Single Balloon Technique: Survival and Event-free Survival

Mitral balloon valvuloplasty with Inoue balloon is the worldwide accepted procedure technique. The aims of this study is to evaluate the long-term follow-up (FU) of mitral balloon valvuloplasty (MBV) with Balt single balloon (BSB) technique and to determine independent predictors of survival and

Complete Transcatheter Repair of Fallot’s Trilogy: A Case Report

Fallot’s trilogy is a relatively uncommon form of cyanotic congenital heart disease characterized by severe valvular pulmonary stenosis (PS), right ventricular hypertrophy and right to left interatrial shunt via an atrial septal defect (ASD) or patent foramen ovale (PFO). Historically, patients with the combination of these lesions were routinely treated by surgical correction. In recent times, transcatheter repair has become an increasingly attractive modality of treating such patients. There is limited experience with such combined transcatheter interventions, and from the scarce data available in published literature it seems that such approach has promising safety and efficacy. Herein, we describe a case of an 18 year old cyanotic male patient who was diagnosed of having severe valvular PS with supra systemic right ventricular pressures and reversed interatrial shunt via a large secundum ASD. We successfully treated him percutaneously with serial balloon pulmonary valvuloplasty, using single balloon and Inoue balloon techniques, followed by Amplatzer device closure of the ASD. The outcome was excellent with marked reduction of trans-pulmonary valvular gradient, complete cessation of shunting across the ASD, dramatic improvement of symptoms and completes disappearance of cyanosis. There were no procedure related complications and the benefits were sustained at follow up of three years. Our case demonstrates that transcatheter repair is a feasible, safe and effective alternative to surgery in selected patients with Fallot’s trilogy. With further experience, it may well become the standard of care in the management of such patients.

The "Dog Bone Technique" A Novel Easy and Safe Catheter Maneuver for Aortic Arch and Coarctation Stenting.

Various techniques are described to facilitate stable stent implantation in aortic arch stenosis or coarctation. We describe an alternative technique, which due to its unique appearance during stent implantation, we have named "Dog Bone Technique" (DBT). The stent/balloon assembly is placed across the stenosis, the long sheath is retrieved to uncover the distal 20-50% of the stent. The balloon is inflated with the pressure inflator just to expand slightly the stent. Thereafter the sheath is pulled back and the proximal end is uncovered and partially inflated; therewith the assembly takes the typical "dog bone" shape before complete inflation and final positioning. Repositioning of the stent and control angiography is possible at each time of this procedure. Between 1/2010 and 12/2014 we implanted 91 stents in 87 patients (mean age 20.2 years). About 71 patients had native or re-coarctation and 16 patients had transverse aortic arch stenosis. In 38 patients (44%) a pharmacological exercise test with Orciprenaline was performed during implantation resulting in high-cardiac output. In none of the patients reduction of cardiac output by adenosine or a rapid pacing of the right ventricle was required for stable stent implantation. All stents were implanted in the targeted position using this single balloon technique. There were no acute or short-term complications detected. DBT is a safe and feasible technique for aortic stent implantation even at high-cardiac output. Other additional techniques for stent placement are not necessary to obtain a stable final position in the target region.

Controlled weather balloon ascents and descents for atmospheric research and climate monitoring.

In situ upper-air measurements are often made with instruments attached to weather balloons launched at the surface and lifted into the stratosphere. Present-day balloon-borne sensors allow near-continuous measurements from the Earth's surface to about 35 km (3-5 hPa), where the balloons burst and their instrument payloads descend with parachutes. It has been demonstrated that ascending weather balloons can perturb the air measured by very sensitive humidity and temperature sensors trailing behind them, particularly in the upper troposphere and lower stratosphere (UTLS). The use of controlled balloon descent for such measurements has therefore been investigated and is described here. We distinguish between the single balloon technique that uses a simple automatic valve system to release helium from the balloon at a preset ambient pressure, and the double balloon technique that uses a carrier balloon to lift the payload and a parachute balloon to control the descent of instruments after the carrier balloon is released at preset altitude. The automatic valve technique has been used for several decades for water vapor soundings with frost point hygrometers, whereas the double balloon technique has recently been re-established and deployed to measure radiation and temperature profiles through the atmosphere. Double balloon soundings also strongly reduce pendulum motion of the payload, stabilizing radiation instruments during ascent. We present the flight characteristics of these two ballooning techniques and compare the quality of temperature and humidity measurements made during ascent and descent.

CRT-400.24 Percutaneous Mitral Valvuloplasty With Balt Single Balloon. Long-term Follow-up

To evaluate the long-term follow-up (FU) of mitral balloon valvuloplasty (MBV) with Balt single balloon (BSB) technique and to determine independent predictors of survival and event-free survival (EFS). From 1987 to 12-31-2013, 526 procedures of MBV were perfomed, 404 (77.1%) with BSB. There were

Novel Software-Assisted Hemodynamic Evaluation of Pelvic Flow During Chemoperfusion of Pelvic Arteries for Bladder Cancer: Double- Versus Single-Balloon Technique.

PurposeApproximately 83 % of patients with bladder cancer have achieved a complete response after undergoing a novel bladder preservation therapy involving balloon-occluded intra-arterial infusion chemotherapy (BOAI) using a four-lumen double-balloon catheter, known as the Osaka Medical College regimen. This study aimed to show the quantitative difference in hemodynamics of the bladder arteries using syngo iFlow (Siemens Healthcare, Erlangen, Germany), which provides an automatic tool for quantitative blood flow analysis between double BOAI (D-BOAI) and conventional single BOAI (S-BOAI).Materials and MethodsFifty patients were included. The catheters were introduced into both posterior trunks of the internal iliac arteries via contralateral femoral artery access. A side hole between the distal and proximal balloons was placed at the origin of each bladder artery to allow clear visualization of angiographic flow of the injected agent into the urinary bladder. Digital subtraction angiography was used during analysis with the syngo iFlow to evaluate the hemodynamics of the contrast medium in the pelvic arteries during BOAI. The comparative change in the amount of contrast medium in the bladder arteries between D-BOAI and S-BOAI was assessed using syngo iFlow.ResultsOne-hundred pelvic sides were analyzed. The amount of contrast medium in the bladder arteries using D-BOAI was more than twice that using S-BOAI (right, 3.03-fold; left, 2.81-fold).ConclusionThe amount of contrast medium in the bladder arteries using D-BOAI was higher than that using conventional S-BOAI. This may increase the anticancer drug concentration in the affected bladder, leading to a good clinical response.

Comparison of Immediate and Long-term Results between the Single Balloon and Inoue Balloon Techniques for Percutaneous Pulmonary Valvuloplasty

This study was undertaken to compare the immediate and long-term follow-up results of balloon pulmonary valvuloplasty (BPV) between the single balloon and Inoue balloon for isolated pulmonary valve stenosis (PS). A retrospective analysis of outcomes following BPV in 38 children using the single balloon and 42 adults using the Inoue balloon at a single institution was performed. The majority of children (76.3%) were asymptomatic while 26 adults (61.9%) presented with symptoms. The ratio of balloon size to pulmonary valve annulus was 1.23 ± 0.12 in the children group and 1.22 ± 0.10 in the adult group (P=0.641). The children group had a right ventricle-pulmonary artery systolic gradient of 52.79 ± 35.08 mmHg that decreased to 22.55 ± 12.92 mmHg following BPV (P<0.001). The adult group had a gradient of 94.79 ± 42.19 mmHg that decreased to 34.02 ± 15.00 mmHg following BPV (P<0.001). Mild pulmonary regurgitation occurred in eight children (21.1%) and 10 adults (23.8%) (P=0.768). During a median follow-up of 15 years, gradients were not significantly different from that obtained at one-month follow-up in children (P=0.280) and adults (P=0.373). Adults can be treated with BPV using the Inoue balloon with encouraging immediate and long-term follow-up results that are similar to those in children using the single balloon.

GW24-e2470 Safety and efficacy of percutaueous balloon mitral valvuloplasty in patients with mitral stenosis and thrombus in the left atrial appendage after thrombolytic and anticoagulation therapy

ObjectivesTo evaluate the safety and efficacy of percutaueous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis and thrombus in the left atrial appendage after thrombolytic and anticoagulation therapy.Methods25 patients,...

Balloon Pulmonary Valvuloplasty in patients with Congenital Valvular Pulmonary Stenosis

Background Congenital valvular pulmonary stenosis (PS) accounts for most of the etiology of PS, and constitutes about 5 to 10% of all congenital heart disease. Balloon Pulmonary Valvuloplasty has become the choice of treatment for valvular PS since the first series reported by Kan et al in 19824 and has almost replaced surgical valvotomy in pediatric patients. The purpose of this study was to investigate the immediate results of balloon valvuloplasty in patients with congenital valvular pulmonary stenosis. Method We analyzed hemodynamic data of 122 patients who underwent balloon pulmonary valvuloplasty (ages14days- 50 years mean 25 years). Single-balloon technique was used. Right ventricle systolic pressure and pulmonary valve Peak-to-peak systolic pressure gradient were recorded before and after balloon dilatation of pulmonary valve. Result Right ventricle systolic pressure decreased from 128±44.9 to 60±24.9 mmHg (p &lt;0.001) and pulmonary valve peak-to-peak systolic pressure gradient decreased from 89±38.6 to 45 ± 22.4 mmHg (p &lt;0.001). No major complication or mortality was noted. Conclusion Balloon pulmonary valvuloplasty is a safe and effective treatment for patients with congenital valvular PS. DOI: http://dx.doi.org/10.3126/njh.v9i1.8340 Nepalese Heart Journal Vol.9(1) 2012 pp.7-9ca

Research of the treatment in patients with rheumatic mitral stenosis merging left atrial thrombosis by percutaneous balloon mitral valvuloplasty

ObjectiveTo evaluate the feasibility, safety and efficacy of percutaneous balloon mitral valvuloplasy (PBMV) in patients with rheumatic mitral stenosis merging left atrial thrombosis.MethodsOne hundred and four patients with mitral stenosis...

Catheter Balloon Adjustment of the Pulmonary Artery Band: Feasibility and Safety

The study aimed to assess the feasibility and safety of increasing pulmonary artery band (PAB) diameter by catheter-based PAB balloon dilation (PABBD). Eight dilations were performed between October 2006 and December 2008. Hemoclips were used to fix PABs surgically in a procedure designed to permit progressive clip dislodgment in a controlled manner. The PABBD resulted in gradual band loosening until the desired physiologic state was achieved. At time of PABBD, the patients had a mean age of 6 months (range 3–14 months) and a mean weight of 5 kg (range 2.6–7.3 kg). The median time from PAB placement until PABBD was 4.5 months (range 1–9 months). The single-balloon technique was used in seven cases (serial dilations in 5 cases) and the double-balloon technique in one case. The PABBDs were successful for all the patients, who experienced a mean saturation increase of 75–89% (P = 0.01) (mean increase of 20%), a mean PAB gradient decrease from 69 to 36 mmHg (P = 0.002) (mean decrease of 49%), and a mean band site diameter increase from 4.1 to 6.1 mm (P = 0.01) (mean increase of 45%). The only complication was transient pulmonary edema in one patient. The PABBD procedure is a feasible and safe method for increasing pulmonary blood flow in a staged manner and may eliminate the need for surgical band removal in some cases.

Perkutane Ballonvalvuloplastie der Mitralstenose

Between June 1986 and June 1989, percutaneous balloon valvuloplasty (PBV), using the transseptal, single-balloon technique, was performed in 50 consecutive patients (38 women and 12 men; mean age 54 +/- 14 years) with mitral stenosis. The procedure was technically successful in 48 patients (in one patient the atrial septum could not be crossed, in the other cardiac tamponade occurred). The mean diastolic gradient was decreased from 12.5 +/- 6.6 to 6.1 +/- 3.1 mmHg, mean pulmonary artery pressure (PAP) reduced from 29 +/- 12 to 22 +/- 6 mmHg, and valve opening area increased from 1.0 +/- 0.25 to 1.6 +/- 0.4 cm2. Redilatation had to be undertaken in four patients because of restenosis. Commissurotomy had to be performed in one patient, valve replacement in nine (restenosis in 4, poor primary results in 3, increase in regurgitation in 2). One patient died of a noncardiac cause. Follow-up observations for an average of 14 (3-36) months indicated in 30 of the remaining 33 patients without additional intervention a stable clinical improvement of at least one class (NYHA classification), as well as stable haemodynamic findings (gradient: 6.0 +/- 2.7 mmHg, valve opening area 1.5 +/- 0.3 cm, PAP 23 +/- 7 mmHg. Thus PBV achieved, at least in the medium term, clinical improvement in about two thirds of patients, and an operation was avoided.

Efficacy of pulmonary vein isolation by cryoballoon ablation in patients with paroxysmal atrial fibrillation

Radiofrequency ablation of pulmonary veins (PVs) has emerged as an effective treatment for patients with paroxysmal atrial fibrillation (AF). However, serious complications raise concern about an even wider application. In terms of safety, cryoenergy has advantages compared with radiofrequency. A new cryoenergy balloon catheter has been recently developed to make AF ablation shorter and safer. The purpose of this study was to test the 6-month efficacy of this new device for ablation of paroxysmal AF. Twenty-one patients with highly symptomatic paroxysmal AF, normal left atrial size, and frequent episodes of AF were included. All PVs were targeted during cryoballoon ablation. Patients received 24-hour Holter electrocardiograms (ECGs) and event recorder during follow-up after 1, 3, and 6 months. A total of 81 (95%) of 85 PVs could be completely isolated with a single-balloon technique. Procedure time was 165 +/- 35 minutes, and fluoroscopy time was 39 +/- 9 minutes. After 6 months, 86% of the patients were free of symptomatic AF. In two of three patients with recurrence of AF, complete PV isolation has not been achieved initially. After a second procedure (1.04 procedures per patient), 90% of the patients were free of symptomatic AF. Three phrenic nerve palsies occurred during ablation of the right superior PV; two completely resolved after 6 and 9 months, and one is still persisting after 2 months. This is the first study that reports the results of the new cryoballoon AF ablation approach showing 86% freedom from AF recurrence after 6 months. Cryoballoon PV ablation promises to be effective for patients with paroxysmal AF and normally sized left atria.

Double-balloon colonoscopy after failed conventional colonoscopy: a pilot series with a new instrument

The endoscopes that were developed for double-balloon enteroscopy have been successfully used in cases of failed colonoscopy. This study was a pilot series in which a new colonoscope was tested that utilized this double-balloon principle. A total of 29 patients (5 men, 24 women; mean age 54 years) in whom conventional colonoscopy had failed were included in this study. Both the failed colonoscopy and the double-balloon colonoscopy procedures were performed under general anesthesia, the usual practice in France. A prototype instrument (working length 152 cm, diameter 9.4 mm) designed to incorporate the principles of double-balloon enteroscopy was used. The completeness of colonoscopy was assessed according to conventional criteria by the achievement of a stable position in the cecum. The indicatons for the procedure, the time to reach the cecum, the need for fluoroscopic control, and adverse events were recorded. The previous colonoscopy failed due adhesions (n = 16), or to long or fixed loops (n = 13). Complete colonoscopy using the balloon method was achieved in 28/29 patients, taking an average time of 18 +/- 14 minutes; a long sigmoid loop limited the examination to the left flexure in one patient. Balloon colonoscopy using double-balloon methodology was used in 24 patients and the instrument was used without an overtube (i. e. using a single-balloon technique) in five patients. Fluoroscopy was used in 16 patients to monitor endoscope progression. No complications were reported. Double-balloon colonoscopy enables full colonic examination in almost all patients with a previous incomplete colonoscopy. The overtube should be used in most cases. The use of fluoroscopic assessment of scope progression could be reduced further with increasing experience.

Comparação da evolução a longo prazo da valvoplastia mitral percutânea por balão com a técnica de inoue versus a do balão único: análise dos fatores de risco para óbito e eventos maiores

To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery). The follow-up for the single and Inoue balloon groups were 54 +/- 31 (1 to 126) months and 34 +/- 26 (2 to 105) months, respectively (p < 0.0001). The Balt single balloon was used in 254 (84.1%) patients and the Inoue balloon in 48 (15.9%). The following data were found for the Inoue and single balloon groups, respectively: age, 36.9 +/- 10.4 (19 to 63) years and 38.0 +/- 12.6 (13 to 83) years (p = 0.5769); echocardiographic score, 7.5 +/- 1.3 points and 7.2 +/- 1.5 points (p = 0.1307); female gender, 72.9% and 87.4% (p = 0.0097); atrial fibrillation, 10.4% and 16.1% (p = 0.4275); mortality during follow-up, 2.1% and 4.3% (0.6984); and major events, 8.3% and 17.7% (p = 0.1642). Univariate and Kaplan-Meier curve analyses revealed no differences between the Inoue and Balt single balloon techniques in relation to survival and major event free survival. In the multivariate analysis, age > 50 years and an echocardiographic score > 8 were independent predictors of death; and an echocardiographic score > 8 and post operative mitral valve area < 1.50 cm(2) were predictors for major events. No differences were found in the long term evolution of patients undergoing the Inoue versus the single balloon technique. Predictors of death and/or major events were: age > 50 years, echocardiographic score > 8 and mitral valve area < 1.50 cm(2) after the procedure.

Single-Balloon Enteroscopy: A Preliminary Experience

Introduction: Double balloon enteroscopy is now considered as the gold standard method for small bowel endotherapy. However, double-ballon enteroscopy is frequently described as an heavy and time-consuming procedure. We recently evaluated a new enteroscope with a single balloon. We report here our preliminary experience with this new endoscope. Patients and methods: Between July 2006 and November 2006, 10 patients (8 men and 2 women, median age 60 (22-82)) with gastrointestinal bleeding (n = 5), caeliac disease (n = 2), Peutz-Jeghers syndrome (n = 1), Crohn disease (n = 1) or carcinoid tumor (n = 1) underwent enteroscopy with the single-balloon technique. Capsule endoscopy was previously performed in 8 patients and CT enteroclysis in 5 patients revealing angiodysplasia in 5 patients, small bowel stricture in 1 patient and single or multiple tumor(s) in 2 patients and/or fresh blood in the small bowel in 2 patients. The single balloon enteroscope consisted in an endoscope of 200-cm working length (videoendoscope Olympus CIF-160) and a soft flexible overtube with an inflatable balloon attached to its distal end. This endoscope has a 2-mm diameter operative channel. Results: Enteroscopy with the single balloon technique was carried out using an oral approach in 9 patients and an anal approach in 1 patient. The median duration of the procedure was 120 minutes (60-150). Final diagnosis was multiple angiodysplasia alone (n = 4), associated lipoma and angiodysplasia (n = 1), a carcinoid tumor (n = 1), a small bowel lymphoma (n = 1), multiple hamartoma (n = 1), non complicated caeliac disease (n = 1), and a small bowel inflammatory stricture (n = 1). Endoscopic treatment was performed in 6 cases (argon plasma coagulation (n = 5) and/or polypectomy (n = 1) and/or sclerosis (n = 1). Of course, comparison to double ballon is too early but we felt that the single balloon enteroscopy system was easier to prepare and handle in all cases. No complication occurred. Conclusion: From this preliminary experience, this single-balloon enteroscope appears easy to prepare and use, and was safe and efficient for diagnostic and therapeutic approaches. A comparative study versus double-balloon enteroscope can and should be conducted.

Prospective Evaluation of the Balloon‐to‐Annulus Ratio for Valvuloplasty in the Treatment of Pulmonic Stenosis in the Dog

Background: In dogs, treatment of pulmonic valve stenosis (PS) with pulmonary balloon valvuloplasty (PBV) is a viable method to decrease the pressure gradient across the valve. However, to the authors' knowledge, the variables that influence the selection of the correct balloon size for the procedure have not been explored. Moreover, the lesions caused by the procedure have not been detailed. Hypothesis: Variables that influence the measurement of the annulus could affect selection of the balloon size. We sought to determine the effects of treatment when the balloon‐to‐annulus ratio (BAR) was or &gt; 1.3, but within the recommended range of 1.2–1.5, regardless of whether dilation was performed with single or double balloon technique. Animals: Twenty‐five Beagles with PS were studied. Methods: Inter‐and intra‐observer variability, echocardiography versus angiocardiography, and systolic versus diastolic timing were evaluated for the BAR. Assessment of right ventricular (RV) pressure, Doppler gradient, stenotic valve area, and RV wall thickness were compared before and 1, 90, and 180 days after treatment. Postmortem examination of the heart was done. Results: Significant correlations existed in measurement of the annulus; however, variation existed that would change balloon size. Improvement in the degree of PS was significant regardless of the BAR or single or double ballooning. In the most severely affected dogs, continued improvement was noted on day 90. Postmortem examination revealed tears in the commissures and the valve leaflets. Conclusions: Multiple factors influenced determination of the BAR and a range of 1.2–1.5 was effective without detrimental consequences. Dogs with severe PS had continued decrease in RV pressure 3 months after treatment.

Push-and-Pull Enteroscopy Using a Single-Balloon Technique for Difficult Colonoscopy

Several factors predict difficult or incomplete colonoscopy with a standard colonoscope, including female gender, low body mass index, extensive diverticulosis, and prior pelvic surgery. A push-and-pull enteroscopy device and a single-balloon technique was used in 14 patients (six men, eight women; mean age 62 +/- 15 years) after failure of ileocolonoscopy or endoscopic therapy using either a standard or a pediatric colonoscope. The original ileocolonoscopy had been performed to investigate colon polyps (n = 6), an obscure inflammatory process in the ileocecal region (n = 6), or iron deficiency anemia with a positive fecal occult stool test (n = 2). Ileocolonoscopy was successfully performed using this push-and-pull technique in all 14 patients without technical problems or complications. All the endoscopic therapeutic interventions that were required were also performed without complications, with the exception of one instance of bleeding. Multiple polyps were found in six patients; a colon cancer was found in one patient; appendicitis combined with a carcinoid tumour of the appendix was diagnosed in one patient; ileocolitis was observed in two patients; one patient with Crohn's disease had stenoses in the region of an anastomosis; and in three patients no relevant pathological finding was seen. It was possible to perform ileocolonoscopy with therapeutic interventions using this new thin push-and-pull enteroscopy device with a single-balloon technique in patients who had previously undergone incomplete colonoscopy using a standard colonoscope.