Triple-lumen Balloon Catheter Research Articles

Minimally invasive cardiac surgery by the port-access method.

Recently, minimally invasive surgery has come to be an important theory in cardiac surgery, the goal of which is shortening of hospital stay, earlier recovery of employment, and cosmetics. In this paper, we will describe our experience with port-access cardiac surgery conducted under the support of our new technology. This study assesses the quality of cardiac surgery performed by the port-access method. The author developed a direct endoaortic clamp balloon (Yozu balloon). This balloon is a triple-lumen balloon catheter of 3.6 mm in outer diameter and 40 cm in full length. The balloon is inserted directly into the ascending aorta. Injection of cardioplegic solution and aortic vent can be conducted. Also, we introduce a modified Cosgrove flex clamp to apply in small-incision surgery, aiming at a less invasive procedure. The modified point is that the original, united Cosgrove flex clamp can be divided into the handle part equipped with a ratchet, and the bellows part equipped with a clamp jaw. By this modification, it became possible to apply the Cosgrove flex clamp transthoracically; that is, it became possible to conduct aortic clamping safely and securely through this small port of 8 mm in diameter. Port-access cardiac surgery is one of the developing and promising methods of cardiac operation. In view of future technological progress, we can expect the gradual but wide popularization of this method.

Comparison of the cardiopulmonary effects of isoflurane and sevoflurane in foals

The purpose of this study was to compare the cardiopulmonary effects of isoflurane (ISO) and sevoflurane (SEV) in foals. Six healthy 1–3-month-old foals (75–163 kg) that were undergoing two minor orthopedic procedures were randomly anesthetized with ISO or SEV in a crossover design. After induction with the inhalation agent in oxygen, foals were placed in dorsal recumbency and 0.1 mg kg−1 butorphanol was administered IV to provide intraoperative analgesia. A 7 Fr 110 cm triple-lumen balloon catheter was advanced through a 8 Fr introducer in a jugular vein until the balloon was wedged in the pulmonary artery. The lungs of each foal were ventilated to maintain normocapnia. During the period of data collection, there was no surgical stimulation and individual depth of anesthesia was adjusted to maintain a weak palpebral reflex (expired ISO 1.45 ± 0.06%, SEV 2.34 ± 0.14%). Measured parameters for the study included heart rate, direct systemic arterial pressure, central venous pressure, cardiac output, direct pulmonary arterial pressure, pulmonary wedge pressure, arterial and venous pH, HCO3, and O2 and CO2 tensions, tidal volume, minute ventilation, and temperature. Measured parameters were used to calculate systemic vascular resistance, pulmonary vascular resistance, cardiac index, stroke volume, stroke index, arterial and mixed venous oxygen contents, oxygen delivery, oxygen consumption, extraction ratio, shunt fraction, and physiological dead space. Baseline data were recorded at 15 minutes after anesthetic agent was first introduced. Data were recorded every 15 minutes after baseline until 60 minutes, and arterial and mixed venous blood gas samples were collected at baseline, 30 minutes, and 60 minutes. After the final data were collected at 60 minutes, surgery commenced. Data were analyzed for normality, and were compared using a two-way anova and Bonferroni's test. Significant differences between drugs were taken if p = 0.05. No significant differences in any of the measured or calculated parameters were observed between ISO and SEV during this study. Sample data for ranges of mean values included: heart rate (ISO 63–67 beats minute−1, SEV 68–73 beats minute−1), mean arterial pressure (ISO 46–96 mm Hg, SEV 44–83 mm Hg), cardiac index (ISO 93–116 mL kg−1 minute−1, SEV 100–117 mL kg−1 minute−1), mean pulmonary pressure (ISO 10–23 mm Hg, SEV 13–19 mm Hg). Based on the results of this study, both ISO and SEV will provide comparable maintenance of anesthesia in 1–3-month-old foals.

CT arterial portography and CT arteriography with a triple-lumen balloon catheter.

To evaluate the usefulness of the triple-lumen balloon catheter in the serial performance of CT arterial portography (CT-AP) and CT arteriography (CT-A). A combined CT-AP and CT-A examination of 58 patients was carried out in which a cobra-type triple-lumen balloon catheter was used. CT-AP was performed by injecting contrast medium either into the splenic artery through a side-hole in the catheter proximal to the balloon inflated in the common hepatic artery, or into the superior mesenteric artery through an end-hole in the catheter. Then CT-A was serially performed by delivering contrast medium either to the common hepatic artery or the proper hepatic artery from the end-hole, or to the accessory right hepatic artery through a side-hole proximal to the inflated balloon. Sufficient CT-APs were obtained in 53 of the 58 patients (91%), CT-A in 42 (72%), and both in 42 (72%). Incomplete CT-AP was due to technical failure or anatomical anomaly, as was incomplete CT-A. No complications were seen. The triple-lumen balloon catheter technique is useful and convenient in the serial performance of CT-AP and CT-A.

CT Arterial Portography and CT Arteriography with a Triple-Lumen Balloon Catheter

CT Arterial Portography and CT Arteriography with a Triple-Lumen Balloon Catheter

Biliary balloon dilation using a triple-lumen balloon catheter

Biliary balloon dilation using a triple-lumen balloon catheter

Utilization of Triple-Lumen Balloon Catheter for Occlusion of the Ascending Aorta During Distal Aortic Arch Surgery with Hypothermic Retrograde Cerebral Circulation TechniqueThrough Left Thoracotomy

A technique of using a triple-lumen balloon catheter for occlusion of the ascending aorta in patients with distal aortic arch aneurysm during open proximal anastomosis utilizing hypothermic retrograde cerebral circulation technique through left thoracotomy was described. The balloon greatly facilitated (1) occlusion of the ascending aorta without cross clamping, (2) delivery of cardioplegic solution, (3) suctioning blood pooled in the aortic arch, and (4) prevention of entrance of debris into the left ventricle or coronary arteries.

A triple lumen balloon catheter (TLBC) allows simultaneous balloon dilatation (BD) of the biliary tree, guidewire advancement (GA) and contrast injection (CI)

A triple lumen balloon catheter (TLBC) allows simultaneous balloon dilatation (BD) of the biliary tree, guidewire advancement (GA) and contrast injection (CI)

Sclerotherapy of the Gallbladder in Pigs

Gallbladder sclerotherapy after permanent cystic duct occlusion, to prevent gallstone recurrence in nonsurgical gallstone therapy, is at least a two-stage procedure. A balloon catheter was developed to perform gallbladder sclerotherapy with only temporary occlusion of the cystic duct, and the efficacy and safety of this method was subsequently investigated. Twenty pigs underwent cholecystostomy for positioning of a 7-Fr triple-lumen balloon catheter with proximal side holes. Sclerotherapy with 96% ethanol and 3% sodium tetradecyl sulfate for 20 minutes was performed. The animals were killed 24 hours, two, six, and 12 weeks after the procedure. The balloon catheter functioned well and seems suitable for procedures in which a temporary occlusion of the cystic duct is required. Although gallbladders after six and 12 weeks were shrunken and fibrotic, a single treatment of gallbladder sclerotherapy with subsequent catheter removal and no permanent cystic duct occlusion, as performed in this experiment, did not produce complete gallbladder ablation. In this study, sclerotherapy proved safe in the short term, but long-term effects remain to be assessed.

Pulmonary hypertension induced with an intra-arterial balloon: an alternate mechanism.

The Laks catheter is a triple-lumen balloon catheter used to distend the canine main pulmonary artery while recording right ventricular pressure and the arterial pressure distal to the balloon. A rise in arterial pressure reported to occur during distension has been attributed to vasoconstriction rather than passive obstruction by the balloon. We tested this in six anesthetized dogs by inflating the Laks catheter-balloon while recording pressure distal to the balloon from the Laks catheter as well as from additional catheters in right and left pulmonary arteries placed retrogradely through lobar branches following thoracotomy. We found that balloon inflation increased pressures in the arterial port of the Laks catheter and in the left pulmonary artery catheter but reduced it in the right pulmonary artery. Tightening a snare around the right pulmonary artery had the same effects on pressures. Similar results were obtained while cardiac output was controlled by left ventricular bypass perfusion in four dogs. We conclude that the Laks catheter-balloon obstructs flow to the right lung and that the arterial pressure rise recorded in it during balloon inflation cannot be distinguished from that caused by occlusion of the right pulmonary artery.

Intracavitary irradiation for carcinoma of the urinary bladder: rationale, technique, and preliminary results.

Twelve patients with transitional cell carcinoma of the bladder have been treated employing a combination of external beam radiation (4000 to 5040 cGy/4 to 5.5 weeks) supplemented by intracavitary irradiation (1500 to 3000 cGy mucosal dose) using a triple lumen balloon catheter containing a central 137Cs source. The rationale, patient selection, and preliminary results are reported, and the technique of the intracavitary brachytherapy is described.

Experimental Pulmonary Hypertension Produced by Surgical and Chemical Denervation of the Pulmonary Vasculature

The purpose of this study was to investigate the hypothesis that balloon distention of the main pulmonary artery (MPA) induces pulmonary hypertension that is produced by a neural reflex and to investigate the possible efferent components of its reflex arc. Using a specially designed triple-lumen balloon catheter, positioned under fluoroscopy in the MPA, the hemodynamic responses to MPA distention were studied before and after the following: surgical denervation of the bifurcation of the MPA, chemical sympathectomy (6-hydroxydopamine), 100 percent oxygen breathing, and vagotomy. Our findings suggest that the experimental pulmonary hypertension caused by distention of the MPA is produced by excitation of stretch receptors in or near the bifurcation of the MPA and that the efferent limb of this reflex is predominantly mediated via the adrenergic nervous system.

Acute Pulmonary Artery Hypertension Produced by Distention of the Main Pulmonary Artery in the Conscious Dog

In order to delineate further the function of the main pulmonary artery as a receptor site, a specially designed Laks triple-lumen balloon catheter was inserted transvenously and positioned in the main pulmonary artery. In six conscious nonsedated dogs, inflation of a balloon in the main pulmonary artery produced acute reversible pulmonary arterial hypertension; the pressure beyond the balloon increased from a mean of 21/6 mm Hg to 43/14 mm Hg (P less than 0,001). This observed pulmonary hypertension occurred at an amount of balloon inflation which produced an increase in right ventricular systolic pressure (P less than 0.001), but no significant change occurred in cardiac output (P greater than 0.05) or right ventricular end-diastolic pressure (P greater than 0.1). Left atrial and pulmonary artery wedge pressures did not change or decreased slightly (P greater than 0.1 and P greater than 0.1, respectively). The calculated pulmonary vascular resistance increased (P less than 0.001), while the calculated systemic vascular resistance did not chang (P greater than 0.04). Therefore, we postulate that distention of the main pulmonary artery in the conscious dog reflexly produces constriction of pulmonary arterioles, and possibly venules, due to excitation of receptors probably located in the wall of the pulmonary artery or possibly the right side of the heart, or both.

A modification of the Dotter-Lukas catheter

Because of a high incidence of cardiac perforations with the Dotter-Lukas catheter a modification of the Dotter-Lukas triple-lumen balloon catheter is presented. The advantages include a more flexible tip, a larger balloon, and a platinum electrode to warn of impingement against the endocardium during passage of the catheter as well as to insure complete occlusion by the balloon by the hydrogen-gas or ascorbic-acid technique.