Valvuloplasty For Pulmonary Stenosis Research Articles

Adult Congenital Heart Disease and Percutaneous Interventions : Analysis of Cases over five years in a Bangladeshi Center

Background: In recent year ‘s considerable progress has been made in the early diagnosis and treatment of congenital heart disease (CHD) and a significant number of children are expected to survive into adulthood after completion of treatment. This has created a scope of a substantial population of patients with adult congenital heart disease. In Bangladesh, milder or simple from of congenital heart diseases are prevalent among populations but palliated and treated cases of CHD are gradually increasing the load of work for adult congenital heart disease (ACHD) professionals. Many of these cases can be treated by transcatheter intervention with excellent outcome. Methods: This is a retrospective study conducted in a tertiary level cardiac hospitals of Bangladesh from January 2015 to December 2020. All cases aging 18 years and above were included who had undergone cardiac catheterization or percutaneous interventions. Data were collected from Echocardiography department, Catheterization Laboratory and indoor department. Follow up data were collected from echocardiography and outpatient department. Results: Total Two hundred Ninety-four cases were enrolled for cardiac catheterization. Two hundred eighteen cases had various types of intervention. Most of the cases were in 18-25 years age group. Among shunt lesions, 165 cases (56.12%) had atrial septal defect (ASD), 48(22.02%) had ventricular septal defect (VSD), 32 (14.67%) had patent ductus arteriosus (PDA), and 4(1.83%) had patent foramen ovale (PFO). Device closure was performed in 120(55.04%) cases of ASD, 13(5.96%) cases of VSD, 30 (13.76%) cases of PDA and in 4(1.83%) cases of PFO. Nineteen (8.72%) had valvuloplasty for pulmonary stenosis (PS), 2 (0.68%) had valvuloplasty for aortic stenosis (AS), 2(0.068%) had coarctoplasty for coarctation of the aorta (CoA), 4 (1.83%) had percutaneous pulmonary valve implantation (PPVI). Seventeen (7.79%) cases had double intervention of ASD device closure and pulmonary stenosis, 5 (2,29%) cases had ASD and PDA device closure and 2 (0.92%) cases had PDA device closure and balloon coarctoplasty. ASD device was embolized in 4 cases. There were no other complications. Conclusion: Outcome of intervention in ACHD was found safe and effective and no significant short or long-term complications were noticed. Cardiovasc j 2022; 14(2): 121-127

The diagnostic and interventional procedures performed in Angiography Laboratory of Pediatric Cardiology Section

Our aim was to compare the diagnostic and interventional procedures performed in our clinic and evaluate the increase in number and diversity of interventional procedures. Between July 2003 and May 2011 medical records of 1989 patients on whom diagnostic and interventional procedures had been performed was examined. 1036 of the patients (52%) were female and 953 of the patients (48%) were male. Diagnostic procedures were performed in 998 (50.2%) patients, while interventional procedures were performed in 991 (49.8%) patients. The interventional procedures are coil occlusion for patent ductus arteriosus, trans-catheter closure of atrial septal defect, pulmonary balloon valvuloplasty for pulmonary stenosis, aortic coarctation angioplasty, pericardiocentesis for pericardial effusion, aort balloon valvuloplasty for valvular aortic stenosis, permanent and temporary pacemaker insertion for acquired or congenital third degree atrioventricular block and /or sinus node disfunction in 321 (16.1%), 210 (10.6%), 146 (7.3%), 50 (2.5%), 45 (2.3%), 42 (2.1%), 40 (2%) and 33 (1.6%) patients; retrospectively. Interventional procedures were performed in 2,4 and 35 patients in 2003, 2004, and 2005; respectively. Following Angiography Laboratory of Pediatric Cardiology Section set up, interventional procedures were performed in 234 and 439 patients in 2009 and 2010; respectively. Number and variety of interventional procedures have been increased over the years after increased experience of Angiography Laboratory of Pediatric Cardiology Section. Diagnostic angiography procedures have been decreasing over the years by increase in development of new devices and progress of use of interventional treatment techniques. Therefore, interventional procedures have been replaced by diagnostic procedures.

Changes in ventricular repolarization after balloon valvuloplasty in patients with pulmonary stenosis

Background:Alterations in ventricular loading conditions lead to changes in action potential duration via mechanoelectrical feedback. A decrease in load immediately leads to the prolongation of repolarization. QT interval and QT dispersion were measured in order to determine the long-term effect of changes in ventricular systolic load on the ventricular repolarization. Method:Corrected QT interval and QT dispersion were measured in 26 patients before and 3-6 months after valvuloplasty for pulmonary stenosis. In order to determine the effect of ventricular load on ventricular repolarization, patients were divided in 2 groups;Group 1 was those patients with a decrease in the right ventricular systolic pressure greater than 30 mmHg and Group 2 was those patients with a less than 30 mmHg decrease. Results:Corrected QT interval (412.6±14.5 msec vs 426.4±16.8 msec, p<0.05) and QT dispersion (35.0±7.3 msec vs 45.7±14.1 msec, p<0.05) were increased significantly only in Group 1 after valvuloplasty. Conclusion:It suggested that mechanoelectrical interactions are operative for long duration in humans that changes in ventricular load after successful pulmonary valvuloplasty showed a long-term effect on ventricular repolarization. (Korean Circulation J 2001;31(3):341-346)

Changes in myocardial repolarization in patients undergoing balloon valvuloplasty for congenital pulmonary stenosis: evidence for contraction-excitation feedback in humans.

Alterations in ventricular loading conditions lead to changes in action potential duration and arrhythmias via contraction-excitation feedback; a decrease in load leads to prolongation of repolarization. To determine whether changes in right ventricular load alter ventricular repolarization in man, the corrected QT interval, a measure of overall ventricular repolarization, was measured in 32 patients before and after valvuloplasty for pulmonary stenosis. Right ventricular systolic pressure decreased (82.5 +/- 30.7 to 40.5 +/- 9.5 mm Hg, p less than .001) and the QTc increased concurrently (409.1 +/- 24.3 to 440.7 +/- 28.0 msec, p less than .001) after successful valvuloplasty. The increase in QTc was most marked for those patients with a greater than 30 mm Hg decrease in right ventricular pressure (40.0 +/- 23.3 vs 16.3 +/- 21.3 msec, p = .006). In a subset of seven patients in whom monophasic action potentials were recorded, monophasic action potential duration, a measure of local repolarization, was prolonged (230.0 +/- 24.3 vs 216.9 +/- 21.9, p less than .001) after successful valvuloplasty, confirming that the QTc prolongation reflected changes in local ventricular repolarization. In addition, during nine acute right ventricular outflow tract occlusions in a subset of six patients, monophasic action potential duration shortened (206.6 +/- 17.6 vs 221.7 +/- 20.9 msec, p less than .01) and early afterdepolarizations developed consistent with contraction-excitation feedback. These data suggest that, in humans, changes in mechanical load are associated with changes in ventricular repolarization consistent with contraction-excitation feedback.