scholarly journals Combined Echo and Fluoroscopy-Guided Pulmonary Valvuloplasty in Neonates and Infants: Efficacy and Safety

2021 ◽  
Author(s):  
Nicholas K. Brown ◽  
Nazia Husain ◽  
Jennifer Arzu ◽  
Sandhya R. Ramlogan ◽  
Alan W. Nugent ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Efficacy And Safety ◽  
Historical Cohort ◽  
Dose Area Product ◽  
Percutaneous Balloon ◽  
Excellent Safety Profile ◽  
Area Product ◽  
Neonates And Infants ◽  
Procedural Outcomes

AbstractPercutaneous balloon pulmonary valvuloplasty (PBPV) is the treatment of choice for isolated pulmonary valve stenosis. While this procedure is highly efficacious and has an excellent safety profile, as currently practiced, patients are obligatorily exposed to the secondary risks of ionizing radiation and contrast media. To mitigate these risks, we developed a protocol which utilized echo guidance for portions of the procedure which typically require fluoroscopy and/or angiography. Ten cases of echo-guided pulmonary valvuloplasty (EG-PBPV) for isolated pulmonary stenosis in children less than a year of age were compared to a historical cohort of nineteen standard cases using fluoroscopy/angiography alone, which demonstrated equivalent procedural outcomes and safety, while achieving a median reduction in radiation (total dose area product) and contrast load of 80% and 84%, respectively. Our early experience demonstrates that EG-PBPV in neonates and infants has results equivalent to standard valvuloplasty but with less radiation and contrast.

Percutaneous Balloon Valvuloplasty for Congenital Pulmonary Stenosis

1988 ◽  
Vol 10 (6) ◽  
pp. 179-182
Author(s):  
Jon B. Tingelstad
Keyword(s):  
Heart Surgery ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Open Heart Surgery ◽  
Balloon Catheter ◽  
Balloon Valvuloplasty ◽  
Safe Procedure ◽  
Percutaneous Balloon ◽  
Valvular Stenosis ◽  
Percutaneous Balloon Valvuloplasty

Percutaneous balloon valvuloplasty is an effective alternative to open-heart surgery for moderate and severe pulmonary valvular stenosis and is the treatment of choice for the typical form of this congenital heart defect in many medical centers. Standard right and left heart catheterizations with biplane cineangiocardiography to evaluate the anatomy and motion of the pulmonary valve are performed. If the criteria for balloon valvuloplasty are met, a balloon catheter is inserted in the vein and advanced so that the balloon straddles the stenotic pulmonary valve. The balloon is inflated by hand until the constriction caused by the stenosis disappears. The procedure is repeated to confirm the absence of the constriction and the catheter is removed. Balloon valvuloplasty is a safe procedure, and no fatalities or major morbidity have been reported.

scholarly journals Percutaneous Balloon Pulmonary Valvuloplasty of Critical Pulmonary Stenosis and severe pulmonary stenosis in Neonates and Early Infancy: A Challenge in the Cyanotic

2021 ◽  
Vol 13 (2) ◽  
pp. 156-161
Author(s):  
Hojjat Mortezaeian ◽  
Mohammadrafie khorgami ◽  
Negar Omidi ◽  
Yasaman khalili ◽  
Maryam Moradian ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Ductus Arteriosus ◽  
Pressure Ratio ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Percutaneous Balloon ◽  
The Right

Introduction: Pulmonary stenosis with an intact ventricular septum (PS-IVS) is one of the common causes of cyanotic heart disease in neonates with diverse morphologies as well as management and treatment protocols. The aim of this study was to evaluate short and midterm results of balloon pulmonary valvuloplasty (BPV) for this disorder. Methods: Between 2012 and 2016, Totally 45 neonates and infants under 6 months old were evaluated.The patients had a minimum right-to-left ventricular pressure ratio of 1, right-to-left shunting at the patent foramen ovale or atrial septal defect level, and tricuspid valve Z-scores higher than -4. Results: Immediately after the procedure, the right ventricular pressure dropped to the normal values in 8 (20%) patients. The immediate procedural success rate was seen in 42 (93.3%) cases: the right-to-left ventricular pressure ratio dropped to below 50% or the level of O2 saturation rose above 75%. Of three cases unresponsive to BPV, two of them underwent patent ductus arteriosus (PDA) stenting and one procedural death occurred. At 6 months’ follow-up, of 42 patients, this pressure was still with in the normal range in 36 (80%) infants, while it had returned to high values in 9 (20%) patients and necessitated repeat valvuloplasty. After BPV, severe pulmonary valve regurgitation was observed in14.2% patients; the condition was more common when high-profile noncompliant balloons were used. Conclusion: Balloon pulmonary valvuloplasty in infants with PS-IVS confers acceptable results insofar as it improves echocardiographic parameters and hemodynamic changes at short- and midterm followups.Balloon selection with sizes more than 1.2 of the diameter of the pulmonary valve annulus and the use of noncompliant high-pressure balloons results in higher degrees of pulmonary regurgitation.

Pulmonary valve cusp augmentation for pulmonary regurgitation after percutaneous balloon pulmonary valvuloplasty of valvular pulmonary stenosis

2018 ◽  
Vol 28 (3) ◽  
pp. 507-510 ◽  
Author(s):  
Irfan Tasoglu ◽  
Atakan Atalay ◽  
Omer Nuri Aksoy ◽  
Vural Polat
Keyword(s):  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Anterior Leaflet ◽  
Surgical Operation ◽  
Percutaneous Balloon ◽  
Expansion Technique ◽  
Valvular Stenosis ◽  
Valvular Pulmonary Stenosis ◽  
Polytetrafluoroethylene Patch

AbstractPulmonary valvular stenosis is a relatively common disorder, accounting for approximately 10% of all CHDs. Pulmonic valvular disease can get clinically detected at different ages of life. The more severe the obstruction, the earlier detected the valvular abnormality. Surgical pulmonary valvotomy has been available as a treatment since 1956. This article is about a case of pulmonary annular and valvular stenosis in a 1-year-old child, and it also explores surgical operation of this condition. Transannular patches are usually used within the 1st year of age in pulmonary annular and valvular stenosis. In recent years, anterior leaflet augmentation has been preferred for annulus enlargements. In our 1-year-old case, we expanded the annulus by the anterior leaflet expansion technique and we also augmented other leaflets by polytetrafluoroethylene patch.

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

2020 ◽  
Vol 33 (6) ◽  
pp. 838-844
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Marc Hohenhaus ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Image Data ◽  
3D Image ◽  
Flat Panel ◽  
3D Navigation ◽  
Data Set ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
3D Scan ◽  
Area Product

OBJECTIVEIntraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector. However, the presumably associated higher radiation exposure to the patient has essentially not yet been investigated and is therefore the objective of this study.METHODSPatients were retrospectively included if a thoracolumbar 3D scan was performed intraoperatively between 2016 and 2019 using a 3D C-arm with a large 30 × 30–cm flat-panel detector (3D scan volume 4096 cm3) or a 3D C-arm with a smaller 20 × 20–cm flat-panel detector (3D scan volume 2097 cm3), and the dose area product was available for the 3D scan. Additionally, the fluoroscopy time and the number of fluoroscopic images per 3D scan, as well as the BMI of the patients, were recorded.RESULTSThe authors compared 62 intraoperative thoracolumbar 3D scans using the 3D C-arm with a large flat-panel detector and 12 3D scans using the 3D C-arm with a small flat-panel detector. Overall, the 3D C-arm with a large flat-panel detector required more fluoroscopic images per scan (mean 389.0 ± 8.4 vs 117.0 ± 4.6, p < 0.0001), leading to a significantly higher dose area product (mean 1028.6 ± 767.9 vs 457.1 ± 118.9 cGy × cm2, p = 0.0044).CONCLUSIONSThe novel, noninvasive patient tracker mask facilitates intraoperative 3D navigation while eliminating the need for an additional skin incision with detachment of the autochthonous muscles. However, the use of this patient tracker mask requires a larger intraoperative 3D image data set for accurate registration, resulting in a 2.25 times higher radiation exposure to the patient. The use of the patient tracker mask should thus be based on an individual decision, especially taking into considering the radiation exposure and extent of instrumentation.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

scholarly journals Outcomes of percutaneous balloon pulmonary valvuloplasty in congenital pulmonary valve stenosis

2021 ◽  
Vol 9 (9) ◽  
Author(s):  
Dan Yin ◽  
Xiaoyun Wu ◽  
Ping Xiang ◽  
Yu Zhang ◽  
Jie Tian ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Pulmonary Valve Stenosis ◽  
Percutaneous Balloon

Accuracy of a dose-area product compared to an absorbed dose to water at a point in a 2 cm diameter field

2016 ◽  
Vol 43 (7) ◽  
pp. 4085-4092 ◽  
Author(s):  
S. Dufreneix ◽  
A. Ostrowsky ◽  
B. Rapp ◽  
J. Daures ◽  
J. M. Bordy
Keyword(s):  
Absorbed Dose ◽  
Dose Area Product ◽  
Absorbed Dose To Water ◽  
Area Product

Establishment of dosimetric references in terms of dose-area product for small sizes MV X-ray beams

2015 ◽  
Vol 31 ◽  
pp. e52-e53 ◽  
Author(s):  
M. Le Roy ◽  
S. Dufreneix ◽  
J. Daures ◽  
F. Delaunay ◽  
J. Gouriou ◽  
...  
Keyword(s):  
X Ray ◽  
Dose Area Product ◽  
Area Product

scholarly journals From Bush Medicine to Modern Phytopharmaceutical: A Bibliographic Review of Devil’s Claw (Harpagophytum spp.)

2021 ◽  
Vol 14 (8) ◽  
pp. 726
Author(s):  
Thomas Brendler
Keyword(s):  
Grey Literature ◽  
Reasonable Doubt ◽  
Efficacy And Safety ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Devil’S Claw ◽  
Clinical Investigations ◽  
History Of ◽  
Excellent Safety Profile ◽  
Bush Medicine

Devil’s claw (Harpagophytum spp., Pedaliaceae) is one of the best-documented phytomedicines. Its mode of action is largely elucidated, and its efficacy and excellent safety profile have been demonstrated in a long list of clinical investigations. The author conducted a bibliographic review which not only included peer-reviewed papers published in scientific journals but also a vast amount of grey literature, such as theses and reports initiated by governmental as well as non-governmental organizations, thus allowing for a more holistic presentation of the available evidence. Close to 700 sources published over the course of two centuries were identified, confirmed, and cataloged. The purpose of the review is three-fold: to trace the historical milestones in devil’s claw becoming a modern herbal medicine, to point out gaps in the seemingly all-encompassing body of research, and to provide the reader with a reliable and comprehensive bibliography. The review covers aspects of ethnobotany, taxonomy, history of product development and commercialization, chemistry, pharmacology, toxicology, as well as clinical efficacy and safety. It is concluded that three areas stand out in need of further investigation. The taxonomical assessment of the genus is outdated and lacking. A revision is needed to account for intra- and inter-specific, geographical, and chemo-taxonomical variation, including variation in composition. Further research is needed to conclusively elucidate the active compound(s). Confounded by early substitution, intermixture, and blending, it has yet to be demonstrated beyond a reasonable doubt that both (or all) Harpagophytum spp. are equally (and interchangeably) safe and efficacious in clinical practice.

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