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Author(s):  
Jogendra Singh ◽  
Dibyasundar Mahanta ◽  
Rudra Pratap Mahapatra ◽  
Debasis Acharya ◽  
Ramachandra Barik

A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had higher refractory period than atrioventricular node.


2021 ◽  
Vol 27 (4) ◽  
pp. 53-59
Author(s):  
Elena Yordanova ◽  
Vasil Velchev ◽  
Arman Postadzhiyan ◽  
Nikolay Stoyanov ◽  
Blagorodna Karatancheva ◽  
...  

Besides the standart echcardiografic parameters for mitral stenosis assessment it is necessary to inquire the hemodynamic characteristics as well. The following article describes and illustrates step-by-step the invasive parameters and their significance in the assessment of mitral stenosis in patients who underwent percutaneous balloon mitral valvuloplasty.


VASA ◽  
2021 ◽  
Author(s):  
Anja Boc ◽  
Barbara Eržen ◽  
Rok Luciano Perme ◽  
Vinko Boc

Summary: Background: Disabling peripheral arterial disease (PAD) of femoropopliteal segment is usually treated with percutaneous balloon dilatation, and when this is not successful, stent is placed. Long-term patency of stent is often compromised due to in-stent restenosis (ISR). We aimed to identify factors associated with bailout stenting, and to recognise risk factors for ISR in procedures without paclitaxel application. Patients and methods: We analysed 592 consecutive successful femoropopliteal interventions performed in patients with either disabling intermittent claudication or chronic critical limb ischemia (CLI). In patients with stent implantation, clinical and ultrasound (US) examination were performed one year after the intervention to establish the presence of ISR, defined as >50% stenosis on US imaging. Results: Bailout stenting was required in 133 (22.5%) procedures. Patients with stent placement were younger (70±10 vs 72±11 years, p=0.007) and less often presented with CLI (29.3% vs 40.5%, p=0.019). They more often reported smoking (63.2% vs 49.2%, p=0.005), less often had diabetes mellitus (35.3% vs 47.5%, p=0.013) and arterial hypertension (82.0% vs 90.8%; p=0.004). Stenting was also dependent on lesion complexity (TASC II C>B>A; p<0.001). Subgroup analysis of 110 procedures with bare metal stent (BMS) placement performed in 107 patients revealed ISR in 46.4% of stents, in half of cases it was symptomatic. Neither clinical nor lesion characteristics proved to differ between the group of procedures with ISR and group of procedures without ISR. Conclusions: Factors associated with bailout stenting were age, diabetes mellitus, arterial hypertension, smoking, clinical picture of PAD and complexity of treated lesions. We did not find any risk factors influencing development of ISR in BMS.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Domenico Sirico ◽  
Giulia Spigariol ◽  
Alessia Basso ◽  
Elena Reffo ◽  
Roberta Biffanti ◽  
...  

Abstract Aims Pulmonary valve stenosis accounts for 6–9% of all congenital heart diseases. The main effect of this obstructive lesion is a rise in right ventricular pressure; this overload leads to multiple changes in shape, dimensions, and volume of the ventricle. The diagnosis is based on transthoracic echocardiography and invasive heart catheterization. Usually the stenosis is classified into mild, moderate, and severe based on pressure gradient between right ventricle and pulmonary artery and on the ratio between right ventricle and left ventricle systolic pressure. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages; alternatively surgical valvotomy is an option in selected cases. The aim of this study is to evaluate the mechanical changes of the right ventricle in patients undergoing balloon pulmonary valvuloplasty using transthoracic and speckle-tracking echocardiography (STE). Furthermore, we sought to investigate the correlation between haemodynamic and echocardiographic parameters to better evaluate the degree of pulmonary valve stenosis before and after treatment. Methods and results Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited at the University Hospital of Padua. All patients underwent standard transthoracic echocardiography (TTE), STE with analysis of right ventricle global longitudinal strain (RVGLS) one day before and one day after the procedure. For each patient were collected invasive parameters during the interventional procedure before and after balloon valvuloplasty. After the procedure, there was an immediate statistically significant reduction of both peak-to-peak transpulmonary gradient (Dp post) and ratio between the systolic pressure of right and left ventricle (RV/LV ratio) with a drop of 29.3 ± 14.67 mmHg and 0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (50 ± 32.23 and 31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, following the intervention it reached 29% with a statistically significant increase (P = 0.007). However, the incidence of pulmonary valve moderate and severe regurgitation remained stable after the procedure. The analysis of right ventricular function and mechanics showed a significant improvement of Fractional Area Change (FAC) immediately after the procedure (40.11% vs. 44.42%, P = 0,01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE (P = 0.60) and longitudinal strain (P = 0.31), did not improve significantly after intervention. Finally, pre-procedural invasive RV/LV ratio showed good correlation to echocardiographic transvalvular peak and mean pressure gradient (R = 0.375, P = 0.019 and R = 0.40, P = 0.012, respectively), as well as with FAC (R = 0.31, P = 0.05), TAPSE (R = 0.62, P &lt; 0.001), and RVGLS (R = 0.46, P = 0.01). Conclusions Percutaneous balloon pulmonary valvuloplasty represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. Interestingly, the analysis of right ventricular mechanics on echocardiography demonstrated an immediate global systolic function improvement following afterload reduction. Conversely, longitudinal systolic function did not show improvement immediately after intervention, possibly due to the necessity of longer time to recover. Finally, invasive preprocedural RV/LV ratio demonstrated better correlation with echocardiographic evaluation of stenosis degree and right ventricular function compared to invasive peak-to-peak pressure gradient. Therefore, RV/LV ratio should be preferred for the assessment of pulmonary valve stenosis.


2021 ◽  
Vol Volume 14 ◽  
pp. 3805-3814
Author(s):  
Chenglong Sun ◽  
Wenhao Zheng ◽  
Qiang Zhu ◽  
Quan Du ◽  
Wenhua Yu

Author(s):  
Nicholas K. Brown ◽  
Nazia Husain ◽  
Jennifer Arzu ◽  
Sandhya R. Ramlogan ◽  
Alan W. Nugent ◽  
...  

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.


2021 ◽  
Vol 38 (05) ◽  
pp. 581-583
Author(s):  
Tirth Patel ◽  
George Raymond Wong ◽  
Clayton W. Commander ◽  
Kyung Rae Kim ◽  
Peter R. Bream

Author(s):  
Omar Mohamed Raouf Mohamed Ahmed Elsaka ◽  
Omar Elsaka

Background: Percutaneous balloon mitral valvuloplasty is a procedure used to dilate the mitral valve in cases of rheumatic mitral stenosis. The catheter is inserted into the female vein to the right atrium and atrial septum. The mitral valve is then passed through the inflated balloon to facilitate effective integration of mitral adhesions, which increases the area of the mitral valve and decreases the rate of mitral stenosis. Mitral regurgitation is a potential problem, and thus balloon percutaneous mitral valvuloplasty (PBMV) is prevented in moderate to severe relapse. The Wilkins score studies mitral valve morphology and evaluation by echocardiography to assess the viability of PBMVs based on specific echocardiographic conditions. Conclusion: There are many factors in the immediate and long-term outcomes of patients undergoing PMV. Echo-Sc can be used in combination with other clinical and morphological predictions of PMV effects to identify patients who experience the best effects on PMV.


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