DOCSLIB.ORG

Combined Aortic and Mitral Balloon Valvuloplasty in Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Combined Aortic and Mitral Balloon Valvuloplasty in Patients View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector ,*cc “0,. I I, NO. 6 1213 June 1WWXM METHODS Combined Aortic and Mitral Balloon Vahloplasty in Patients With Critical Aortic and Mitral Valve Stenosis: r(esults in Six Cases AARON D. BERMAN, MD, JOSEPH S. WEINSTEIN. MD. ROBERT D. SAFIAN, MD, DANIEL J. DIVER, MD, WILLIAM GROSSMAN. MD, FACC. RAYMOND G. MCKAY, MD Combined amtic and mifral valve disease may pose a dif- risk pzienis 01 in patients who refuse operarive intervex- ficult technical dilemma for the cardiac surgeon. Prolonged lion. peicllfaneous ballwn valvuloplasty was recently de- amtic cross clamp time, congestive heart failure aed eoex- scribed as etTective in pediatric patients (6.7) and adults istent coronary anay disease may all contribute 10 the !8-191 fo? both the aortic and the mitral valve. Krit-xr ad diflculty of operative and postotwative management of coworkers 120)recently reported successful performance of these patients. Investigators reporting early results (I) found a combined am-tic and mitral balloon vaivsbp!wy in an a significant operative mortality with dmble valve replace- elderly patient with combined aonic and mitral vale steno- ment. but since the advent of cold potassium cardioplegia. tis and severe heart failure. We herein repon our expertence the morbidity and mortality of this procedure have been in six patxots with eombincd awtic and mitral valve steno- markedly reduced (l-4). Nonetheless. patients with ad- sis. who uderwent successful simultaneous double valve vanced congestive heart failure continue to have pax short- balloon dilation. term survival (2.5). Otherassoeiated medical p&terns. such as renal. pulmonary or hepalic dysfunction. may also ad- Methods versely affect the outcome of patients undergoing double valve replacement. Miint chamteris4ii. Six patients with combined a(Klic As a nonsurgical alternative to valve replacement in high and mitral valve stenosis were referred 10 the Beth Israel Hospital for balloon valvuloplasty. Thar clinical character- istics and reasons for referral for balloon valvuloplasty rather than surgery weshowinTable 1. Patient Zalone was conrtdcred D good surgical candidate, but firmly refused any s:rgical intervention. Patient I had severe restrictive lung disease secondary to prior radiation therapy administered for breast carcinoma: in addition. she had undergone open mlt:at valve commissurotomy in 1978and had redeveloped rympbxn. Patient 3 was believed to be a high risk surgical candidate because of her advanced age. Patient 4 had retrograde and twnsseptal catheterization techniques advanced heart disease with pulmonary hypertension. se- G?-11.20).Although the aortic valve was dilated before the vere right heart Failure, cardiac cechexia and general debil- mitral valve in all but Patient 4. it was necessaryto perfarm ity. In addition, he had a dense right hemiparesis and the transseptal catheterization before aortic valvuloplasty to moderate aphasia as the residua of an embatic stroke ws- avoid anticoagulation before transseptal puncture was at- tained several years ago. and For these reasons. his surgical tempted. risk was believed to be prohibitively high. Patient 5 was also All patierds were premeditated with diw.epam and di. quite debilitated and had undergone previous coronary nr- phenhydraminc. Percutaneous right and left heart catheter- tew bypass surwy in 1982.Patient 6 had a hisrorv of dor ization was performed From the left femoral vein and left right them&e ~ncumolhoran for luberculorir~and~ had Femoral artery with a 7F pacing balloon flotation catheter mmterately severe restrictive and obs!mctive lune disease, (Elecath) and a 7F pigtail catheter, respectively. and a and hence was believed LObe a pour surgical candidate. weening oximetry study was performed. Next, tmnswptnl Table 2 shows kemodynnmic vnlucs in rheporienrs before catheterization was performed with a standard Brockm- valvrrloplnstyy.All patients had severe combined aortic and brough wedIe and an 8F Mullins sheath-dilator, which were mitral stenosis, and four OFthe six patients had a depressed advanced From the right femoral vein. After entry into the cardiac index. left atrium, a 7F balloon Rotation catheter (Ctitikon Inc.) Vahuloptasty prowlure. Combined aortic and mitral bal- was advanced through the Mullins sheath to the left atrium loon valvuloplasty pmcedures were performed with both and lO,ooOU otheparin was administered. AtIer tmnsseptal catheterization, the aortic valve was crowd retrograde by occasion. hemoptysir. It was believed that if the patient‘s way of the left femoral artery with a 0.035 in. <OS9 cm) pulmonary venous Blling oressure weld be lowered rud- straight guide wire passed thrwgh a 7F angled pigtail cdh- henly by rmtral valve dil%on. he would tolerate the rest of eter. The catheter was thee advanced over the wire into the the procedure with more comfort and less risk. left ventricle. Baseline hemodynamic variables and Fick cardiac outpot mewrement~ v&e recorded. Oxygen con- sumption ~3s measured with a commercial metabolic rate met&(Waters Instruments). Aarric ba/!oorr valv~rlo&~~ was then performed by Brst sdwncing a 270 cm, 0.038 in. (O.lOcm) I &p guide wire with surentents demonstrated a de&ax in both miti and aortic a handmade secondary curve into the left ventricle through valve gradients in all patients. Figure I shows the aortic and thc7F oigtail catheter and then removinnthc oktailcatheter. mmal gradients lor Patient 2 before and after valveloplasty. Next, the left femoral artery was dilated with ; IZF dilator, Cardmc ourpur. ncasured by the Fick technique. with use of anda9Fvalvulopiastycathcter withaZOmm balloon, 5Scm s metabolic rate meter (Waters Sciwiiic) to measureowan in length (Mansfield Inc.) was introduced over the guide wire consumption, increased sigoikxmtly in Patients 2.5 id 6. into the left ventricle. Calloon dilatioc of the aartic valve Left atrial preswre decreasedmarkedly in Patients 2.3 and was performed by h&on inflation with a dilute contrast- 6. These laxer three pa:ients also had the largest decreases saline mixture. and the aortic valvulopiasty catheter was in transmitral gradient and concomitant increases in mitral removed from the left ventricle. valve area, with wore ew&st results obtained in Patient I Afrcr aortic valve dilation, the 7F balloon Rotation cath- and 4 derpite the useof the double balloon technique in these eter in the left atrium was advanced into the left ventricle. A patients Patient I experienced an inc:eese in both right and 270 cm. 0.038 in. (0.10 em) J tip guide wire with a large ieft heart filling preswres after valvuloplasty. This increase handmade deflecting cone ~83 advanced through the 7F may have been related in part to the length of her procedure balloon Rotation catheter into the left ventricle and the 13 t IO mini and to the 1.800 ml of intravcnws Ruid she catheter and the Mullins sheath were removed. Next, an 8 received during the procedure. mm balloon dilation catheter (Mansfield. Inc.) V+BSadvanced Complkaticms mnltiag from tke praedore iTebk 3). No over this guide wire to the level of the inter&al septum. and complication resulted in significant mwbidity except for the multiple inRations were performed to dilate the septum. In femoral artery thrombus in Patient 3. for which catheter Patients Land 4, a double balloon technique was subs- thrombectom~ under local anesthesia was necessary. This m~nllv utilized for mival valve dilation. In these two procedure was p?rfoimed without complication. lo addition, &ients the 8 II balloon catheter was removed and B this patient had a left to right shunt et the atrial level with a second guide wire was placed across the atrird septum and pulmonary to systemic Row ratio of 1A:t. into the left ventricle with a 7F double lumen catheter Clinical fdkwap. ~ppkr-echcardiiphic studies af- (Manslielri, Inc.), which can accomodate two 0.038 in. (0.10 ter valvoioplasty demonstrated a decreasedgmdient across cm) guide wires. Two balloon dilation catheters (18 and 20 the aonic and mitral valves in all except Patient 3. with no mm in diawer, 3 em in length) were advanced separately. mtior increases in L3opplewJetectableregwgitation by two- one ~?er arh guide wire, aid positioned awo~s the mitral dimensional echocerdiographic pulsed LloQ&r mapping valve. Sisltaneou; intlations of the 18 and 20 mm balloons techniques. Regorgitation w&s not qoantitated ang&rephi- were thet: perfomwd. with a resulting reduction ofthe mitral tally because rmrtomems and ventricukwamo were not valve wad&t. In the four other patients. mitral valve pelformed before and after valwdoplasty a; a result of time dilation was performed with a single ballcon (25 mm i’l coostremts and the hemodyoamic conditions of many of the diameter, 3 cm in length). patients. Patient I to 3 and 6 were monitored after their After mirrul valve dilation. repeat measurementsof Fick procedures in the cardii intensive care unit for 24 h and cardiac output and traosvalvular sonic and mitral gradients were discharged from the hospital on the 4th day after -were wformed to essessvalve areas after valveloplast,‘. valvuloplasty. Patiems 4 and 5 required a longer recupera- After these measeremeets. oximetry was repeated to detect tion period but were discharged in markedly improved any iatmgenic left to right shunt. If such a shunt was condition after 2 weeks. detected. systemic Row war used in the valve area cakula- Patient I noted only modest improvement initially but lions. The mean duration of the valvslopiasty procedure vies after returning home. found that her exercise tolerance was 2.5 h (range 0.75 to 3. IJ. much improved with less palpitation and dyspnca. In eddi- In Patient 4. mitral balloon valvuloplasty was performed hon. she was ahte to undergo phammcologic conversion to before dilation of the uortic valve because this patient was normal sinus rhythm of lwrg-standing atrial fibrillation. Re- unable to lie Rat for more than a few minutes without peat Doppler-echocardiographic examir!ations 6 weeks after developing severe pulmonary wwos congestion and.
Load more

Recommended publications
  • Balloon Aortic Valvuloplasty
    Original Research Article Journal of Structural Heart Disease, May 2015, Received: December 8, 2014 Volume 1, Issue 1: 20-32 Accepted: December 15, 2014 Published online: May 2015 DOI: http://dx.doi.org/10.12945/j.jshd.2015.00009-14 Balloon Aortic Valvuloplasty Patient Selection and Technical Considerations Ted Feldman, MD, FESC, FACC, MSCAI*, Mohammad Sarraf, MD, Wes Pedersen, MD, FACC, FSCAI Evanston Hospital, NorthShore University Health System, Evanston, Illinois NOTE: This manuscript includes videos. Not all PDF readers support video. For desktop computers we recommend using Adobe Acrobat Reader. To view videos within a PDF on an iPad we recommend viewing in ezPDF Reader or PDF Expert. On desktop computers you may view videos full screen by clicking on a video, right click on the video, then choose Full Screen Multimedia. Abstract BAV occurs in the vast majority of patients. While in BAV has had resurgence in association with the dissem- many this clinical improvement is short-lived, a ma- ination of TAVR. The lack of clear mortality benefit from jority of patients feel improved symptoms for as long BAV does not translate to lack of efficacy as a palliative as 1 year [1]. The utility of this therapy as a palliative therapy. BAV remains a useful bridge to surgical AVR or TAVR, and for symptom relief in patients who are not treatment is seen best among patients, who truly candidates for either AVR approach. It is also useful as a have no other option [2]. For example, the extreme diagnostic test for patients with low gradient-low out- risk patient, who is a candidate for neither surgical put AS, and for those with mixed pulmonary and aortic nor transcatheter AVR may undergo BAV periodically valvular disease.
    [Show full text]
  • Coronary Artery Disease and Transcatheter Aortic Valve Replacement JACC State-Of-The-Art Review
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. 74, NO. 3, 2019 ª 2019 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER THE PRESENT AND FUTURE JACC STATE-OF-THE-ART REVIEW Coronary Artery Disease and Transcatheter Aortic Valve Replacement JACC State-of-the-Art Review Laurent Faroux, MD, MSC, Leonardo Guimaraes, MD, Jérôme Wintzer-Wehekind, MD, Lucia Junquera, MD, Alfredo Nunes Ferreira-Neto, MD, David del Val, MD, Guillem Muntané-Carol, MD, Siamak Mohammadi, MD, Jean-Michel Paradis, MD, Josep Rodés-Cabau, MD ABSTRACT About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary artery disease (CAD), and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized trials, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Also, scarce data exists on the incidence, characteristics, and management of coronary events post-TAVR, and increasing interest exist on potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the current landscape of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management, unresolved issues and future perspectives. (J Am Coll Cardiol 2019;74:362–72) © 2019 by the American College of Cardiology Foundation.
    [Show full text]
  • Aortic Valve Disease and Associated Complex CAD: the Interventional Approach
    Journal of Clinical Medicine Review Aortic Valve Disease and Associated Complex CAD: The Interventional Approach Federico Marin 1 , Roberto Scarsini 2, Rafail A. Kotronias 1 , Dimitrios Terentes-Printzios 1, Matthew K. Burrage 1 , Jonathan J. H. Bray 3, Jonathan L. Ciofani 4 , Gabriele Venturi 2, Michele Pighi 2, Giovanni L. De Maria 1 and Adrian P. Banning 1,* 1 Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; [email protected] (F.M.); [email protected] (R.A.K.); [email protected] (D.T.-P.); [email protected] (M.K.B.); [email protected] (G.L.D.M.) 2 Department of Cardiology, University of Verona, 37129 Verona, Italy; [email protected] (R.S.); [email protected] (G.V.); [email protected] (M.P.) 3 Institute of Life Sciences 2, Swansea Bay University Health Board and Swansea University Medical School, Swansea SA2 8QA, UK; [email protected] 4 Department of Cardiology, Royal North Shore Hospital, Sydney 2065, Australia; [email protected] * Correspondence: [email protected] Abstract: Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to Citation: Marin, F.; Scarsini, R.; elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve Kotronias, R.A.; Terentes-Printzios, stenosis and subsequent impact on blood flow.
    [Show full text]
  • PQI #13 Angina Without Procedure Admission Rate
    AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov PQI #13 Angina without Procedure Admission Rate Numerator All discharges of age 18 years and older with ICD-9-CM principal diagnosis code for angina. Include ICD-9-CM diagnosis codes: 4111 INTERMED CORONARY SYND 4130 ANGINA DECUBITUS 41181 CORONARY OCCLSN W/O MI 4131 PRINZMETAL ANGINA 41189 AC ISCHEMIC HRT DIS NEC 4139 ANGINA PECTORIS NEC/NOS See Prevention Quality Indicators Appendices: • Appendix A – Admission Codes for Transfers Exclude cases: • transfer from a hospital (different facility) • transfer from a skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) • transfer from another health care facility • MDC 14 (pregnancy, childbirth, and puerperium) • with a code for cardiac procedure ICD-9-CM Cardiac procedure codes 0050 IMPL CRT PACEMAKER SYS OCT02- 3502 CLOSED MITRAL VALVOTOMY 0051 IMPL CRT DEFIBRILLAT OCT02- 3503 CLOSED PULMON VALVOTOMY 0052 IMP/REP LEAD LF VEN SYS OCT02- 3504 CLOSED TRICUSP VALVOTOMY 0053 IMP/REP CRT PACEMKR GEN OCT02- 3510 OPEN VALVULOPLASTY NOS 0054 IMP/REP CRT DEFIB GENAT OCT02- 3511 OPN AORTIC VALVULOPLASTY 0056 INS/REP IMPL SENSOR LEAD OCT06- 3512 OPN MITRAL VALVULOPLASTY 0057 IMP/REP SUBCUE CARD DEV OCT06- 3513 OPN PULMON VALVULOPLASTY 0066 PTCA OCT06- 3514 OPN TRICUS VALVULOPLASTY 1751 IMPLANTATION OF RECHARGEABLE 3520 REPLACE HEART VALVE NOS CARDIAC CONTRACTILITY MODULATION 3521 REPLACE AORT VALV-TISSUE [CCM], TOTAL SYSTEM OCT09- 3522 REPLACE AORTIC VALVE NEC 1752 IMPLANTATION OR REPLACEMENT OF 3523 REPLACE MITR VALV-TISSUE
    [Show full text]
  • Balloon Aortic Valvuloplasty Ngozi C
    & The ics ra tr pe a u i t i Agu and Syamasundar Rao, Pediat Therapeut 2012, S5 d c e s P Pediatrics & Therapeutics DOI: 10.4172/2161-0665.S5-004 ISSN: 2161-0665 Research Article Open Access Balloon Aortic Valvuloplasty Ngozi C. Agu and P. Syamasundar Rao* Department of Pediatrics, Division of Pediatrics Cardiology, University of Texas Health Science Center at Houston, Houston Texas, USA Abstract Following the description by Lababidi in 1983 of balloon aortic valvuloplasty, it has been adopted by several groups of workers for relief of aortic valve stenosis. The indications for the procedure are peak-to-peak systolic pressure gradients in excess of 50 mmHg with symptoms or ECG changes or a gradient greater than 70 mmHg irrespective of the symptoms or ECG changes. One or more balloon dilatation catheters are placed across the aortic valve percutaneously, over extra-stiff guide wire (s) and the balloon (s) inflated until waist produced by the stenotic valve is abolished. A balloon/annulus ratio is 0.8 to 1.0 is recommended. While trans-femoral arterial route is the most commonly used for balloon aortic valvuloplasty, trans-umbilical arterial or venous or trans-venous routes are preferred in neonate and young infants to avoid femoral arterial injury. Reduction of peak-to-peak systolic pressure gradient along with a fall in left ventricular peak systolic and end- diastolic pressures is seen after balloon aortic valvuloplasty in the majority of patients. Significant aortic insufficiency, though rare, may develop, particularly in the neonate. At intermediate-term follow-up, peak-to-peak gradients, at repeat cardiac catheterization and noninvasive Doppler gradients remain low for the group as a whole.
    [Show full text]
  • Nitroglycerin in Cardiac Arrest Before Transcatheter Aortic Valve Implantation
    DOI: 10.14744/ejmi.2019.2101 EJMI 2019;3(1):81-83 Case Report Nitroglycerin in Cardiac Arrest Before Transcatheter Aortic Valve Implantation Mustafa Zungur Department of Cardiology, Cigli Kent Hospital, Izmir, Turkey Abstract We present a 75-year-old male patient having aortic stenosis for which transcatheter aortic valve implantation (TAVI) had been planned. Patient developed cardiac arrest before TAVI. Cardiopulmonary resuscitation (CPR) followed by 10 mg intravenous bolus nitroglycerine administration at the 40 min was per-formed. Patient was conscious and cooper- ated at the 80th hour following CPR and was stable hemodynamically. TAVI was applied on the 8th day and patient was discharged to home from the cardiology clinic on the 6th day after TAVI. Bolus nitroglycerine administration may have a place in CPR protocols, which needs to be evaluated in further clinical studies. Keywords: Aortic Stenosis, nitroglycerine, transcatheter aortic valve implantation Cite This Article: Zungur M. Nitroglycerin in Cardiac Arrest Before Transcatheter Aortic Valve Im-plantation. EJMI 2019;3(1):81-83. round 45% of deaths throughout the world develop The patient reviewed the case report and gave written per- Adue to cardiovascular diseases among which aortic mission for the authors to pub-lish the report. stenosis is an important cause for cardiac mortality and morbidity.[1] Transcatheter aortic valve implantation (TAVI) Case Report is the preferred therapeutic option in the treat-ment of aor- TTAVI application had been planned for a 75-year-old male tic stenosis, particularly for patients with multiple severe patient having severe aortic stenosis. Standard laboratory comorbidities, for those having expected high periopera- tive mortality, or for those having contraindication for con- tests and consultations were made preoperatively.
    [Show full text]
  • In Vitro Assessment of Pacing As Therapy for Aortic Regurgitation
    Open access Cardiac surgery Open Heart: first published as 10.1136/openhrt-2018-000976 on 24 May 2019. Downloaded from In vitro assessment of pacing as therapy for aortic regurgitation Paolo Peruzzo ,1 Francesca Maria Susin,1 Andrea Colli,2 Gaetano Burriesci3,4 ► Additional material is ABSTRACT Key questions published online only. To view Background and objective Clinical evaluation of please visit the journal online pacing therapy in mitigating the aortic insufficiency (http:// dx. doi. org/ 10. 1136/ What is already known about this subject? after transchateter aortic valve implantation often gives openhrt- 2018- 000976). Some in- vivo studies have debated the role of pac- contradictory outcomes. This study presents an in vitro ► ing to mitigate aortic regurgitation and its use as investigation aimed at clarifying the effect of pacing on To cite: Peruzzo P, Susin FM, therapy to this aim. Colli A, et al. In vitro assessment paravalvular leakage. ► The discrepancies on the results are mainly due to of pacing as therapy for aortic Methods A series of in vitro tests reproducing the heart some inaccuracies of in- vivo measurements and the regurgitation. Open Heart operating changes clinically obtained by pacing was improper use of aortic regurgitation index to assess 2019;6:e000976. doi:10.1136/ carried out in a 26 mm Edwards Sapien XT prosthesis the enhancement of the grade of insufficiency. openhrt-2018-000976 with mild paravalvular leakage. The effect of pacing on the regurgitant volumes per cycle and per minute was What does this study add? quantified, and the energy and power consumed by the Received 27 November 2018 ► The study indicates that pacing is ineffective as a Revised 22 March 2019 left ventricle were calculated.
    [Show full text]
  • Cardiovascular Medicine
    Cardiovascular Medicine Kardiovaskuläre Medizin / Médecine cardiovasculaire Supplementum 18 ad Cardiovascular Medicine 2010;13(5) 26 May 2010 www.cardiovascmed.ch Jahrestagung Schweizerische Gesellschaft für Kardiologie (SGK) Gastgesellschaften: Schweizerische Gesellschaft für Pädiatrische Kardiologie (SGPK) Schweizerische Gesellschaft für Thorax-, Herz- und Gefässchirurgie (SGTHGC) Schweizerische Hypertonie Gesellschaft (SHG) Assemblée Annuelle Société Suisse de Cardiologie (SSC) Sociétés invitées: Société Suisse de Cardiologie Pédiatrique (SSCP) Société Suisse de Chirurgie Thoracique et Cardio-vasculaire (SSCTCV) Société Suisse d’Hypertension (SSH) St. Gallen, 9.–11. Juni 2010 Official journal of the Swiss Society of Cardiology, the Swiss Society of Hypertension, the Swiss Society of Angiology and the Swiss Society of Paediatric Cardiology IMPRESSUM Cardiovascular Medicine www.cardiovascmed.ch Official journal of the Swiss Society of Cardiology, the Swiss Society of Hypertension, the Swiss Society of Angiology and the Swiss Society of Paediatric Cardiology Kardiovaskuläre Medizin / Médecine cardiovasculaire VET EL IC H A S C A A R T D E I I O C L O S O G A I C Editors Editors in chief Section editors: Section editors: Section editors: Editors Thomas F. Lüscher, Zürich Images in cardiovascular The new compound The interesting ECG Urs Bauersfeld, Zürich René Lerch, Genève medicine Jérôme Biollaz, Lausanne Stefan Osswald, Basel Paul Erne, Luzern Alain Delabays, Morges Georg Noll, Zürich Jürg Schläpfer, Lausanne Augusto F. Gallino, Bellinzona Deputy editors Michel Zuber, Luzern Andres Jaussi,Yverdon-les-Bains Georg Noll Section editor: Section editors: Lukas Kappenberger, Lausanne Jan Steffel The new device Evidence-based Bernhard Meier, Bern Haran Burri, Genève cardiology Matthias Pfisterer, Basel Stephan Windecker,Bern Heiner Bucher, Basel Jan Steffel, Zürich Jens Hellermann, Altstätten Bernard Waeber,Lausanne Jörg Muntwyler, Kloten Editorial Board D.
    [Show full text]
  • Percutaneous Aortic Balloon Valvuloplasty Under Echocardiographic Guidance Solely
    483 Original Article Percutaneous aortic balloon valvuloplasty under echocardiographic guidance solely Yongquan Xie, Shouzheng Wang, Guangzhi Zhao, Muzi Li, Fengwen Zhang, Wenbin Ouyang, Xiangbin Pan Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China Contributions: (I) Conception and design: Y Xie, X Pan; (II) Administrative support: Y Xie, S Wang; (III) Provision of study materials or patients: Y Xie, G Zhao, M Li, W Ouyang, X Pan; (IV) Collection and assembly of data: F Zhang; (V) Data analysis and interpretation: Y Xie, F Zhang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Dr. Xiangbin Pan. National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Rd, Xicheng District, Beijing 100037, China. Email: [email protected]. Background: Percutaneous balloon aortic valvuloplasty (PBAV) is an alternative to surgical valvulotomy for the treatment of congenital aortic stenosis (AS). This article aims to summarize our preliminary experience on feasibility and safety of PBAV under only echocardiographic guidance in patients with congenital AS. Methods: Clinical data from 20 consecutive patients with aortic valve stenosis who underwent PBAV under only echocardiographic guidance at Fuwai Hospital from January 2016 to January 2019 were analyzed retrospectively. Median age of patients was 18.38±15.88 years and 65% of the patients were male. Aortic annulus diameter was 18.40±3.25 mm and balloon diameter was 17.38±3.89 mm, with B/A ratio of 0.93±0.06.
    [Show full text]
  • Balloon Aortic Valvuloplasty
    COVER STORY Balloon Aortic Valvuloplasty Current indications and use in unique clinical settings. BY WES PEDERSEN, MD, AND PAUL SORAJJA, MD n large series, balloon aortic valvuloplasty (BAV) has our opinion, should be broadened in this era of TAVR. demonstrated restenosis rates of 40% to 80% at 5 to The 2014 guidelines give stand-alone BAV a class IIb 9 months and failure to improve survival1-3; however, it indication.4 It is believed to be appropriate as a bridge still has palliative benefits and other important indica- to surgical aortic valve replacement (SAVR) or TAVR in Itions in the era of transcatheter aortic valve replacement patients with severe, symptomatic aortic stenosis (AS). (TAVR). The arrival of TAVR has resulted in an increase Most centers have broadened their indications for in the overall use of BAV. Currently, it is being used not stand-alone BAV (Table 1). Multiple published expe- only for palliation in high-surgical-risk patients, but addi- riences for indications used over the years and at tionally plays a diagnostic role in clarifying the signifi- Minneapolis Heart Institute (MHI) have demonstrated cance of aortic stenosis in patients with multiple comor- consistent improvement in quality of life. The patients’ bidities and most commonly in “stand-alone” cases as a New York Heart Association functional class frequently bridge to TAVR. Its role in TAVR includes both predilata- improves from III/IV to I/II. The demonstrated safety of tion and postdilatation and, on occasion, annular sizing. serial BAV for restenosis extends the period of enhanced It has also been helpful in evaluating a patient’s risk for quality of life.
    [Show full text]
  • Successful Coronary Protection During TAVI in Heavily Calcified Aortic Leaflets in Patient with Short and Low Left Coronary System
    Hindawi Case Reports in Cardiology Volume 2018, Article ID 2758170, 4 pages https://doi.org/10.1155/2018/2758170 Case Report Successful Coronary Protection during TAVI in Heavily Calcified Aortic Leaflets in Patient with Short and Low Left Coronary System Mohamad Kabach , Abdulah Alrifai, Lawrence Lovitz, Mark Rothenberg, Cristiano Faber, and Marcos Nores JFK Medical Center, University of Miami School of Medicine, Atlantis, FL, USA Correspondence should be addressed to Mohamad Kabach; [email protected] Received 14 July 2017; Revised 15 February 2018; Accepted 4 March 2018; Published 14 May 2018 Academic Editor: Man-Hong Jim Copyright © 2018 Mohamad Kabach et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Transcatheter aortic valve replacement has been recently approved for patients who are high or intermediate risk for surgical aortic valve replacement. The procedure is associated with several known complications including coronary related complications. Coronary obstruction is rare but disastrous complication, and it is associated with a high mortality rate. Coronary protection technique has emerged as a preemptive technique to avoid this complication. We present a case of successful coronary protection during TAVR in severely calcified left cusp in patient with short and low left ostium. 1. Introduction calcified aortic valve in patient with short and low left coronary system. Surgical aortic valve replacement has been the mainstay of treatment of symptomatic severe aortic stenosis. The 2. Case Presentation transcatheter approach comes to the rescue as a less invasive treatment in these high-risk patients [1] or old patients with An 86-year-old woman with known history of coronary intermediate risk [2] as well as inoperable patients [3].
    [Show full text]
  • Surgical Data Collection Form AVSD Other Surgical Procedure Form
    AVSD – A CHSS Inception Cohort Study: Surgical Data Collection Form Study Number ☐☐☐☐☐☐☐☐ Event Number ☐☐ Operation Date (DD/MMM/YYYY) ☐☐/☐☐☐/☐☐☐☐ Procedure ☐PA Band ☐Norwood Procedure ☐Glenn Procedure ☐Hemi-Fontan ☐Fontan Procedure ☐One and Half Ventricle Repair ☐Heart Transplant ☐Subsequent AVSD Procedures ☐Hybrid Procedure ☐Interval Procedure If Fontan, specify type: ☐ECC ☐Lateral Tunnel ☐Transcatheter If Subsequent AVSD Procedure, specify type: ☐Atrial Fenestration ☐Ventricular Fenestration ☐AVSD Repair Takedown ☐PA Plasty ☐LAVV Repair ☐LAVV Replacement ☐RAVV Repair ☐RAVV Replacement ☐CAVV Repair ☐CAVV Replacement ☐ASD Repair ☐VSD Repair Concomitant Procedure 1: ☐Damus-Kaye-Stansel procedure (DKS) (creation of AP anastomosis without arch reconstruction) ☐Cavopulmonary anastomosis Bidirectional (BDCPA) (bidirectional Glenn) ☐Cavopulmonary Glenn (unidirectional cavopulmonary anastomosis) (unidirectional Glenn) ☐Cavopulmonary Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) ☐HemiFontan ☐Cavopulmonary anastomosis(es) (Glenn or HemiFontan) + Atrioventricular valvuloplasty ☐Cavopulmonary anastomosis(es) + PA reconstruction (Superior) ☐Palliation, Other (if other explain) ☐ECMO cannulation ☐ECMO decannulation ☐ECMO procedure AVSD Other Surgical Procedure Form Version Date: February 17, 2016 Page 1 of 26 AVSD – A CHSS Inception Cohort Study: Surgical Data Collection Form ☐Intraaortic balloon pump (IABP) insertion ☐Right/left heart assist device procedure ☐VAD explantation ☐VAD implantation ☐Echocardiography
    [Show full text]