ABSTRACT
Rubio and Limon Lason described a technique of dilatation of stenotic pulmonary and tricuspid valves in 1954; a decade later, Dotter and Judkins described a technique of balloon dilatation of atherosclerotic lesions. Balloon dilatation techniques were revived in the mid-1970s when Gruntzig and associates dilated coronary artery stenosis. Similar techniques have also been used in dilating stenotic lesions in renal, iliac, and femoral arteries. More recently, balloon dilatation techniques have been applied in infants and children to relieve congenital, acquired, and postoperative stenotic lesions. Although the initial description of balloon valvuloplasty is by a pullback or dynamic technique as suggested by Rubio and Limon Lason in 1954 and by Semb and his associates in 1979, a static dilatation technique, as described by Kan and her associates, is commonly used. The purpose of this review is to present the state-of-the-art of balloon dilatation of stenotic lesions in infants, children, and adolescents; personal experience with balloon dilatation in approximately 150 infants, children, and adolescents, including our previous publications and that reported in literature will be utilized as supportive material
Subject(s)
Humans , Angioplasty, Balloon/methods , Child , Thoracic SurgeryABSTRACT
The purpose of this paper is to present our experience with percutaneous balloon angioplasty [PBA] for coarctation of the aorta [COA]. The children between the ages of one month and 11 years [mean age 18 months] underwent PBA during an eight-month period ending September 1985. Numbers 5 to 9 French catheters with 5-to 15-mm balloons were used, depending upon the size of the angiographically measured coarcted segment and the aorta proximal to COA. The peak inflation pressure used in the balloons varied from 4 to 8 atmospheres of pressure and the duration of inflation was 8 to 15 seconds. At least four balloon dilatations were performed in every case. Following PBA for COA, descending aortic pressure rose from 86.4 +/- 17.7 to 107.8 +/- 20 [p< 0.02] and the peak systolic pressure gradient across the COA fell from 44.1 +/- 19.1 to 8.5 +/- [p< 0.001]. Increase in the angiographically measured coarcted segment, decrease in Doppler estimate of coarctation gradient, and improvement in the femoral pulses also occurred. No significant complications were encountered. PBA for COA is a safe and effective alternative to surgical coarcttectomy. It may become the procedure of choice for treatment of coarctation of the aorta favorable long-term results are documented
Subject(s)
Angioplasty, BalloonABSTRACT
The purpose of this paper is to present our experience with percutaneous balloon pulmonary valvuloplasty [PBPV]. Nine children between the ages of 15 months and 17 years [median age five years] underwent PBPV during a 15-month period ending December 1984. Number 7 French Meditech catheters with 15-18-, or 20-mm balloons were used depending upon the size of the angiographically measured pulmonary valve annulus. The peak inflation pressure used in the balloon varied from 2 to 7 atmospheres of pressure and the duration of inflation was 10 seconds. At least three balloon dilatations were performed in every case. Following PBPV, right ventricular systolic pressure fell from 99 +/- 21 [mean +/- SD], to 57 +/- 13 [P< 0.001] and the peak systolic pressure gradient fell from 82 +/- 23 to 33 +/- 15 [P< 0.001]. The cardiac index did not change. Sudden disappearance of the "waisting" of the balloon, increase in the width of the jet of contrast material as it passed through the pulmonary valve, decrease in Doppler estimate of pulmonary valvar gradient, and decrease in duration and intensity of the systolic murmur also occurred. No significant complications were encountered. PBPV is a safe and effective alternative to surgical pulmonary valvotomy. It may become the procedure of choice for treatment of valvar pulmonary stenosis once favorable long-term results are documented