Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects

This study is aimed to delineate readers with an overview of percutaneous balloon pulmonary valvuloplasty (PBPV) of pulmonary valve stenosis (PVS) and highlighting outcome based on influential and recent studies. It has been four decades since Kan et al first introduce PBPV. Since then, PBPV has recognized as a gold standard therapy for PVS of all ages. Nowadays, PBPV is practiced for a broad range of indication such as PVS, PV dysplasia and pulmonary atresia. Typically, PBPV is recommended when gradient across the PV is >50 mmHg. The procedure involves the placement of one or more balloon catheters across the stenotic PV with the guidance of a guidewire; thereafter, inflation of the balloons is done by pressure, thus producing valvotomy. Nowadays, PBPV is done by echocardiographic guidance, but previously, it was done by fluoroscopic guidance. The main disadvantage of fluoroscopy was the radiation injury of patients. The recently recommended balloon/annulus ratio is 1.2 to 1.25. Following the procedure, the dramatic reduction of pressure gradient, free motion of the PV leaflets with less doming, the rise of cardiac output have been noted, whereas complications may occur but are unusual and minimal. Significant predictors of restenosis include balloon/annulus ratio <1.2 and immediate post-PBPV gradient ≥30 mmHg. Only a few percentages of patients needed repeat PBPV. Long-term follow-up results are surprisingly excellent. In conclusion, it is our opinion that PBPV is equally successful in patients of all ages, while worldwide recognized studies prove the safety, feasibility, and effectiveness. However, for early detection of any complication, life-long clinical follow-up is mandatory.

Clinical research on autologous valved pericardial patch in the correction surgery of tetralogy of fallot / 安徽医科大学学报

Objective To investigate the activity of autologous pericardial patch treated by distilled water in right ventricular outflow tract reconstruction of tetralogy of fallot,and to evaluate its clinical effect. Methods The study used 125 patients who had applied correction surgery of tetralogy of fallot and autologous pericardial patch treated by distilled water in the right ventricular outflow reconstruction. 39 cases used fresh autologous pericardial patches,and 86 cases used autologous valved pericardial patch. The degree of insufficiency and activity of the pulmonary valve were compared. Results The mean follow-up time was ( 63 ± 8 ) months in fresh autologous pericardial patches group, while (55 ± 7) months in valved patch group. No significant difference was found in age, body surface area, heart rate, pulmonary artery diameter, cardiopulmonary bypass time and priming volume postoperative between the two groups. The exacerbations of pulmonary valve insufficiency and activity in fresh autologous pericardial patches group were significantly higher than in valved patch group. Conclusion Autologous pericardial patch treated by distilled water was beneficial in right ventricular outflow tract reconstruction of tetralogy of fallot. It reduced pulmo-nary valve insufficiency and sclerosis after the correction surgery and showed good mid-term clinical results .