ABSTRACT
Objective To investigate the safety and effectiveness of percutaneous balloon pulmonary valvuloplasty (PBPV) in the treatment of pulmonary stenosis (PS). Methods The subjects were 52 patients with PS from 2007 to 2012, including 24 male and 28 female. Their age ranged from 1 year old to 56 year old and mean age was 9.2±7.6 years old. Their body weight ranged from 10 kg to 60 kg and mean weight was 17.3±8.9 kg. All patients were assessed with electrocardiogram (ECG), chest X-ray, right heart catheterization and right ventricular angiagraphy before the procedure. Results All 52 patients received PBPV successfully. Comparing the transvalvular pressure gradient before and after the operation, it decreased from 86.3±27.6 mmHg (1 mmHg=0.133 kPa) to13.8±7.7 mmHg, and statistically difference (P<0.01). Among these patients, one patient occurred ventricular fibrillation and Aspen syndrome (hypoxie-ischemic encephalopathy), one patient occurred respiratory and cardiac arrest, 24 patients occurred transient arrhythmia, one patient had hypotension, one patient had bradycardia and one patient showed desaturation. All these symptoms resolved after appropriate treatment during the PBPV. Two patients had hematoma in the puncture point and 2 patients had reactive infundibular stenosis after PBPV. Conclusions Performing the percutaneous balloon pulmonary valvoplasty on the patients with pulmonary stenosis is safe and effective. PBPV causes less pain and can be used as the preferred treatment for pulmonary stenosis.
ABSTRACT
Objetivo - Avaliar os resultados hemodinâmicos e angiográficos tardios da valvoplastia mitral por duplo cateter-baläo, para tratamento da estenose mitral reumática. Métodos - Cinquenta e dois pacientes foram submetidos à avaliaçäo, sendo 84,6// do sexo feminino, com idade média de 21,9 anos. Oitenta e um por cento estavam na classe funcional I (NYHA), e 5,7// exibiam fibrilaçäo atrial, 18 meses após dilataçäo. Todos foram submetidos a estudo ecocardiográfico e cateterismo cardíaco com angiografia, 1 ano após o procedimento. Resultados - quarenta e seis pacientes (88,5//) exibiram, imediatamente após a valvoplastia, áerea valvar > 1,50cm². Em 6(11,5//), a área da valva mitral foi ó 1,50cm². Os casos em que se obteve área valvar ò 1,50cm², tiveram boa evoluçäo clínica, sem perda dos bons resultados hemodinâmicos e ecocardiográficos iniciais, incluindo o gradiente de pressäo diastólica mitral, as pressöes médias do átrio esquerdo e da artéria pulmonar e a área valvar mitral. Nos 6 casos em ques e obteve area valvar ó 1,50cm², 2 tiveram evoluçäo favorável, 2 foram redilatados, 1 aguarda tratamento cirúrgico e outro mantém-se em tratamento clínico a despeito do resultado hemodinâmico insatisfarório. Em 3 dos 52 casos (5,7), demonstrou-se, após o procedimento, a existência de comunicaçäo interatrial, em 2 sem repercussäo hemodinâmica, e, no 3º, com repercussäo, foi indicada a correçäo cirúrgica do defeito. A insuficiência mitral ocorreu em 16 casos (30,7//), sendo de grau + em 8 e de + a ++, nos demais, sem nenhum agravamento neste período evolutivo. Conclusäo - A valvoplastia mitral por duplo cateter-baläo é método eficaz para tratamento da estenose mitral reumática, havendo boa evoluçäo tardia, nos casos que apresentam área ò 1,50cm² imediatamente após a dilataçäo
Purpose - To evaluate the late hemodynamic and angiographic results of 52 patients who underwent mitral valvoplasty by the double balloon technique in the treatment of the rheumatic mitral stenosis. Methods - The mean follow-up was of 18 months and the patients had a Doppler-echocardiogram and cardiac catheterization one year after dilatation. Of the 52 patients 84.6% were femule and the mean age was 21.9% years. Eighty one percent were in NYHA class I whereas 5.7% had atrial fibrillation at the end of 18 months. Results Immediatly after valvoplasty 46 patients (88.5%) had a valvar area larger, and 6 (11.5%) smaller than 1.5 cm2 . The first group had a good clinical outcome with maintenance of the clinical, echocardiographic and angiographic results in the late followup, including the dyastolic gradient and the valvar area. Of the 6 cases with mitral area smaller than 1.5 cm2, 2 had a good clinical evolation, 2 were redilated, I was scheduled for surgery and the last one is under clinical management but with poor hemodynamic results. Three (5.7%) cases developed an atrial septal defect after the procedure, with hemodynamic repercussion in 1. Mitral regurgitation developed in 16 cases (+ in 8, +/++ in 8) without changes during the follow-up period. Conclusion - Double balloon mitral valvoplasty is a safe effective method in the treatment of the rheumathic mitral stenosis, and offers a better evolution in patients with a valvar area larger than 1.5 cm2 after the dilatation
Subject(s)
Humans , Male , Female , Pregnancy , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis/therapy , Rheumatic Heart Disease/therapy , Angiography , Echocardiography, Doppler , Follow-Up Studies , Mitral Valve Stenosis/physiopathology , Rheumatic Heart Disease/physiopathology , Evaluation Study , Hemodynamics , Severity of Illness IndexABSTRACT
Objetivo - Avaliar a valvoplastia mitral por duplo cateter-baläo como técnica alternativa näo cirúrgica para tratamento da estenose mitral reumática. Método - Duzentos pacientes foram submetidos ao procedimento, sendo 86,5% do sexo feminino, com idade média de 35,2 anos. Oitenta e um por cento estavam em classes funcionais III e IV (NYHA), e 4% exibiam ritmo de fibrilaçäo atrial. Quatro por cento foram submetidos à comissurotomia cirurgica prévia e 7% eram gestantes. Utilizou-se a técnica de dilataçäo com duplo cateter-baläo, após punçäo septal esquerda. Resultados - O procedimento foi realizado com sucesso em 89% dos pacientes. A área valvar mitral aumentou de 0,91 ñ 0,27 para 2,10 ñ 0,47 cm*, p < 0,001; ocorreu reduçäo do gradiente transvalvar mitral de 20,86 ñ 6,16 para 4,26 ñ 3,13 mmHg, p < 0,001; as pressöes do átrio esquerdo e do tronco da artéria pulmonar reduziram de 25,90 ñ 7,10 para 12,10 ñ 9,0 mmHg e de 36,47 ñ 12,93 para 24,56 ñ 9,98 mmHg, p < 0,001, respectivamente. Dos 21 casos com insucesso, em 19 ocorreram dificuldades com a técnica transeptal. Em 12, constataram-se graus distintos de derrame pericárdico, dos quais 6 exibiram sinais de tamponamento cardíaco. Os 21 casos foram operados, ocorrendo 1 óbito. O refluxo mitral aparece em 50 casos e aumentou em 8. Quinze destes casos, exibiram descompensaçäo clínica, dos quais 10 foram operados, 3 estäo sob controle clínico e 2 faleceram tardiamente. Conclusäo - A valvoplastia mitral pelo duplo cateter-baläo é técnica segura, com bons resultados, constituindo-se me procedimento terapêutico alternativo näo cirúrgico da estenose mitral
Purpose - To study the immediate clinical, echocardiographic and hemodynamic results Of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique. Methods - Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.2 years, and 86.5% were female patients: 81% of them was in functional class, New York Heart Association (NYHAJ III or IV; 4% was in atrial fibrilation and 4% had previous surgical commissurotomy. Results - PMV was successfully performed in 89% of the patients. The mitral valve area, by pressure half time method, increased from 0.91 ± 0.27 to 2.10 ± 0.47 cm2, p < 0.001; the mean mitral gradient decreased from 20,86 ± 6.16 to 4.26 ± 3.13 mmHg, p < 0.001; the left atrium and mean pulmonary artery pressure decreased from 22.3 ± 7.1 to 11.9 ± 8.3 and 36.47 ± 12.93 to 24.56 ± 9.98 mmHg, p < 0.001, respectively. Complications related to transeptal technique occurred in 12 patients, which resulted in cardiac tamponade in 5 and death in 1. In 19 patients the punction of the atrial septum could not be performed. Mitral regurgitation (MR) immediately after PMV appeared 1 + or more grade in 50 patients, increased in 8 patients and remained unchanged in 11 patients. Ten patients needed mitral valve replacement in the first 48h after PMV, for treatment of severe MR. Conclusion - PMV prod uces excellent immediate results and can be considered an alternative to surgery for the relief of mitral stenosis