Ring Fracture of Brazilian Aortic Valve Bioprostheses Using Non-Compliant High-Pressure Transcatheter Balloon, an Ex Vivo Test

ABSTRACT Introduction: Aortic valve bioprostheses ring fracture in valve-in-valve procedures has shown low complication rates and presents as an option in the treatment of patients at high risk for conventional surgery, avoiding high transvalvular gradients, which are associated with increased mortality. Some prostheses available in the market cannot be fractured. In an ex vivo test, the possibility of ring fracture of aortic valve bioprostheses produced in Brazil when submitted to radial force application using a high-pressure non-compliant balloon was evaluated. Methods: One unit of each aortic valve bioprosthesis model, sizes 19 and 21 mm, produced by Brazilian companies (Braile Biomédica, Cardioprótese, and Labcor), was used. In the experiment, a non-compliant high-pressure balloon (Atlas®-Gold), 1 mm larger than the external diameter of the prosthesis, was positioned inside the valve annulus and inflated gradually aiming to fracture the prosthesis. Fracture pressures and photographic and radiological images of the prostheses before and after test were recorded. Results: All prostheses were fractured. In the models with metal ring, the fracture pressures were between 23 and 25 atm. In the other prostheses, the rupture occurred between 10 and 13 atm. No deformations in the structure were observed, which could potentially damage the aortic root. Conclusion: All the Brazilian prostheses evaluated were fractured, although the presence of a metal ring in the prosthesis framework increases the pressure required for fracture. The information obtained helps in the planning of valve-in-valve procedures in patients with aortic valve bioprostheses.

Postnatal management and follow-up of six fetuses affected by pulmonary atresia with intact ventricular septum and right ventricular hypoplasia without intrauterine intervention / 中华围产医学杂志

Objective:To explore the value of current indications for fetal pulmonary valvuloplasty (FPV) by summarizing the postnatal diagnosis, treatment, and prognosis of fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular hypoplasia (RVH).Methods:This prospective study was conducted at the Heart Center of Women and Children's Hospital, Qingdao University from September 2018 to March 2021, which included pregnant women who were (1) with fetal PA/IVS and RVH; (2) unable to receive FPV due to fetal position or gestational age despite the indications; (3) given integrated pre- and postnatal management. Prenatal fetal echocardiography assessment, postnatal diagnosis, treatment, and follow-up were summarized using Wilcoxon matched-pair signed-rank test.Results:A total of 35 singleton pregnant women were diagnosed with fetal PA/IVS and RVH by ultrasonic cardiogram and admitted during the study period. Among the 28 fetuses meeting the FPV indications, 18 underwent FPV, while the other 10 did not due to inappropriate fetal position or gestational age. After excluding four terminated pregnancies, the rest six cases were enrolled. The median gestational age at the initial prenatal fetal echocardiography diagnosis was 28.9 weeks (28.3-30.4 weeks). Compared with the initial evaluation, the fetal right ventricular to left ventricular length/diameter ratio [0.8 (0.6-0.9) vs 0.6 (0.5-0.8)] and tricuspid regurgitation velocity [4.7 m/s (3.2-5.1 m/s) vs 4.1 m/s (3.3-4.8 m/s)] were increased, while tricuspid valve Z value [－0.8(－1.6-0.8) vs 0.4 (－0.3-1.9)] and single-ventricular predictive score [0.5 (0.0-2.0) vs 2.0 (1.0-3.0)] were decreased when re-evaluated six weeks later ( T were－2.21, 2.00,－2.20, and 2.00; all P<0.05). All of the six fetuses were born alive with a median gestational age of 38.9 weeks (37.3-40.1 weeks). The median weight was 3 425 g (3 100-4 160) g after being transferred to cardiac intensive care unit. The median age was 12.5 d (0.0-20.0 d) at the first surgical intervention. The median follow-up duration was 15 months (11.8-18.5 months). At initial diagnosis, the single-ventricular predictive score was 1-2 points in four fetuses, and =3 points in two fetuses. There was no death during follow-up. Four patients achieved anatomical biventricular circulation, one achieved clinical biventricular circulation, and one still needed further follow-up, with single-ventricular predictive score at initial diagnosis of 1-3, 3, and 2 points, respectively. Conclusions:The prognosis is good in fetuses with PA/IVS and RVH who have FPV indications but do not receive intrauterine intervention, which suggests that the current FPV indications may be too broad, and a more suitable FPV indication need to be further explored given the difficulty of implementing FPV.

Comparison of early and long-term follow-up results of percutaneous mitral balloon valvuloplasty and mitral valve replacement

SUMMARY BACKGROUND: Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. ObjectIve: In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. Methods: 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. Results: The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p<0.001). The hospital mortality rate of percutaneous mitral balloon valvuloplasty and mitral valve replacement were 0% and 2% respectively (p=0.024). In the percutaneous mitral balloon valvuloplasty group, early postprocedural success rate was 92.1%. The event-free survival of percutaneous mitral balloon valvuloplasty and mitral valve replacement was found to be similar. While reintervention was higher in percutaneous mitral balloon valvuloplasty-group (p<0.001), mortality rate was higher in mitral valve replacement-group (p<0.001). Conclusion: Percutaneous mitral balloon valvuloplasty seems to be more advantageous than mitral valve replacement due to low mortality rates, easy application of the procedure and no need for general anesthesia.

Valvuloplastia mitral percutánea con balón: experiencia en el Cardiocentro de Santiago de Cuba / Percutaneous balloon mitral valvuloplasty: experiences at the Cardiocentro in Santiago de Cuba

RESUMEN Introducción: La valvuloplastia mitral percutánea con balón actualmente es el primer procedimiento terapéutico que se contempla en el mundo desarrollado para los pacientes con estenosis mitral reumática e indicación para ello, y se realiza en el Cardiocentro de Santiago de Cuba desde julio de 2008. Objetivos: Describir los resultados de la valvuloplastia mitral percutánea con balón en los pacientes estudiados. Método: Se realizó un estudio observacional y descriptivo, unicéntrico, que incluyó a 91 pacientes tratados mediante este procedimiento en el Cardiocentro de Santiago de Cuba, desde julio de 2008 hasta junio de 2019. Se evaluaron variables clínico-epidemiológicas, ecocardiográficas y hemodinámicas, así como el resultado inmediato del procedimiento. Resultados: Predominaron los pacientes jóvenes (60,4% entre 15-44 años), del sexo femenino (86,8%), con antecedentes de fiebre reumática (48,4%), en clase funcional III (64,8%) de la NYHA (New York Heart Association) y en ritmo sinusal (86,8%). Se logró un aumento promedio del área valvular de más del doble (0,99 vs. 2,12 cm2) del valor inicial y una reducción de la presión auricular mayor de 50% (25,0 vs.11, 76 mmHg), lo que permitió evaluar de satisfactorio el tratamiento en el 95,6% de los pacientes. Se identificó una asociación significativa (Prueba de Fisher ≤ 0,05) entre la puntuación de Wilkins ≤ 8 y el resultado satisfactorio del procedimiento. Conclusiones: Los resultados de la aplicación de la valvuloplastia mitral percutánea con balón en el centro fueron satisfactorios y congruentes con los referidos nacional e internacionalmente.

ABSTRACT Introduction: Percutaneous balloon mitral valvuloplasty has flourished as a mainstream therapy (mostly in developed countries) for treating patients with medical indication and those suffering from rheumatic mitral stenosis. This procedure is performed at the Cardiocentro in Santiago de Cuba since July 2008. Objectives: To describe the results of percutaneous balloon mitral valvuloplasty in the study participants. Methods: A descriptive, single-centered and observational study including 91 patients treated by this procedure was conducted at the Cardiocentro in Santiago de Cuba from July 2008 to June 2019. Clinical/epidemiological, echocardiographic and hemodynamic variables were assessed, as well as immediate procedure outcomes. Results: Young individuals (60.4% between 15-44 years), female (86.8%), with a history of rheumatic fever (48.4%), NYHA (New York Heart Association) functional class III (64.8%) and sinus rhythm (86.8%) predominated. An average increase in valve area of over double (0.99 vs. 2.12 cm2) the initial value and a reduction in atrial pressure of more than 50% (25 vs. 11.76 mmHg) was achieved; thus evidencing that the treatment was effective in 95.6% of the patients. A significant association (Fisher Test ≤ 0.05) was identified between Wilkins score ≤ 8 and satisfactory outcome of the procedure. Conclusions: The results of percutaneous balloon mitral valvuloplasty in the medical center were successful and consistent with those achieved nationally and internationally.

Clinical effect of endoscopic sphincterotomy with balloon dilation versus sphincterotomy alone in treatment of large common bile duct stones: A Meta-analysis / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of endoscopic sphincterotomy with balloon dilation (ESBD) versus sphincterotomy (EST) alone in the treatment of large common bile duct stones. Methods Foreign databases (including PubMed, CochraneCentral, and Embase) and Chinese databases (including CNKI and Wanfang Data) were searched for randomized controlled trials (RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8, 2019. Related data were extracted and RevMan5.3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included, with 973 patients in the ESBD group and 953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate (odds ratio ［OR］=1.53, 95% confidence interval ［CI］: 1.03-2.29, P=0.04), one-time clearance rate (OR=1.77, 95%CI: 1.06-2.93, P=0.03), rate of use of mechanical lithotripsy (OR=0.40, 95%CI: 0.25-0.63, P＜0.000 1), bleeding rate (OR=0.23, 95%CI: 0.11-0.50, P＜0.001), incidence rate of cholangitis (OR=0.31, 95%CI: 0.12-0.78, P=0.01), incidence rate of early complications (OR=0.59, 95%CI: 0.42-0.84, P=0.003), and time of operation (mean difference=-8.89, 95%CI: -17.56 to -0.22, P=0.04), while there were no significant differences between the two groups in perforation (OR=0.27, 95%CI: 0.05-1.30, P=0.10) and pancreatitis after endoscopy (OR=1.03, 95% CI: 0.66-1.61, P=0.91). ConclusionIn endoscopic treatment of large common bile duct stones, ESBD has several advantages over EST in stone clearance rate, rate of use of mechanical lithotripsy, bleeding rate, incidence rate of cholangitis, and time of operation.

Efficacy of surgical balloon valvuloplasty via right ventricular outflow tract for right ventricular decompression in the treatment of pulmonary atresia with intact ventricular septum / 中国胸心血管外科临床杂志

@#To analyze the mid-long-term outcomes of surgical balloon valvuloplasty (SBV) for right ventricular decompression in the treatment of pulmonary atresia with intact ventricular septum (PA/IVS). Methods    Clinical data of consecutive 91 patients who were diagnosed with PA/IVS and underwent SBV in our institution from January 2005 to December 2017 were retrospectively analyzed, including 52 (57.1%) males and 39 (42.9%) females. The median age was 3 months (1 d, 24 months) and the median weight was 4.1 (2.5, 12.0) kg. Results    The SBV was performed in all patients, and 62 of whom received other simultaneous surgeries, including ligation of patent ductus arteriosus (PDA, 33 patients), ligation of PDA with modified Blalock-Taussig shunt (23 patients), ligation of PDA with bidirectional Glenn shunt (6 patients). There was no early postoperative death. The median follow-up time was 8.8 (2.5, 13.4) years, 4 patients were lost. There were 7 (8.0%) deaths and 1 (1.1%) patient with a re-SBV for pulmonary stenosis. The one and a half ventricular repair was performed in 5 (5.7%) patients and Fontan procedure in 2 (2.3%) patients. In addition, the mean Z-value of tricuspid valve annulus was −1.7±1.5, which was significant bigger than that before the operation (t=5.587, P<0.001). Conclusion    SBV via right ventricular outflow tract for right ventricular decompression in the treatment of PA/IVS is safe and reliable. The majority of patients can receive biventricular repair instead of single ventricular palliation by SBV with individually customized shunt.

Utilidad de la valvuloplastia en el paciente de alto riesgo con estenosis aórtica severa. Reporte de caso / Valvuloplasty usefulness in the high risk patient with severe aortic stenosis. Case report

Resumen: La estenosis aórtica severa (EAoS) se asocia a comorbilidad pulmonar en un porcentaje considerable de pacientes, siendo complejo decidir sobre el tratamiento definitivo; al poseer elevado riesgo quirúrgico surgen dudas sobre la futilidad del procedimiento. Con la aparición y el desarrollo del implante percutáneo aórtico transcatéter, la valvuloplastia aórtica con balón (VAB) ha resurgido, se ha modificado y juega un rol central en el manejo de los pacientes con EAoS sintomática de muy alto riesgo por inestabilidad hemodinámica o comorbilidad severa. Se reporta un caso clínico que evidencia la utilidad de la VAB como herramienta diagnóstica y como puente a una terapia definitiva.

Summary: Severe aortic stenosis is associated with pulmonary comorbidity in a significant percentage of patients, being difficult to define the definitive therapy, considering they are high surgical risk patients where doubt about the futility of the procedure arises. With the appearance and development of the transcatheter aortic valve implant, balloon aortic valvuloplasty has re-emerged, has been modified and plays a central role in the management of patients with symptomatic high-risk severe aortic stenosis due to hemodynamic instability or severe comorbidity. We report a clinical case which demonstrates the usefulness of the balloon aortic valvuloplasty as a diagnostic tool and as a bridge to a definitive therapy.

Uso de la valvuloplastia mitral percutánea con balón en un hospital provincial / Use of the mitral percutaneous balloon valvuloplasty in a provincial hospital

Se realizó un estudio observacional y descriptivo, que incluyó a 46 pacientes tratados con valvuloplastia mitral percutánea con balón, en el Hospital Provincial Saturnino Lora Torres de Santiago de Cuba, desde julio de 2008 hasta diciembre de 2015, a fin de evaluar el resultado inmediato del proceder empleado. Se analizaron variables clinicoepidemiológicas, ecocardiográficas y hemodinámicas. Predominaron los pacientes jóvenes de 15-44 años (63,0 por ciento), las mujeres con antecedentes de fiebre reumática (87,0 por ciento), la clase III, según la clasificación funcional de la insuficiencia cardiaca (76,1 por ciento) y el ritmo sinusal (84,8 por ciento). Se logró un aumento del área valvular superior a 100,0 por ciento y una reducción de la presión auricular de aproximadamente 50,0 por ciento. El tratamiento fue satisfactorio en 93,5 por ciento de los afectados. Hubo asociación significativa entre los pacientes con una escala de Wilkins de 8 o menos y el sexo femenino, con un resultado favorable de dicho proceder

An observational and descriptive study that included 46 patients treated with mitral percutaneous balloon valvuloplasty, was carried out in Saturnino Lora Torres Provincial Hospital in Santiago de Cuba, from July, 2008 to December, 2015, in order to evaluate the immediate result of the procedure that was used. Clinical epidemiological, echocardiographic and hemodynamic variables were analyzed. There was a prevalence of the young patients aged 15-44 (63.0 percent), women with history of rheumatic fever (87.0 percent), the class III, according to the functional classification of heart failure (76.1 percent) and the sinus rhythm (84.8 percent). A 100.0 percent increase from the upper valvular area and an approximately 50.0 percent reduction of the atrial pressure were achieved. The treatment was satisfactory in 93.5 percent of the affected patients. There was a significant association between the patients with an 8 or less Wilkins scale and the female sex, with a favorable result of the procedure

Feasibility of Complete Aortic Valve Cusp Replacement Using CardioCel® in Early Childhood

The presented case is the report on a successful complete aortic valve cusp replacement using tissue-engineered xenogenic CardioCel® material in early childhood.

Risk factors of postoperative acute pulmonary reperfusion injury in neonatal severe pulmonary stenosis or pulmonary atresia / 中国新生儿科杂志

Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia.Method From February 2014 to February 2018,a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital.Clinical characteristics,perioperative cardiac structure,hemodynamic data and biochemical results were collected.The neonates were assigned into injury group if they had acute lung reperfusion injury,and non-injury group if not.The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model.Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled.The main manifestations were dyspnea and cyanosis.Intravenous prostaglandin E was administered to keep the ductus arteriosus open.The age of operation ranged from 1 to 52 days and the median age was 7.5 days.Postoperative acute lung reperfusion injury occurred in 7 cases (21.9％).Preoperative and intraoperative pulmonary valve annulus diameter,balloon diameter,preoperative hemoglobin,hematocrit and blood albumin were significantly lower in the injury group.The operation duration,total length of hospital stay and postoperative duration were longer than in the non-injury group,the differences were statistically significant (P ＜ 0.05).Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR =5.814,95％CI 1.106 ～30.568),preoperative blood albumin (OR =1.361,95％ CI 1.063 ～ 1.742),and hematocrit (OR =1.173,95％ CI 1.010 ～ 1.363) were risk factors of acute lung reperfusion injury,with statistically significant differences (P ＜ 0.05).Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia.The severity of pulmonary valve annulus stenosis,preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.

Predictors of Long-Term Outcomes of Percutaneous Mitral Valvuloplasty in Patients with Rheumatic Mitral Stenosis

PURPOSE: We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). MATERIALS AND METHODS: Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death. RESULTS: The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ≤Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01–2.41] and post-MVA cut-off (p 8 and post-MVA ≤1.76 cm² were independent predictors of poor long-term clinical outcomes after PMV, including MV reintervention, stroke, and cardiovascular-related death.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil / Implante de Válvula Aórtica por Cateter e Seus Fatores de Morbimortalidade em Experiência de 5 Anos no Brasil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Resumo Fundamento: O implante de válvula aórtica por cateter tornou-se uma opção para pacientes com doença valvar aórtica de elevado risco cirúrgico. Objetivo: Avaliar os resultados dos seguimentos intra-hospitalar e de até 1 ano do implante de válvula aórtica por cateter. Métodos: Estudo de coorte prospectiva de casos de implante de válvula aórtica por cateter entre julho de 2009 e fevereiro de 2015. Análise de variáveis clínicas e do procedimento, correlacionando com mortalidade intra-hospitalar e de 1 ano. Resultados: Foram submetidos ao implante 136 pacientes, com média de idade de 83 (80-87) anos, sendo 49% mulheres, 131 (96,3%) deles com estenose aórtica, um (0,7%) com insuficiência aórtica e quatro (2,9%) com disfunção de prótese. A classe funcional da NYHA foi III ou IV em 129 (94,8%) casos. A área valvar inicial foi 0,67 ± 0,17 cm2 e o gradiente ventrículo esquerdo-aorta médio de 47,3 ± 18,2 mmHg, com STS de 9,3% (4,8%-22,3%). As próteses implantadas eram autoexpansíveis em 97% dos casos. A mortalidade peroperatória em 1,5% dos casos; em 30 dias em 5,9%; intra-hospitalar em 8,1%; e após 1 ano em 15,5% dos casos. A hemotransfusão (risco relativo de 54; p = 0,0003) e a hipertensão arterial pulmonar (risco relativo de 5,3; p = 0,036) foram preditoras de mortalidade hospitalar; e a proteína C-reativa pico (risco relativo de 1,8; p = 0,013) e a hemotransfusão (risco relativo de 8,3; p = 0,0009) de mortalidade em 1 ano. Aos 30 dias, 97% dos pacientes estavam em classe NYHA I/II e, em 1 ano, o número chegou a 96%. Conclusão: O implante de válvula aórtica por cateter foi realizado com alto índice de sucesso e baixa mortalidade. A hemotransfusão associou-se com maior mortalidade hospitalar e de 1 ano. Proteína C-reativa pico se associou com a mortalidade de 1 ano.

Importância do comprometimento subvalvar nos resultados da valvoplastia mitral com cateter de inoue / Severity of subvalvular impairment in the results of mitral valvuloplasty with inoue catheter

Fundamentos: A valvoplastia mitral por cateter-balão foi introduzida em 1984 por Inoue e colaboradores, e atualmente é considerada o método de eleição no tratamento da estenose mitral. Objetivo: Comparar resultados de valvoplastia mitral em pacientes com estenose mitral com comprometimento subvalvar ≥3 e <3. Métodos: Estudo retrospectivo com 104 pacientes submetidos à valvoplastia mitral com balão de Inoue. Os pacientes foram estratificados em dois grupos: com comprometimento subvalvar (ASV) ≥3 e ASV <3. Realizada a comparação dos resultados imediatos, aos 12 meses e aos 24 ou mais meses entre os grupos com os dados obtidos por estudo ecocardiográfico e hemodinâmico. Resultados: Os resultados imediatos mostraram sucesso nos dois grupos, com significância estatística pré/pós procedimento, quanto aos parâmetros ecocardiográficos e hemodinâmicos, e ausência de diferenças significativas entre os grupos. Os resultados ecocardiográficos aos 12 meses evidenciaram que o gradiente médio e a área valvar foram semelhantes e sem significância estatística entre os grupos, o mesmo a correndo na comparação dos resultados ecocardiográficos aos 24 ou mais meses. Conclusão: Os resultados obtidos com a valvoplastia mitral com o balão de Inoue não diferiram tanto nos pacientes com comprometimento do aparelho subvalvar ≥3 quanto <3.

Background: Balloon mitral valvuloplasty was introduced in 1984 by Inoue et al and is currently considered the method of choice in the treatment of mitral stenosis. Objective: To compare results of mitral valvuloplasty in patients with mitral stenosis with subvalvular impairment ≥3 and <3. Methods: Retrospective study with 104 patients undergoing mitral valvuloplasty with Inoue balloon. Patients were stratified into two groups: subvalvular impairment (SVI) ≥3 and SVI <3. The immediate results were compared at 12 months and 24 months or more between the groups with data obtained by echocardiography and hemodynamic study. Results: The immediate results revealed success in both groups, with statistical significance pre/post-procedure regarding the echocardiographic and hemodynamic parameters and no significant differences between groups. Echocardiographic results at 12 months showed that the mean gradient and the valve area were similar and not statistically significant between the groups, the same occurring in the comparison of echocardiographic results at 24 or more months. Conclusion: The results obtained with mitral valvuloplasty with Inoue balloon did not differ both in patients with subvalvular impairment ≥3 and <3.

The impact of prenatal diagnosis on treatment and prognosis of neonatal pulmonary atresia with intact ventricular ;septum and critical pulmonary stenosis with intact ventricular septum / 临床儿科杂志

Objective To explore the impact of prenatal diagnosis on the early treatment and short and medium term outcome of neonatal pulmonary atresia with intact ventricle septum (PA/IVS) or critical pulmonary stenosis with intact ventricle septum (CPS/IVS). Methods According to the case-control method, twenty-eight neonates with (PA/IVS) or (CPS/IVS) who had percutaneous pulmonary balloon valvuloplasty (PBPV) surgery indications, were divided into the prenatal diagnosis group (n?=?15) and the postnatal diagnosis group (n?=?13). The prenatal diagnosis group was diagnosed in fetal period and the intervention program was since developed . The postnatal diagnosis group was referred from other hospitals, and the intervention program was developed after conifrmation of the diagnosis. All the neonates accepted the PBPV surgery after the hemodynamic parameters stable. All neonates were followed-up at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Clinical situations, echocardiography results, and interventional cardiology measurements were compared between two groups. Result The average age and weigh was 7.53?±?3.18 days and 3102.32?±?708.40 g respectively at the time of PBPV surgery in 28 neonates. Among them, 9 neonates were PA/IVS and 19 neonates were CPS/IVS. The mean follow-up time was 18.8?±?5.22 months and there were no death. The ages at admission and at the ifrst treatment were signiifcantly younger in the prenatal diagnosis group than those in the postnatal diagnosis group (P??0.05). Conclusion Prenatal diagnosis is helpful for the early intervention in neonates with PA/IVS and CPS/IVS, and can reduce the complications after surgery.

Valvuloplastia percutánea con balón de válvula mitral durante la gestación. Reporte de dos casos en un hospital de cuarto nivel de atención en Cali, Colombia y revisión de la literatura / Percutaneous balloon mitral valvuloplasty during pregnancy. Report of two cases in a level IV hospital in Cali, Colombia, and review of the literature

Objetivo: Describir la experiencia de dos casos de gestantes con estenosis mitral valvular, llevadas a valvuloplastia percutánea con balón y dilatación como alternativa terapéutica para contrarrestar los riesgos de colapso y deterioro materno-fetal y permitir la progresión del embarazo sin complicaciones cardiovasculares o el deterioro funcional, y realizar una revisión de la literatura publicada sobre la realización del procedimiento en gestantes. Materiales y métodos: Se presentan dos casos de estenosis mitral severa y compromiso funcional asociado, de aparición en el segundo trimestre del embarazo, atendidos en una institución de cuarto nivel de complejidad, centro de referencia regional. Se manejaron por medio de valvuloplastia mitral con balón, con desenlaces clínicos maternos perinatales favorables. La revisión de la literatura se hizo a partir de los términos: "valvuloplastia", "estenosis mitral" y "embarazo". Se realizó una búsqueda en la base de datos Medline vía PubMed, Medes y Scopus. Se excluyeron los procedimientos descritos que estaban dirigidos al reparo valvular del feto. Los estudios se centraron en los cambios en las mediciones de la válvula, los resultados obstétricos y la seguridad. Resultados: Se identificaron doce títulos. Los resultados obtenidos son comparables a los reportes de casos de estenosis de válvula mitral con procedimiento asistido por balón para dilatación de la válvula. En general, el procedimiento es exitoso, incrementa el área de la válvula mitral y reduce el gradiente de presión en la válvula. No obstante, existe el riesgo de desarrollar insuficiencia de válvula mitral tras la conducta, trombosis y muerte. Conclusión: La valvuloplastia percutánea con balón y dilatación como alternativa terapéutica es una opción por considerar en el manejo de la estenosis mitral en la gestante con deterioro de la clase funcional y el aumento durante el seguimiento de la presión en cuña pulmonar. Se requieren estudios controlados que validen los resultados de los estudios observacionales.

Objective: To describe the experience of two cases of pregnant women with mitral stenosis taken to percutaneous balloon valvuloplasty and dilatation as a therapeutic option to counteract the risk of collapse and maternal and foetal deterioration, and to allow progression of the gestation without cardiovascular complications or functional impairment; and to conduct a review of the published literature regarding this procedure in pregnant women. Materials and methods: Two cases of severe mitral stenosis and associated functional involvement of early onset during the second trimester of pregnancy, seen in a level IV regional referral centre. The two cases were managed with balloon mitral valvuloplasty, with favourable perinatal maternal outcomes. The review of the literature was done using the terms Valvulopasty, Mitral Stenosis and Pregnancy. A search was conducted in Medline via Pubmed and in the MEDES and SCOPUS databases. Procedures described for the performance of foetal valve repair were excluded. Studies were focused on the diagnostic findings and the course of the surgical procedure. Results: Overall, 12 titles were identified. The results obtained are comparable with the case reports found in the literature on mitral valve stenosis using balloon-assisted procedures for valve dilatation. In general terms, the procedure is successful, increasing the area of the mitral valve and reducing the pressure gradient across the valve. However, there is a risk of mitral regurgitation, thrombosis and death following the procedure. Conclusion: Percutaneous mitral valvuloplasty with balloon dilatation is a therapeutic option that may be considered for the management of mitral stenosis in pregnant women with functional class deterioration and increasing pulmonary wedge pressure during follow-up. Controlled studies are required in order to validate the results of observational studies.

Infective Endocarditis in a Patient after Percutaneous Mitral Balloon Valvuloplasty / 대한내과학회지

Percutaneous mitral balloon valvuloplasty (PMBV) is the treatment of choice for mitral stenosis. Only a few reported cases have been reported in PMBV patients worldwide. In this study, a case of a 34 year-old female with infective endocarditis a year after PMBV is presented. The patient presented with fever, and peripheral vascular symptoms. Transthoracic echocardiography showed vegetation on the anterior mitral leaflets and Staphylococcus Viridans was isolated from blood cultures. The patient was successfully treated with Amoxicillin + Clavulate and Gentamicin. Further studies on the correlation between PMBV and infective endocarditis are needed.

Balloon valvuloplasty for severe subaortic stenosis in a Pomeranian dog

A nine-month-old Pomeranian dog with exercise intolerance and syncope was presented. The dog was depressed with grade 4 systolic murmur on cardiac auscultation. Based on cardiac examination, the dog was diagnosed with severe subaortic stenosis with involvement of the anterior mitral valve. β-blocker administration was initiated and clinical signs were improved, but not fully resolved. Balloon valvuloplasty was performed and the dog survived for nearly one year without clinical sign and the cardiac troponin I level was normalized. This case describes successful management of severe subaortic stenosis in a small breed dog through balloon valvuloplasty.

Desfechos hospitalares e tardios de pacientes submetidos à valvoplastia mitral percutânea em centro com volume intermediário de procedimentos estruturais / In-hospital and late outcomes of patients undergoing percutaneous mitral valvuloplasty in a center with intermediate volume of structural procedures

A valvoplastia mitral percutânea é o tratamento de escolha da estenose mitral reumática comanatomia favorável, por sua capacidade de prevenir complicações inerentes ao tratamento cirúrgico e com manutenção da eficácia. Faz-se necessário promover comparações entre os resultados obtidos com o procedimento por centros de referência e alta drenagem de pacientes e por instituições de menor volume e casuística, sendo este o objetivo principal deste estudo. Métodos: Foram analisados 31 pacientes consecutivos submetidos à valvoplastia mitral percutânea no período de setembro de 2006 a janeiro de 2015. Avaliaram-se o sucesso imediato do procedimento e a sobrevida livre de eventos tardios, definidos como morte cardiovascular ou necessidade de novaintervenção valvar mitral. Resultados: A média de idade foi de 40,9 ± 14,2 anos, com predomínio do sexo feminino (96,8%). O escore médio de Wilkins e Block foi de 8,1 ± 1,2. A totalidade dos procedimentos foi efetivada pela técnica de Inoue, com taxa de sucesso imediato de 90,3%. Em acompanhamento médio de 6,8 ± 2,5 anos, foram constatadossete eventos (22,6%), sendo dois óbitos de etiologia cardiovascular, quatro cirurgias de troca valvar mitral e uma comissurotomia mitral. Conclusões: Em um hospital com volume intermediário de procedimentos, os resultados da valvoplastia mitral percutânea no tratamento da estenose mitral reumática com anatomia favorável foram comparáveis àqueles alcançados por centros de alto referenciamento...

Background: Percutaneous mitral valvuloplasty is the treatment of choice for rheumatic mitral stenosis with favorable anatomy, for its ability to prevent complications inherent to a surgical procedure, while maintaining effectiveness. It is necessary to promote comparisons between the results obtained by the procedure performed at referral centers with high patient inflow and at institutions with lower volume and fewer patients, which represents the main objective of this study. Methods: Thirty-one consecutive patients undergoing percutaneous mitral valvuloplasty were analyzed from September 2006 to January 2015. Immediate procedural success and late event-free survival rates were evaluated, defined as cardiovascular death or need for a new mitral valve intervention. Results: The mean age was 40.9 ± 14.2 years, with a predominance of females (96.8%). The mean Wilkinsand Block score was 8.1 ± 1.2. All procedures were performed using the Inoue technique, with na immediate success rate of 90.3%. At mean follow-up of 6.8 ± 2.5 years, seven events (22.6%) were observed: two cardiovascular deaths, four surgeries for mitral valve replacement, and one mitral commissurotomy Conclusions: In a hospital with intermediate procedure volume, the results of percutaneous mitral valvuloplasty in the treatment of rheumatic mitral stenosis with favorable anatomy were comparable to those achieved by high-volume centers...

A Case of Noonan Syndrome Presenting with Malignant Hypertension in an Adult / 대한내과학회지

Noonan syndrome is an autosomal dominant disorder characterized by dysmorphic facial features, congenital heart defects and short stature. To date, renal artery stenosis has not been associated with Noonan syndrome. We report the case of a 27-year old male who presented with malignant hypertension associated with renal artery stenosis, dysmorphic facial features, pectus excavatum, pulmonary stenosis and hypertrophic cardiomyopathy who was diagnosed with Noonan syndrome.

Resultados a largo plazo de la valvuloplastía mitral con balón / Long term results of mitral balloon valvuloplasty

Background: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. Aim: To assess the late results of MBV. Material and Methods: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. Results: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). Conclusions: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.