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1.
Arch. cardiol. Méx ; 94(1): 7-14, ene.-mar. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1556887

ABSTRACT

Resumen Antecedentes: Las cardiopatías congénitas plantean un desafío terapéutico, específicamente la estenosis de la válvula pulmonar. Esta ha sido tratada durante muchos años con procedimientos invasivos e inserción de bioprótesis, que con el tiempo se vuelven disfuncionales y pueden reestenosarse por acumulación de tejido fibroso y calcificación. Debido a las complicaciones generadas por la injuria quirúrgica, se han descrito medidas menos invasivas para el manejo de la estenosis residual e inicial por medios endovasculares en adultos y más recientemente en población pediátrica. Objetivo: El objetivo de este reporte es describir la misma en el manejo endovascular del tracto de salida del ventrículo derecho, como el inicio de un trabajo continuo para la mejoría de los resultados pediátricos en países en vía de desarrollo. Métodos: Se presentan siete casos pediátricos de manejo endovascular del tracto de salida derecho; tres de ellos sometidos a valvuloplastia quirúrgica con persistencia de la estenosis pulmonar, por lo cual se decidió inserción percutánea de una válvula pulmonar (IVPP) transcatéter con válvula Melody utilizando la técnica valve-in-valve, con lo que se consiguió una resolución del 100% de la estenosis y no se presentó ningún tipo de complicación asociada al procedimiento. Resultados: En cuatro pacientes se logró una implantación exitosa de la válvula por vía percutánea en diferentes cardiopatías congénitas, siendo uno de ellos en tracto nativo; además, destaca el caso de un paciente en quien se realizó fractura intencional de la válvula pulmonar, procedimiento innovador en el manejo endovascular pediátrico en Colombia. Conclusiones: En estos pacientes el procedimiento resultó ser poco invasivo, seguro y efectivo. La técnica IVPP podría ser considerada una opción viable en Colombia (y en otros países en desarrollo) para el manejo de implantes valvulares primarios fallidos o incluso en tractos nativos.


Abstract Background: Congenital heart disease poses a therapeutic challenge, specifically pulmonary valve stenosis. This has been treated for many years with invasive procedures and bioprostheses, which over time, become dysfunctional due to the accumulation of fibrous tissue and calcification. Objective: The aim of this study is to describe the use of endovascular management in the right ventricular outflow tract, as the beginning of an ongoing effot to improve pediatric outcomes in developing countries. Methods: Seven pediatric patients with endovascular management of the right outflow tract are presented. Three of them underwent surgical valvuloplasty with persistent pulmonary stenosis. They decided to insert a percutaneous transcatheter pulmonary valve (PPVI) with a Melody valve using the valve-in-valve technique, with 100% stenosis and no complications associated with the procedure. Results: Four patients with successful percutaneous valve implantation had different congenital heart diseases. In addition, the case of a patient in whom an intentional pulmonary valve fracture was performed, an innovative procedure in pediatric endovascular management in the country, is highlighted. Conclusions: The procedure was minimally invasive, safe, and effective. The IVPP technique could be a viable option in our country for managing failed primary valve implantations or even in native tracts.

2.
Article in Chinese | WPRIM | ID: wpr-1017734

ABSTRACT

Congenital pulmonary valve stenosis(PS)is a common congenital heart disease. Simple PS makes up approximately 8%~10% of congenital heart disease,and 20% of complex congenital heart disease complicated with PS. Percutaneous balloon pulmonary valvuloplasty(PBPV),which has undergone nearly 40 years of continuous improvement,has emerged as the preferred treatment for PS due to its superior safety and less trauma. However,residual stenosis was found in some patients during long-term follow-up,and repeat PBPV or even surgical repair was required. Identifying the risk factors for postoperative restenosis will further improve postoperative outcomes and reduce the probability of reintervention in the future. This article reviews the risk factors for restenosis of PS after PBPV including age,severity,morphologic characteristics of the valve leaflets and the choice of the balloon.

3.
Rev. bras. cir. cardiovasc ; 38(3): 398-404, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1441203

ABSTRACT

ABSTRACT Introduction: Congenital heart diseases (CHDs) constitute the most prevalent congenital pathology, and they are a consequence of structural and functional abnormalities during fetal development. The etiology of CHD involves the interaction of genetic and environmental factors. Fetal cardiac surgery aims at preventing natural pathways of CHD in utero, mitigating progression to more complex abnormalities. The goal of this review was to demonstrate the benefits and risks of fetal interventions in the two most prevalent CHDs, pulmonary stenosis and pulmonary atresia with an intact ventricular septum, but also critical aortic stenosis and hypoplastic left heart syndrome. Methods: Original and relevant articles were selected by meta-aggregation to perform a qualitative analysis of fetal cardiac interventions for pulmonary stenosis and critical aortic stenosis. The Joanna Briggs Institute's Qualitative Assessment and Review Instrument (or JBI-QARI) was used for data quality appraisal. Results: Of 61 potential articles, 13 were selected, and nine were finally included. Discussion: The present review demonstrated that fetal cardiac surgery increases right ventricular growth and hemodynamic flow in pulmonary stenosis, whereas in critical aortic stenosis it enables growth of the left ventricle and increases left ventricular pressure. However, it has a high complication rate, along with considerable morbidity and mortality. Conclusion: The benefits of fetal cardiac surgery for pulmonary stenosis and critical aortic stenosis are well-described in the literature; however, there is a significant risk of complications which can be reduced by the surgeon's technical expertise and well-structured hospital facilities.

5.
Arch. cardiol. Méx ; 90(3): 313-320, Jul.-Sep. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1131049

ABSTRACT

Resumen Los pacientes con cardiopatías congénitas que afectan la continuidad del ventrículo derecho con la arteria pulmonar deben someterse con frecuencia a intervenciones debido a la limitada vida útil de los conductos quirúrgicos, lo que lleva al desarrollo de disfunción ventricular derecha por cambios en la geometría ventricular y predisposición a arritmias letales, con el consiguiente riesgo de reintervenciones. El implante valvular percutáneo pulmonar es una nueva alternativa terapéutica, menos invasiva en comparación con la quirúrgica, para pacientes seleccionados. Se realiza una revisión de las publicaciones médicas actuales disponibles y se describe la experiencia inicial del implante valvular pulmonar percutáneo en un centro colombiano de alta complejidad para el tratamiento de enfermedades cardiovasculares, en dos pacientes con disfunción del homoinjerto aórtico en posición pulmonar con doble lesión valvular, en los cuales el implante valvular pulmonar percutáneo fue una conducta exitosa. Se eligió a pacientes con cardiopatías congénitas, conductos quirúrgicos disfuncionales con estenosis o insuficiencia pulmonar significativa, y disfunción y dilatación ventricular derechas. Se empleó la técnica regular para el implante de la válvula pulmonar Melody, sin documentarse complicaciones durante el procedimiento ni al año de seguimiento. El implante percutáneo de la válvula pulmonar es un gran avance en el tratamiento de pacientes con cardiopatías congénitas, con resultados favorables a corto y mediano plazos, lo cual hace posible la restauración de la función ventricular con riesgo mínimo, frente al reemplazo quirúrgico en pacientes seleccionados.


Abstract Patients with congenital heart disease that involves reconstruction of the right ventricular outflow tract must frequently undergo interventions derived from the limited useful life of the surgical canals, which leads to the development of right ventricular dysfunction due to changes in the ventricular geometry and predisposition to lethal arrhythmias, with the consequent risk of reinterventions. The percutaneous pulmonary valvular implant is a new therapeutic alternative, less invasive, compared to surgery, for selected patients. A review of the available literature is made and the initial experience of percutaneous pulmonary valve implantation in a Colombian center of high complexity for the treatment of cardiovascular diseases is described, in two patients with aortic homograft dysfunction in a pulmonary position with double valvular lesion, in which the percutaneous pulmonary valve implant was a successful strategy. Patients with congenital heart disease were chosen, with dysfunctional surgical conduits with stenosis or significant pulmonary insufficiency, with dysfunction and right ventricular dilatation. The standard technique for the implantation of the Melody pulmonary valve was used, without complications during the procedure or one year of follow-up. Percutaneous implantation of the pulmonary valve is a great advance in the management of patients with congenital heart diseases, with favorable results in the short and medium term, allowing the restoration of ventricular function with minimal risk, compared to surgical replacement in selected patients.


Subject(s)
Humans , Male , Adolescent , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Stenosis/surgery , Heart Valve Prosthesis Implantation/methods , Prosthesis Design , Pulmonary Valve/surgery , Pulmonary Valve/pathology , Pulmonary Valve Insufficiency/congenital , Pulmonary Valve Stenosis/congenital , Colombia
6.
Article in Chinese | WPRIM | ID: wpr-837693

ABSTRACT

@#Objective    To analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound. Methods    From March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated. Results    The transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001). Conclusion    PBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.

9.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1051745

ABSTRACT

Objetivo: Determinar los resultados del tratamiento percutáneo que se realizaron a pacientes con diagnostico de Cardiopatía Congénita (CC) en el Hospital Almanzor Aguinaga Asenjo (HNAAA) durante los años 2008 al 2015. Material y Métodos: Estudio cuantitativo de diseño descriptivo transversal, la población fue de 66 pacientes con diagnostico de CC sometidos a este tratamiento en el HNAA durante los años 2008 al 2015, los datos se obtuvieron del sistema de Gestión Hospitalaria y el registro medico solicitado en el área de hemodinámica del servicio de cardiología para la confección de la base de datos en Excel 2007. Resultados: Del registro de los 66 pacientes evaluados en este estudio, predomino el sexo femenino (74,2%). En el grupo etario menor de 10 años (59,1%) fue en los cuales se realizo con mayor frecuencia el tratamiento percutáneo. La cardiopatía congénita de mayor abordaje terapéutico fue el Conducto Arterioso Permeable (72,7%); seguidas de estenosis de la válvula pulmonar (EVP) (18,2%); Los resultados obtenidos por cardiopatía son: PCA (87,5%), EVP (100%), coartación aortica (CoA) (100%) y comunicación interauricular (CIA) (100%). Las complicaciones fueron: Embolizacion del dispositivo hacia la arteria pulmonar y hematoma inguinal pequeño. Conclusiones: El tratamiento percutáneo realizado en el hospital Almanzor Aguinaga Asenjo durante los años 2008 al 2015 presentó similitud a la literatura Internacional en cuanto a los resultados en pacientes con diagnostico de Cardiopatía Congénita, las complicaciones presentadas y el perfil clínico de los pacientes.


Objetive: To determine the results of the percutaneous treatment that were performed in patients with a diagnosis of Congenital Heart Disease (CHD) in the Almanzor Aguinaga Asenjo Hospital (HNAAA) during the years 2008 t o 2015. Mat er i al and Met hods: A quantitative study with a cross-sectional descriptive design, the population was 66 patients with CC diagnosis undergoing this treatment in the HNAA during the years 2008 to 2015, the data was obtained from the Hospital Management system and the medical record requested in the hemodynamic area of the cardiology service for the preparation of the database in Excel 2007. Results: From the registry of the 66 patients evaluated in this study, the female sex predominated (74.2%). In the age group younger than 10 years (59.1%), percutaneous treatment was the most frequent. The congenital cardiopathy with the greatest therapeutic approach was the Permeable Arterial Conduit (72.7%); followed by pulmonary valve stenosis (PVS) (18.2%); The results obtained by heart disease are: PCA (87.5%), PVS (100%), aortic coarctation (CoA) (100%) and atrial septal defect (ASD) (100%). The complications were: Embolization of the device towards the pulmonary artery and small inguinal hematoma. Conclusions: The percutaneous treatment performed in the Almanzor Aguinaga Asenjo hospital during the years 2008 to 2015 presented similarity to the International literature in terms of the results in patients with a diagnosis of congenital heart disease, the complications presented and the clinical profile of the patients.

10.
Chinese Journal of Pediatrics ; (12): 445-450, 2018.
Article in Chinese | WPRIM | ID: wpr-809984

ABSTRACT

Objectives@#Two cases who underwent fetal pulmonary valvuloplasty (FPV) for pulmonary atresia with intact ventricular septum (PA-IVS) or critical pulmonary stenosis with intact ventricular septum (CPS-IVS) successfully were reported. The aim of the report was to explore the criteria for case selection, the technical essentials of FPV, and the postpartum outcome of the fetus.@*Methods@#One case with PA-IVS and the other with CPS-IVS were enrolled in September 2016 and February 2017 in Guangdong General Hospital, and both cases were diagnosed with severe right ventricular dysplasia and tricuspid regurgitation by fetal echocardiogram. Parameters of right ventricle development and hemodynamics from echocardiography included tricuspid/mitral annulus (TV/MV), right ventricle/left ventricle long-axis (RV/LV), pulmonary/aortic annulus (PV/AV), tricuspid inflow duration/cardiac cycle, degree of tricuspid regurgitation (TR), blood flow direction of arterial duct and ductus venosus. Multidisciplinary team including the maternal-fetal cardiology, pediatric cardiology, cardiac surgery, obstetrics, neonatology and anesthesiology was summoned to discuss the indications and timing of PFV. Two cases underwent ultrasound-guiding trans-abdominal PFV at the 28 weeks of gestational age. Echocardiography was performed to observe the opening and closing of the pulmonary valve, and to evaluate the development of right ventricle and improvement in hemodynamics every 2-4 weeks until delivery.@*Results@#From the technical perspective, pulmonary balloon valvuloplasty was successfully performed in these two cases. The opening of pulmonary valve improved in these two cases at 2-4 weeks after FPV. However, an obvious restenosis was detected in the first case at 5-8 weeks after FPV. In the first case, the echocardiography parameters including TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle increased from 0.56, 0.42, 0.85,0.26 to 0.59, 0.51, 0.87, 0.32 at 5-8 weeks after FPV, respectively. However, the direction of blood flow through the arterial duct was still reverse. In the second case, TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle ratio increased from 0.70, 0.63, 0.91,0.35 to 0.80, 0.80, 0.97, 0.42 at 5-8 weeks after FPV, respectively. The direction of blood flow through the arterial duct changed to bidirectional. Both fetuses were born alive. The first case underwent pulmonary valve commissurotomy and modified Blalock-Taussig shunt on the 8th day after delivery and received follow-up for 6 months. The strategy for the next-step therapy was still pending. The second case underwent transcutaneous pulmonary balloon valvuloplasty on the 19th day after delivery and received follow-up for 3 months. The opening of pulmonary valve improved obviously and the cardiac function was normal in the second case.@*Conclusions@#FPV is safe and effective for fetus during the second and third trimester of pregnancy, and FPV is beneficial for the development of fetal ventricle, valve and large artery. In addition, FPV may help to avoid the postnatal surgery for isolated single ventricle, improve fetal heart failure and prevent fetal death.

11.
Article in Chinese | WPRIM | ID: wpr-696326

ABSTRACT

Objective To evaluate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV)in the treatment of the children with pulmonary stenosis (PS),and to observe the long - term prognosis and analyze the influencing factors. Methods The total of 230 children were collected,who had been diagnosed with pul-monary valve stenosis and had undergone percutaneous balloon pulmonary valvuloplasty between November 1987 and November 2015 in Shandong Provincial Hospital Affiliated to Shandong University. Their ages ranged from 4 months to 17 years,and the follow - up duration lasted from 1 month to 29 years. The data included clinical data and long - term follow - up data of hospitalized children,and the echocardiography data from the healthy peers in the same period. Then the data were analyzed statistically. Results In this study,228 cases of children were successfully performed PBPV, and the success rate was 99%(228 / 230 cases). The pulmonary transvalvular gradient (△P)of preoperation,24 hours postoperatively,half a year postoperatively,2 years postoperatively,5 years postoperatively,and 10 years postope-ratively was (63. 5 ± 23. 8)mmHg (1 mmHg = 0. 133 kPa),(26. 2 ± 11. 1)mmHg,(24. 8 ± 9. 8)mmHg,(20. 9 ± 8. 9)mmHg,(18. 1 ± 8. 7)mmHg,(15. 3 ± 7. 3)mmHg and (15. 3 ± 7. 3)mmHg,respectively. The immediate post-operative △P was significantly lower than that of preoperation (P < 0. 01),and the △P of the most children decreased in the long - term follow - up. The results of Logistic regression analysis showed that valve dysplasia with right ventricu-lar outflow tract stenosis and the immediate postoperative residual transvalvular gradient degree were the risk factors for long term curative effect of PBPV in children who could not reach the best standard. The restenosis rate was 4. 6%(3 /65 cases)with children followed up for more than 10 years. The incidence of long - term follow - up pulmonary valve regurgitation (83%)was significantly higher than that before operation (58%)and short term (68%)after operation, and the degree of regurgitation also increased (P < 0. 05),while the degree of regurgitation of the tricuspid regurgitation decreased gradually during the follow - up (P < 0. 05);the right ventricular diastolic diameter of the patients at 10 years or more after the operation was measured as (19. 27 ± 3. 03)mm,which was significantly higher than that (15. 24 ± 2. 89)mm of the healthy children of at the same term healthy age (P < 0. 05). Conclusions The PBPV has a high success rate in the treatment of children with PS,and it has good medium - long - term curative effect,less com-plications and lower restenosis rate. Therefore,PBPV can be used as the first choice for PS. However,the incidence and degree of pulmonary regurgitation has an increasing trend after PBPV and the right ventricular diastolic diameter is still larger than that of the healthy children. Therefore,the long - term follow - up is necessary out of the hospital.

12.
Chinese Journal of Neonatology ; (6): 401-405, 2018.
Article in Chinese | WPRIM | ID: wpr-699317

ABSTRACT

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.

13.
Chinese Circulation Journal ; (12): 904-907, 2017.
Article in Chinese | WPRIM | ID: wpr-660007

ABSTRACT

Objective:To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty (PBPV) in comparison with conventional X-ray guidance.Methods:Our research included in 2 groups:Ultrasound group,n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group,n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time.Post-operative effect was evaluated by echocardiography and compared between 2 groups.Results:The patients' age,body weight,pulmonary artery diameter,immediate post-operative pulmonary transvalvular pressure gradient (PTPG),the in-hospital time and cost were similar between 2 groups,P>0.05.The success rate of operation in Ultrasound group and X-ray group was 99.0% vs 100%,P=0.267.In the ultrasound group,1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation.The operation time in X-ray group was longer than Ultrasound group,(38.9±9.2) min vs (34.6±10.0) min,P<0.001.The X-ray exposure time was (3.9±1.2) min in X-ray group.The mean follow-up time was (25.5±13.2) months and PTPG in Ultrasound group and X-ray group were (16.2±4.3) mmHg and (15.3±4.5) mmHg,P=0.120.No serious complications as death,peripheral vascular injury,cardiac perforation and pericardial effusion occurred in either group.Conclusion:PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent,but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.

14.
Korean Circulation Journal ; : 786-793, 2017.
Article in English | WPRIM | ID: wpr-78945

ABSTRACT

BACKGROUND AND OBJECTIVES: We investigated the effectiveness of balloon dilatation of homograft conduits in the pulmonary position in delaying surgical replacement. SUBJECTS AND METHODS: We reviewed the medical records of patients who underwent balloon dilatation of their homograft in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and after the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. RESULTS: Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograft insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografts were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval after conduit implantation was 26.7 months. The mean ratio of balloon to graft size was 0.87. The pressure gradient through the homograft and the ratio of right ventricle to aorta pressure were significantly improved after balloon dilatation (p<0.001). There were no adverse events during the procedure with the exception of one case of balloon rupture. The median interval to next intervention was 12.9 months. The median interval of freedom from re-intervention was 16.6 months. Cox proportional hazards analysis revealed that the interval of freedom from re-intervention differed only according to origin of the homograft (p=0.032), with the pulmonary artery having the longest interval of freedom from re-intervention (p=0.043). CONCLUSION: Balloon dilatation of homografts in the pulmonary position can be safely performed, and homografts of the pulmonary artery are associated with a longer interval to re-intervention.


Subject(s)
Humans , Allografts , Angioplasty, Balloon , Aorta , Catheters , Dilatation , Femoral Vein , Freedom , Heart Ventricles , Medical Records , Pulmonary Artery , Pulmonary Valve Stenosis , Rupture , Transplants , Ventricular Pressure
15.
Chinese Circulation Journal ; (12): 904-907, 2017.
Article in Chinese | WPRIM | ID: wpr-662420

ABSTRACT

Objective:To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty (PBPV) in comparison with conventional X-ray guidance.Methods:Our research included in 2 groups:Ultrasound group,n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group,n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time.Post-operative effect was evaluated by echocardiography and compared between 2 groups.Results:The patients' age,body weight,pulmonary artery diameter,immediate post-operative pulmonary transvalvular pressure gradient (PTPG),the in-hospital time and cost were similar between 2 groups,P>0.05.The success rate of operation in Ultrasound group and X-ray group was 99.0% vs 100%,P=0.267.In the ultrasound group,1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation.The operation time in X-ray group was longer than Ultrasound group,(38.9±9.2) min vs (34.6±10.0) min,P<0.001.The X-ray exposure time was (3.9±1.2) min in X-ray group.The mean follow-up time was (25.5±13.2) months and PTPG in Ultrasound group and X-ray group were (16.2±4.3) mmHg and (15.3±4.5) mmHg,P=0.120.No serious complications as death,peripheral vascular injury,cardiac perforation and pericardial effusion occurred in either group.Conclusion:PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent,but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.

16.
Article in Chinese | WPRIM | ID: wpr-505132

ABSTRACT

Pulmonary valve stenosis (PS) is a relatively common congenital heart disease,and there are 2 treatment methods of surgical operation and intervention.Percutaneous balloon pulmonary valvuloplasty (PBPV) was applied successfully in children with PS for the first time by Kan.For more than 30 years,with the update of intervention equipment,improvement of operation method and accumulation of clinical experience,the application of PBPV continuously has made new progress.Most of the previous reports of the PBPV were for the immediate and short-term efficacy,while long-term follow-up data and some special types of PS review research were less.Now,combined with PBPV clinical data and long-term follow-up study in recent years,an overview of the application progress of PBPV including indications,methods,curative effect and follow-up,prevention and cure of complications and some special type of PS are provided.

17.
Chinese Journal of Surgery ; (12): 459-462, 2017.
Article in Chinese | WPRIM | ID: wpr-808813

ABSTRACT

Objective@#To compare the clinical outcome of patients with pulmonary valve stenosis underwent transthoracic and percutaneous balloon pulmonary valvuloplasty.@*Methods@#Clinical data of 806 patients diagnosed as pulmonary valve stenosis underwent transthoracic(171 patients as group A)or percutaneous balloon pulmonary valvuloplasty (635 patients as Group B) in Fuwai Hospital from February 2006 to January 2016 were analyzed retrospectively. There were 72 males in group A (42.1%) and 344 males in group B (54.2%). The average age was (1.6±1.1) years in group A and (21.0±18.5) years in group B. The median weight was 7.65 (7.68) kg (M(QR)) in group A and 43.75 (47.38) kg in group B. There were 732 (90.9%) patients followed up from 3 months to 10 years, with an average interval of (6.3±3.6) years. Sixty cases were ligated patent ductus arteriosus simultaneously, and 20 cases got Blalock-Taussig shunt at the same time of valvuloplasty in group A. There were 47 cases of transcatheter closure of atrial septal defect and 6 cases of transcatheter closure of patent ductus arteriosus in group B. The t test, rank sum test and χ2 test were used to compare data of two groups.@*Results@#There were no hospital death or cardiac tamponade and other serious complications for all patients. The postoperative hospital stayin group A was significantly longer than that in group B (8(5) days vs. 2(2) days, Z=-9.404, P=0.000). In every further consultation, patients were reviewed with transthoracic echocardiography to assess transpulmonary gradient and pulmonary regurgitation. There were significant difference between group A and B of preoperative transpulmonary pressure gradient ((80.6±22.4) mmHg vs.(72.6±20.5) mmHg, t=1.611, P=0.032, 1 mmHg=0.133 kPa) and so as transpulmonary pressure gradient reduction value ((55.9±21.0) mmHg vs. (46.6±23.4) mmHg, t=-1.710, P=0.026). Patients in both groups had good cardiac function during follow-up interval. One patient needed surgical valvuloplasty 10 months after percutaneous balloon pulmonary valvuloplasty and 1 case occurred moderate to severe tricuspid regurgitation in group B. During follow-up period, there was no significant difference between group A and B of transpulmonary pressure gradient ((22.3±6.5) mmHg vs. (25.2±12.6) mmHg, t=1.320, P=0.072), the incidence of pulmonary valve regurgitation in patients of group A was significantly lower than patients of group B (56.1% vs.65.2%, χ2=4.755, P=0.029).@*Conclusions@#The clinical outcome and complications are similar between patients underwent two different routes of balloon pulmonary valvuloplasty. Transthoracic balloon pulmonary valvuloplasty is more suitable for infant and underweight children patients with pulmonary valve stenosis. Percutaneous balloon pulmonary valvuloplasty is more suitable for the treatment of the elder children or adults.

18.
Article in English | WPRIM | ID: wpr-122302

ABSTRACT

Percutaneous balloon valvuloplasty is considered the standard of care for treatment of valvular pulmonic stenosis, a common congenital defect in dogs. Supravalvular pulmonic stenosis is a rare form of pulmonic stenosis in dogs and standard treatment has not been established. Although, there have been reports of successful treatment of supravalvular pulmonic stenosis with surgical and stenting techniques, there have been no reports of balloon dilation to treat dogs with this condition. Here, a case of supravalvular pulmonic stenosis diagnosed echocardiographically and angiographically in which a significant reduction in pressure gradient was achieved with balloon dilation alone is presented.


Subject(s)
Animals , Dogs , Angiography , Angioplasty, Balloon, Coronary , Balloon Valvuloplasty , Congenital Abnormalities , Pulmonary Valve Stenosis , Standard of Care , Stents
19.
Rev. bras. cir. cardiovasc ; 31(5): 400-405, Sept.-Oct. 2016. tab
Article in English | LILACS | ID: biblio-829754

ABSTRACT

Abstract Carcinoid heart disease is a rare but important cause of intrinsic right heart valve disorders leading to right heart failure. Occasionally, left-sided heart valves may also be involved. The characteristic cardiac pathological findings of carcinoid heart disease are endocardial thickening as a result of fibrous deposits on the endocardium. Echocardiographic examination and right heart catheterization are very useful for the diagnosis of the lesion. If more cardiac valves are affected, multiple valve replacement should be considered. The management of the pulmonary valve lesion depends on the extent of the diseased valve, either by valvulotomy, valvectomy, or valve replacement. Percutaneous valve implantations in the pulmonary and in the inferior vena cava positions have been advocated for high-risk patients.


Subject(s)
Humans , Carcinoid Heart Disease/complications , Carcinoid Heart Disease/diagnosis , Carcinoid Heart Disease/therapy , Echocardiography , Disease Progression , Heart Valve Prosthesis Implantation , Heart Valve Diseases/diagnosis , Heart Valve Diseases/etiology
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