A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes

Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus / 中国修复重建外科杂志

Objective: To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Methods: Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days). Results: All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred. Conclusion: The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Study of the clinical effects of jailed-balloon protection technique for the treatment of bifurcation lesions of percutaneous coronary intervention / 天津医药

Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique in simple strategy. Methods Ninety patients with bifurcation lessions (Duke D or F type) who received the side branch protection technique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailed-balloon protection group (n=48) and jailed guidewire group (n=42). The process operating, procedural success of percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA), complications and the results of follow-up were investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailed-balloon group and jailed guidewire group (P>0.05). The procedural success rate of PCI was 100%in jailed-balloon group and 97.6%in jailed guidewire group, no significance difference user between two groups (P>0.05). The perioperative complications (the rate of no reflow) was lower in jailed-balloon group than those of jailed guidewire group (1.0%vs. 19.0%, P0.05) and the maximum restenotic level (19.24%vs. 21.46%,P>0.05) in the main branch were not significant different between jailed-balloon group and jailed guidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that of jailed guidewire group (51.2% vs. 72.46%, P < 0.01). Conclusion The jailed-balloon technique reduces the operation complications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch with simple strategy is safe and effective in treatment of bifurcation lesions.

Hysteroscopic Septotomy of a Complete Septate Uterus Using a Balloon with Methylene Blue / 대한불임학회지

A complete septate uterus with cervical duplication and a longitudinal vaginal septum is a rare uterine malformation. The dissection of the septum can be difficult because it is difficult for hysteroscopists to find out initial point, direction and final point of a complete septum. This study aimed the introduction of more efficient surgical procedure using a balloon with methylene blue. We have experienced three cases with a complete septate uterus. We performed hysteroscopic dissection of a complete uterine septum using a balloon with methylene blue and obtained good reproductive outcomes. So we report three cases with a brief review of literatures.

Optimal Balloon Inflation Pressures for Stent Deployment: High Pressure is Always Good?

BACKGROUND AND OBJECTIVES: To reduce the subacute stent thrombosis, the use of high pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound has been recommended. The purpose of this study is to compare incidence of stent thrombosis and major cardiac events (MACE) between high and moderate pressure balloon technique without using intravascular ultrasound (IVUS) guidance. MATERIALS AND METHODS: We prospectively studied 147 patients (110 males & 37 females, mean;56.9+/-9.9 years, 154 lesions) who were deployed intracoronary stents with the use of conventional technique except IVUS guidance. According to inflation pressure, patients were divided into two groups; G1 (moderate pressure group, maximum inflation balloon pressure or =14ATM, 77 lesions). We investigated the incidence of stent thrombosis and MACE between two groups during the 10 month follow up examination. RESULTS: 1) The mean inflation presure is different between two groups by definition (G1:G2 10.2+/-1.8; 15.2+/-1.3 ATM p<0.001). 2) The stenotic lesion lengths of the group of patients treated with the moderate pressure techique were longer than those treated under the high pressure technique (G1:G2 19.8+/-7.1 mm; 16.3+/-4.1 mm p=0.002). 3) There were no significant differences between the moderate pressure group and the high pressure group during the 10 month follow-up examination in terms of MACE[early event (0-14D)-subacute thrombosis G1:G2 0:0 death G1; G2 1:1/late events (15D - 10M)-repeat revascularization:G1; G2 8; 7, CABG G1; G2 1; 0, Q.M.I G1; G2 1; 0]. CONCLUSION: Onselectedpatients,itispossibletoconsidermoderatepressure technique as an other option for coronary stenting.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.

Comparison of Outcome between Double and Inoue Balloon Techniques for Percutaneous Mitral Valvuloplasty in Mitral Stenosis: A Randomized Prospective Study

BACKGROUND: Since the nonsurgical treatment of mitral stenosis using a single balloon has been introduced by Inoue et al. in 1984. percutaneous mitral valvuloplasty has became an accepted therapeutic modality for selected patients with mitral stenosis. Zeibag et al. demonstrated the double balloon technique showed a better outcome than the single balloon in obtainning the optimal mitral valve area. On the other hand, there are several reports that single balloon technique was comparable with the double balloon technique. Therefore, there are still controversies in efficacy, benefit and complications between balloon techniques. METHOD: To compare the efficacy and complications of percutaneous mitral valvuloplasty with the double balloon or the Inoue balloon technique, 40 patients were studied consecutively by random method in selecting the balloon technique. RESULTS: In all cases, percutaneous mitral valvulopasty was performed successfully. Optimal outcome defined as mitral valve area larger than 1.5cm2 was obtained in 12 cases out of 16(75%) in double balloon group and 15 out of 24(63%) in Inoue balloon group(p=NS). Mitral valve area was significantly increased after valvulopasty in both technique but there was no different between both groups(Mean+/-SD ; 0.9+/-0.3 to 1.7+/-0.2 vs 0.9+/-0.2 to 1.9+/-0.2cm2). There were also hemodynamic improvement significantly in mean mitral gradient(MG). pulmonary artery pressure (PAP) and left atrial pressure(LAP) after PMV but there were no difference between groups (18+/-8 to 7+/-2 vs 21+/-13 to 9+/-4 mmHg for MG. 29+/-12 to 22+/-9 vs 28+/-9 to 18+/-5mmHg for PAP and 22+/-8 to 11+/-5 vs 21+/-6 to 11+/-4 for LAP respectively). Mitral requrgitation greater than grade 2 occurred in 2 cases of the double balloon group and one case of the Inoue balloon group(p=NS). New development of atrial shunt was found in 3 cases in both groups. CONCLUSIONS: The double and Inoue balloon techniques were quite comparable in immediate outcome and complications.

Immediate and Late Results of Percutaneous Mitral Balloon Valvuloplasty Using Inoue and Double Balloon Techniques(Prospective Randomized Trial): Comparison of Mechanism of Dilation and 1 Year Follow-up

BACKGROUND: Large series of patients with symptomatic mitral stenosis have undergone percutaneous mitral balloon valvuloplasty(PMV) with use of the Inoue or double balloon technique. But to date the result of the two procedure have not been compared with a single series prospectively. METHODS: In order to assess the immediate hemodynamic results and the longterm efficacy of two different PMV technique, a prospective, randomized trial of PMV was performed using the Inoue balloon(Toray, I group) in 59 patients and the double balloons(a pair of Mansfield balloon. D group) in 61 patients with moderate to severe mitral stenosis. Before valvuloplasty, the patients series were comparable with regard to average age. gender, most clinical and echocardiographic variables. All the patients(120 patients, M/F 38/82, mean age 41+/-11 year) were preselected with good echoscore> or =9. RESULTS: The success rate was 83% in the I group and 89% in the D group when the success defined as mitral valve area(MVA)> or =1.5cm2 with 25% gain in MVA and mitral regurgitation> or =2+ at the end of procedure. The magnitude of increase of mitral valve area and decrease of mitral gradient, left atrial pressure and pulmonary arterial pressure were not significantly different in the Inoue and double balloon series(1.0+/-0.4 and 1.1+/-0.4cm2 for mitral vale area, 10.2+/-6.6 and 11.7+/-6.4mmHg for mitral gradient, 10.5+/-6,4 and 12.9 +/-7,3mmHg for left atrial pressure, and 8.7+/-7.3 and 10.1+/-9.4 mmHg for pulmonary artrial pressure respectively). Immediatly after dilation, the long diameter changes of the mitral orifice was more prominent in the D group(from 1.0+/-0.2 to 2.6+/-0.4cm p1.5) was 3.4% in group I and 4.9% in group D. Severe mitral regurgitation> or =3+ occurred in 2 patients in each I(3.4%) and D(3.3%) group respectively. At follow-up, the mitral valve area was significantly decreased(1.6 in group I vs 1.8cm2 in group D, P<0.001 vs immediate after MVA) at 6 months and well maintained at 1 year follow-up in both groups. Until 6 months after valvuloplasty, the long diameter of orifice was greater in group D, however the difference was not apparent at 1 year follow-up. CONCLUSION: The Inoue and double balloon techniques obtained equivalent results of the success rate and the frequently of complications. However, the Inoue balloon technique reduced significantly fluoroscope time and total procedure duration. Double balloon technique afforded a longer longitudinal splitting of the commissure immediatly and 6 months after valvuloplasty. However the differences was not apparent at 1 year follow-up. Increased MVA was well maintained at 1 year in both groups. The severity of the newly developed mitral regurgitation immediately after valvuloplasty reduced significantly in 53% of the Inoue and 43% in the double balloon group at 6 months follow-up. In the view point of similiar immediate and late results of the two methods, the stepwise dilation with Doppler echocardiographic monitoring during the Inoue procedure appeared to be cumbersome.