Echocardiographic assessment of the size of aortic and pulmonary valve annulus before balloon valvoplasty.

Two dimensional echocardiographic measurements of the size of aortic and pulmonary valve annulus were made in 60 patients before balloon valvoplasty and compared to the angiographic measurements. Aortic valve annulus was measured in 34 patients (26 with valvar aortic stenosis and 8 with discrete subaortic stenosis) in the parasternal long axis or apical 5-chamber views. The pulmonary valve annulus was measured in 26 patients with valvar pulmonary stenosis (PS) in the parasternal short axis view of the right ventricular outflow view. The visualization of the annulus was good in all except 2 patients with valvar PS. Angiographic measurements of the aortic and pulmonary valve annulus were made in aortic root and right ventricular angiograms respectively, taken in both right and left anterior oblique views. There was an excellent correlation between the measurements of the annulus size by the two techniques (r value for pulmonary valve 0.91; for aortic valve 0.96; over all 0.94). Echocardiography can accurately measure valve annulus size and help in choosing balloon dilatation catheter of appropriate size before the valvoplasty procedure.

Experience with activity sensing rate responsive ventricular pacing. A study based upon assessment of exercise tolerance.

Fourteen patients (mean age 41 years) who received rate responsive activity sensing VVI pacemakers were studied to evaluate the relationship between the rate response and exercise tolerance by analysing the symptom limited maximum treadmill time both during fixed rate VVI oacubg abd dyrubg VVI + activity mode pacing (RRP). The proper functioning of RRP mode was confirmed by Holter monitoring in all. The indications for pacing were, sino-atrial block with high grade AV block, tachybrady syndrome, atrial fibrillation with complete heart block, congenital complete heart block and persistent slow junctional rhythm. Basic rate was programmed to 70 PPM in both pacing modes; rate response and activity threshold were programmed to 5 and medium respectively. The order in which two pacing modes were tested was chosen randomly. The maximum treadmill time (MTT) was 25.4% longer in the RRP than in VVI mode with a mean of 11.4 minutes in RRP and 8.5 mins in VVI(p less than 0.01). for the subgroup of patients who demonstrated paced only rhythm the average increase in MTT was 31.4% with a mean of 11.8 minutes in RRP and 8.1 mins in VVI (p less than 0.01). Five patients who showed intermittent spontaneous rhythm, increased their average MTT by 22.3% with a mean of 11.2 minutes in RRP and 8.7 mins in VVI mode (p less than 0.05). During RRP a significance positive correlationship was seen between MTT and the increase in heart rate (N = 14, r = 0.85, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term efficacy of balloon pulmonary valvoplasty in late adult life.

We performed percutaneous transluminal balloon valvoplasty in a 53-year-old woman with severe valvar pulmonary stenosis. Peak systolic gradient across the pulmonary valve reduced from 112 mm Hg before valvoplasty to 47 mm Hg immediately after dilatation, which further fell to 30 mm Hg six months after valvoplasty with virtual disappearance of gradient at one year follow up. Patients of isolated valvar pulmonary stenosis presenting in late adult life can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.