ABSTRACT
We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.
Subject(s)
Bioprosthesis , Catheterization , Heart Valve Prosthesis , Constriction, Pathologic/therapy , Humans , Prosthesis FailureSubject(s)
Aortic Valve/surgery , Heart Valve Prosthesis , Adult , Echocardiography , Female , Humans , MaleABSTRACT
To evaluate the role that coronary arteriography has in the induction of the Bezold-Jarisch reflex we study 9 patients (group I) to whom 1 mg. of atropine was administered 45 min. before the coronary arteriography and 9 patients (group II) without pre-medication. The heart rate was measured before, during and after each intracoronary injection. In group I there was no change in heart rate in 6 patients, in 3 cases the heart rate dropped to 15 beats/min. In group II the heart rate decreased in 8 cases. We conclude that the injection of radiologic contrast material in the coronary arteries triggers the Bezold-Jarisch reflex and that this reflex is prevented by the administration of atropine.
Subject(s)
Angiocardiography , Contrast Media/adverse effects , Reflex, Abnormal/chemically induced , Atropine/therapeutic use , Bradycardia/etiology , Female , Heart Rate/drug effects , Humans , Male , Reflex, Abnormal/drug therapyABSTRACT
Para valorar el efecto de la arteriografia coronaria en la produccion del reflejo de Bezold-Jarisch estudiamos 9 enfermos (grupo I) a los que se les administro 1 mg de atropina por via subcutanea 45 min antes de ser sometidos a arteriografia coronaria y 9 enfermos (grupo II) sin premedicacion.En todos ellos se midio la frecuencia cardiaca antes, durante y despues de cada inyeccion intracoronaria.Dicha medicion no vario en 6 enfermos del grupo I aunque en los 3 restantes disminuyo 15 latidos/min en alguno de los disparos. En el grupo II la frecuencia cardiaca disminuyo en 8 enfermos. Se concluye que la inyeccion de medio de contraste radiologico en las arterias coronarias desencadena el refeljo de Bezold-jarisch que este se previene con la administracion de atropina
