Angioscopically monitored saphenous vein valvulotomy

Angioscopy was used during in situ saphenous vein bypass grafting in seven patients. We were able to visualize valve incision, immediately identify and correct incomplete valvulotomy, identify side branches as potential arteriovenous fistulas, and assess distal anastomotic integrity. We encountered no retained valve cusps after angioscopy, as verified by Doppler ultrasound and completion angiography. Angioscopy verified distal anastomotic integrity in all patients with distal vein grafts large enough to accept the angioscope. Angioscopy requires minimal time, is relatively easy to use, serves as an adjunct to Doppler ultrasound and completion angiography, and has future potential as a therapeutic tool.     

Pulmonary edema following pulmonary valvulotomy.

A previously unreported combination of critical pulmonary valve stenosis and mitral stenosis is described. The initial clinical presentation was one of right ventricular failure that obscured the evidence of pulmonary venous hypertension. Following pulmonary valvulotomy, pulmonary edema ensued because of the increased pulmonary blood flow. The importance of urgent cardiac catheterization postoperatively following an operation that increases pulmonary blood flow is discussed.