Percutaneous pulmonary valvuloplasty

Five patients (aged between 11 and 59 years) with valvular pulmonary artery stenosis and pressure gradients between 60 and 143 mm Hg underwent percutaneous transluminal balloon valvuloplasty. Selection of the appropriate balloon size was based on the measurement of the dimension of the value anulus as a determinant from the angiogram. Balloon catheters were used with a diameter of 18 to 20 mm. After placement in the stenotic valve the balloon was filled with diluted contrast material for 10-20 s. The balloon indention by the stenotic valve disappeared suddenly during expansion with one to three atmospheres. The pressure gradient in individual patients decreased from 60 to 25, from 143 to 60, 100 to 55, 143 to 60, and 60 to 37 mm Hg, in the mean from 101 to 52 mm Hg. All patients were discharged two to four days after the procedure. During follow-up with recatheterization after three to nine months (four patients) the gradients decreased as compared to the value immediately after valvuloplasty. The exercise capacity increased in all patients. No complications were observed. Balloon valvuloplasty of pulmonary valvular stenosis seems to be an alternative to the operative procedure.     

Percutaneous balloon valvuloplasty for congenital pulmonary valve stenosis in adults.

BACKGROUND: Although pulmonary valvular stenosis is not uncommon in adults, there are few reports of percutaneous pulmonary valvuloplasty in adults, despite the possibility of avoiding heart surgery. AIM: This report describes the experience in adult patients undergoing this procedure and evaluates its effectiveness and tolerance. METHODS: Over an 8-year period (1989-1997), pulmonary valvuloplasty was considered in 22 adult patients [8 men, 14 women; mean age 28.0 years +/- standard deviation (SD) 10.3; range 16-46 years] with congenital pulmonary valve stenosis. Sixteen patients were asymptomatic with pulmonary systolic murmurs, although 6 patients presented with dyspnea. Before the procedure, the mean transpulmonary valve gradient was 53.2 +/- 24.8 mmHg SD, with a mean right ventricular systolic pressure of 74.6 +/- 28.4 mmHg SD, and mean pulmonary artery pressure was 21.4 +/- 6.4/10.2 +/-3.9 mmHg. RESULTS: The procedure was successful in 19 patients (6 men, 13 women) and was well tolerated and free of complications. Following the procedure, the mean transvalvular gradient was 15.5 +/- 11.5 mmHg, with a mean right ventricular systolic pressure of 40.5 +/- 13.6 mmHg and a mean pulmonary systolic pressure of 24.3 +/- 7.4 mmHg. This represented mean fall in transpulmonary valve gradient of 42.4 +/- 22.0 mmHg (paired t-test, p < 0.0001). After a mean follow-up of 20.1 months (13.4 SD), most patients remained well and asymptomatic, although two patients required repeat valvuloplasty. CONCLUSION: Pulmonary valvuloplasty is a well tolerated and effective treatment for pulmonary valve stenosis in adults, with few complications and no need for surgery. This procedure should be considered as the primary treatment of adult patients with pulmonary valve stenosis.     

Percutaneous balloon pulmonary valvuloplasty

Percutaneous pulmonary valvuloplasty was performed in 27 patients with congenital pulmonary valve stenosis. A fall in the transvalve gradient of at least 15 mm Hg occurred in 22 patients. In five there was little change in the severity of the stenosis; in three of these the pulmonary valve was dysplastic. None of the successfully treated patients had a dysplastic valve. The two other failures, early in the series, were probably due to inadequate balloon size. In one patient the procedure was performed twice, with a successful result from the second dilatation with a larger balloon. Follow up studies in a further six patients showed no evidence of restenosis in those who had been successfully treated and no late improvement in the remainder. There were no important complications. Percutaneous pulmonary valvuloplasty should be the initial treatment for congenital pulmonary valve stenosis, although when the valve is dysplastic the result is less likely to be satisfactory.     

Percutaneous balloon pulmonary valvuloplasty

Percutaneous balloon pulmonary valvuloplasty (BPV) was performed in 18 consecutive patients with valvular pulmonary stenosis (PS) with no associated cardiac defects. The patients were 11 months to 19 years of age. The balloon was positioned across the pulmonary valve and inflated to pressures of 80, 100, and 120 pounds/square inch (psi). Each inflation lasted approximately 10 seconds. Peak systolic pulmonary valve gradient (ΔP) and cardiac output were measured before and 15 minutes after BPV. There was no change in cardiac output, but all patients had an improved ΔP. The prevalvuloplasty ΔP was 81 ± 31 mm Hg, decreasing to 23 ± 11 mm Hg after BPV (p < 0.01). The right ventricular peak systolic pressure decreased from 106 ± 31 to 50 ± 12 mm Hg (p < 0.01). No pulmonary regurgitation was noted after BPV. The balloons were 12 or 15 mm in diameter, chosen according to the diameter of the pulmonary valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. BPV also was performed in a patient with tetralogy of Fallot. Subsequent total repair provided an opportunity to observe the mechanism of the dilatation. Evidence of a small tear alongside the anterior valve raphe was noted. BPV induced a significant decrease in ΔP and may offer an alternative method for treating PS.     

Percutaneous balloon pulmonary valvuloplasty.

Percutaneous pulmonary valvuloplasty was performed in 27 patients with congenital pulmonary valve stenosis. A fall in the transvalve gradient of at least 15 mm Hg occurred in 22 patients. In five there was little change in the severity of the stenosis; in three of these the pulmonary valve was dysplastic. None of the successfully treated patients had a dysplastic valve. The two other failures, early in the series, were probably due to inadequate balloon size. In one patient the procedure was performed twice, with a successful result from the second dilatation with a larger balloon. Follow up studies in a further six patients showed no evidence of restenosis in those who had been successfully treated and no late improvement in the remainder. There were no important complications. Percutaneous pulmonary valvuloplasty should be the initial treatment for congenital pulmonary valve stenosis, although when the valve is dysplastic the result is less likely to be satisfactory.     

Percutaneous valvuloplasty of congenital pulmonary stenosis in adults over 50 years of age

The authors report three cases of congenital pulmonary stenosis in adults over 50 years of age treated by percutaneous balloon valvuloplasty. Three symptomatic women aged 74, 80 and 51, had systolic pressure gradients ranging from 107 to 113 mmHg between the right ventricle and pulmonary artery. After valvuloplasty with two balloons or one trefoil balloon, the transvalvular pressure gradient fell to 25 to 30 mmHg. It was only 14 mmHg in one patient controlled after one year's follow-up. The cardiac index was initially decreased and did not change very much immediately after the procedure, increasing from 1.68 1/m2/mn to 1.77 1/m2/mn. The pulmonary valve surface area increased from 0.22 to 0.43 cm2. There were no complications and in one patient, reviewed two years later, the clinical improvement was maintained. Percutaneous valvuloplasty is indicated in severe and/or poorly tolerated pulmonary stenosis. With the 10 other previously reported cases of patients over 50 years of age, the procedure was successful in 12 out of 13 patients (92%). In these patients of 51 to 80 years of age, the systolic pressure gradient between the right ventricle and pulmonary artery was reduced from 112 +/- 46 mmHg to 43 +/- 26 mmHg (-62%). Slight pulmonary regurgitation appeared in 5 out of 9 cases. Valvuloplasty was usually well tolerated and there were no fatalities. There were no signs of restenosis in 5 cases controlled 10 days to 1 year after dilatation. In the future, systematic Doppler echocardiographic examinations should help comparison of cardiac haemodynamics before, immediately after valvuloplasty and at long-term.(ABSTRACT TRUNCATED AT 250 WORDS)     

经皮球囊肺动脉瓣成形术133例

目的 :评价经皮球囊肺动脉瓣成形术 （ PBPV）治疗肺动脉瓣狭窄 （ PS）的临床疗效和安全性。方法 :1989～ 2 0 0 0年 PBPV患者共 13 3例 ,年龄 1～ 5 7（ 12± 10 ）岁。结果 :PBPV术后即刻右室收缩压由 97± 3 5 mm Hg降至 5 2± 2 0mm Hg,肺动脉至右心室跨瓣压差由 67± 3 6m m Hg降至 12± 11m m Hg（ P<0 .0 1）。 2 8例发生右室流出道痉挛 ,2例患者行外科手术治疗 ,余者口服普萘洛尔 3～ 6个月。超声随访 6个月～ 8年 ,右室一肺动脉收缩压差明显下降。结论 :PBPV操作安全 ,疗效可靠 ,可作为治疗各年龄组 PS的首选方案     

Percutaneous pulmonary valvuloplasty in adults. An immediate evaluation and follow-up of 3 cases

The immediate and late results of percutaneous pulmonary valvuloplasty in three symptomatic adult patients (21, 38 and 45 years) with severe pulmonary valve stenosis are reported. The right ventricle-pulmonary artery gradient fell from 135 mmHg to 50 mmHg in patient n. 1, from 124 mmHg to 95 mmHg in patient n. 2 and from 132 mmHg to 27 mmHg in patient n. 3. Six months later a further hemodynamic study showed a further reduction in the gradient in patient n. 1 and n. 2 (28 and 33 mmHg). A year and half after of clinical follow-up symptomatic improvement is still present without any clinical or echo-Doppler signs of restenosis. In conclusion, percutaneous pulmonary valvuloplasty is a simple and safe procedure for severe pulmonary valve stenosis even in adults with immediate and long-term good results.     

Percutaneous balloon valvuloplasty in carcinoid pulmonary valve stenosis

More than half of patients with carcinoid syndrome develop carcinoid valve disease. Both the tricuspid and pulmonary valve are often involved. Symptoms of carcinoid syndrome with flushing, diarrhea, and bronchospasm often precedes cardiac symptoms. We report a case of carcinoid initially presenting with rapid development of right heart failure due to severe pulmonary valve stenosis. In untreated carcinoid, there is a risk of carcinoid crisis with anesthesia and surgery. In local anesthesia, we performed a sub‐acute balloon pulmonary valvuloplasty. The procedure was successful without any residual pulmonary valve stenosis and with immediately relief of dyspnea. The final diagnostic workup for the underlying malignancy continued the day after valvuloplasty. © 2015 Wiley Periodicals, Inc.     

Percutaneous pulmonary valvuloplasty in an octogenarian with calcific pulmonary stenosis.

We describe a patient in whom calcific pulmonary vascular stenosis was diagnosed at the age of 84 years. Valve stenosis was relieved by percutaneous transluminal pulmonary valvuloplasty. To our knowledge, PTPV performed at this age has not been previously reported.     

Percutaneous transluminal balloon valvuloplasty in congenital pulmonary valve stenosis

From March 1984 to September 1986, 49 transluminal balloon valvuloplasties (TBVs) were performed in 44 consecutive patients with congenital pulmonary valve stenosis, aged 1 day to 60 years. Seventeen of the patients were infants aged less than 1 year, five of whom were neonates. The peak systolic gradient was greater than 50 mm Hg (mean, 80.0 mm Hg) in 36 patients and was less than 50 mm Hg (mean, 35.4 mm Hg) in eight. A single balloon catheter was used in 41 cases, and two balloon catheters were used in eight cases. In patients with a gradient greater than 50 mm Hg, the mean right ventricular peak systolic pressure was reduced from 99.8 to 51.8 mm Hg, and the mean transvalvular gradient was reduced from 80.0 to 22.4 mm Hg. In infants and neonates, the mean right ventricular pressure expressed as a percentage of systemic pressure decreased from 122.2% to 63.5%. Follow-up cardiac catheterization 1 to 17 months later (in 19 cases) revealed no significant change in the right ventricular systolic pressure (which had decreased from 53.0 to 48.5 mm Hg) or the peak systolic pressure gradient (which had decreased from 29.0 to 24.5 mm Hg), in comparison with the changes seen immediately after TBV. Thus, TBV is an effective method of relieving pulmonary stenosis in patients of all ages, including neonates.     

Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis

Transluminal balloon valvuloplasty was used to treat congenital pulmonary valve stenosis in 20 patients. Follow-up cardiac catheterization was performed in 11 patients at intervals of from 2 to 12 months after the procedure. Peak systolic pressure gradient across the pulmonic valve decreased from 68 +/- 27 to 23 +/- 5 mm Hg (p less than .001) after valvuloplasty. There were no complications. Follow-up catheterization demonstrated persistent relief of right ventricular hypertension in the patients with typical pulmonary valve stenosis.     

Percutaneous pulmonary valvuloplasty. Short-term and long-term results

Percutaneous angioplasty was performed in twenty consecutive patients, with congenital pulmonary valve stenosis. Ages ranged from eight months to thirty-two years (mean 9.5 years old). We achieved a valvular gradient dropping from 91 +/- 39 to 19 +/- 11 mm Hg (P less than 0.001) in early post angioplasty level and it was practically unchanged at three months and one year later. (19 +/- 12, 19 +/- 17 mm Hg) (P less than 0.001). Similar change was observed in the right ventricle systolic pressure which was diminished in a progressive way during the follow-up from 113 +/- 37 to 39 +/- 35 (P less than 0.001), 59 +/- 18 and 53 +/- 25 mm Hg (P less than 0.001) immediately, three months and one year later, respectively. The ratio right ventricle systolic pressure/left ventricle was diminished from 0.96 +/- 29 to 0.63 +/- 0.35 in the early post angioplasty period and later from 0.50 +/- 0.16 and 0.44 +/- 0.22 (P less than 0.001). Only one case had restenosis one year later and we repeated the angioplasty with good results. Most of the patients are asymptomatic, the pulmonary murmur features changed. We observed improvement in electrocardiographic and echocardiographic signs. One patient died of anesthetic complications. The remainder of patients did not have severe complications and they were discharged from 48 to 72 hours after angioplasty. In conclusion, valvuloplasty is an effective procedure in a short and long term basis. We considered valvuloplasty in congenital pulmonary valve stenosis the treatment of choice in this group of patients.     

Percutaneous balloon aortic valvuloplasty in adults with calcific aortic stenosis

After 5 years' experience with percutaneous balloon aortic valvuloplasty and more than 550 patients dilated for calcific aortic stenosis in our series, the limits of the method are well recognized, and the indications have been reviewed. To date, the two main indications are very old patients with increased surgical risks and critically ill patients in whom the procedure is most often used as a bridge to surgery. From our series of 180 octogenarians and nonagenarians with several factors increasing the predicted perioperative mortality, we showed that the technique is able to efficiently palliate the symptoms and improve survival. Valve replacement remains, however, recommended in otherwise healthy and active elderly patients. Balloon aortic valvuloplasty is also clearly useful in critically ill patients with major left ventricular dysfunction and severe heart failure, especially in patients with cardiogenic shock in whom it may be life saving. A dramatic improvement of left ventricular function is most generally obtained, allowing valve replacement to be performed later with an acceptable lowered risk. Balloon aortic valvuloplasty, a low-cost and low-risk procedure in experienced hands, requiring only local anesthesia and a short hospitalization stay, partially reduces aortic stenosis but may in many cases be the only valuable therapeutic option for patient improvement.     

Long-term results of percutaneous pulmonary valvuloplasty in adults

We performed percutaneous balloon valvuloplasty of the pulmonaryvalve in 24 patients (aged 17 to 72 years) and in two juvenilepatients. There were no major complications. In almost all thepatients the procedure resulted in a successful pressure gradientreduction from a mean of 92 ± 36 mmHg to 43 ±19 mmHg (P<0·01). In seven patients there was a residualpressure gradient greater than 50 mmHg which, however, decreasedin all patients within the following 3–12 months due toa decrease in subvalvular muscular hypertrophy (from a meanof 70 to 35 mmHg). No restenosis was observed. Only one patient,who had calcified valve leaflets, developed pulmonary insufficiencyand this was of only minor haemodynamic importance. Balloon dilatation of the pulmonary valve can be considereda technique with a high success rate and low complication rateeven in the elderly. Good long-term results support this approachas the first choice in the treatment of pulmonary valve stenosis.     

INOUE球囊经皮肺动脉瓣球囊扩张治疗先天性肺动脉瓣狭窄

目的:总结先天性肺动脉瓣狭窄(PS)经皮INOUE球囊扩张成形术(PBPV)的经验,评价其即刻疗效、安全性。方法:2012年5月至2014年5月间,共对14例单纯肺动脉瓣狭窄患者应用INOUE球囊行PBPV治疗,男性10例,女性4例;手术年龄3~78岁;分析其临床资料、治疗效果及安全性。结果:14例治疗均获得成功,右心室收缩压(RVSP)由术前75~176mm Hg,平均(120.4±27.3)mm Hg(1mm Hg=0.133k Pa)降为术后19~75mm Hg,平均(45.6±18.3)mm Hg。肺动脉收缩压(PASP)由术前14~26mm Hg,平均(18.9±4.1)mm Hg,升为术后16~30mm Hg,平均(20.6±4.6)mm Hg。肺动脉跨瓣压差(TPG)由术前57~132mm Hg,平均(91.7±27.1)mm Hg,降为术后0~50mm Hg,平均(21.8±18.6)mm Hg。术后体检杂音均明显减弱,均未发生严重并发症。结论:应用INOUE球囊行PBPV手术成功率高、并发症少、安全有效,可作为先天性肺动脉瓣狭窄首选治疗方法。