The Experts below are selected from a list of 6639 Experts worldwide ranked by ideXlab platform
Lola Rubio - One of the best experts on this subject based on the ideXlab platform.
-
rebuttal percutaneous balloon dilation of severe Pulmonary Valve Stenosis in patients with cyanosis and congestive heart failure
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Endale Tefera, Ramon Bermudezcanete, Shakeel A. Qureshi, Lola RubioAbstract:Objectives This article reports outcomes of percutaneous balloon dilation in patients with severe Pulmonary Valve Stenosis, in particular in those treated late with cyanosis, congestive heart failure, and pericardial effusion. Background Percutaneous balloon dilation is the treatment of choice for Pulmonary Valve Stenosis. Although earlier intervention may produce better results, patients may present late with congestive heart failure and cyanosis. Methods Fifty-five patients who underwent Pulmonary Valve balloon dilation, were grouped into two groups, based on the presence or absence of congestive right heart failure and/or central cyanosis. Group I included 33 patients with severe Pulmonary Valve Stenosis, but without clinical evidence of congestive right heart failure in the form of liver enlargement, raised jugular venous pressure, and peripheral edema and/or central cyanosis and group II included 22 patients with severe Pulmonary Valve Stenosis and congestive right heart failure and/or central cyanosis. Their outcomes were compared. Results Doppler measured transvalvar pressure gradient decreased from 110.2 ± 34.0 mm Hg before to 52.5 ± 28.7 mm Hg in group I after dilation (P < 0.001), and from 138.4 ± 32.3 mm Hg to 53.9 ± 19.3 mm Hg in group II, (P < 0.001). Complications included ventricular tachycardia/fibrillation in three patients and severe bradycardia in one patient in group II. Twelve patients in group II developed clinical and radiologic evidence of reperfusion injury/Pulmonary edema within the first 24 hr of intervention and needed ventilation for 2–9 days. Three of these patients died from intractable Pulmonary edema. On follow up, clinical and echocardiographic improvement parameters were similar in the two groups. Conclusion Those patients with severe Pulmonary Valve Stenosis with congestive right heart failure, especially those with pericardial effusion, ascites and cyanosis, represent an important technical and clinical challenge. They are a high-risk group with or without treatment. If they survive the procedure, they may still remain at a high risk in the first few days afterward. Maintaining their ventilator and inotropic support after balloon dilation may increase survival. However, excellent results can be obtained. © 2013 Wiley Periodicals, Inc.
-
percutaneous balloon dilation of severe Pulmonary Valve Stenosis in patients with cyanosis and congestive heart failure
Catheterization and Cardiovascular Interventions, 2014Co-Authors: Endale Tefera, Ramon Bermudezcanete, Shakeel A. Qureshi, Lola RubioAbstract:Objectives This article reports outcomes of percutaneous balloon dilation in patients with severe Pulmonary Valve Stenosis, in particular in those treated late with cyanosis, congestive heart failure, and pericardial effusion. Background Percutaneous balloon dilation is the treatment of choice for Pulmonary Valve Stenosis. Although earlier intervention may produce better results, patients may present late with congestive heart failure and cyanosis. Methods Fifty-five patients who underwent Pulmonary Valve balloon dilation, were grouped into two groups, based on the presence or absence of congestive right heart failure and/or central cyanosis. Group I included 33 patients with severe Pulmonary Valve Stenosis, but without clinical evidence of congestive right heart failure in the form of liver enlargement, raised jugular venous pressure, and peripheral edema and/or central cyanosis and group II included 22 patients with severe Pulmonary Valve Stenosis and congestive right heart failure and/or central cyanosis. Their outcomes were compared. Results Doppler measured transvalvar pressure gradient decreased from 110.2 ± 34.0 mm Hg before to 52.5 ± 28.7 mm Hg in group I after dilation (P < 0.001), and from 138.4 ± 32.3 mm Hg to 53.9 ± 19.3 mm Hg in group II, (P < 0.001). Complications included ventricular tachycardia/fibrillation in three patients and severe bradycardia in one patient in group II. Twelve patients in group II developed clinical and radiologic evidence of reperfusion injury/Pulmonary edema within the first 24 hr of intervention and needed ventilation for 2–9 days. Three of these patients died from intractable Pulmonary edema. On follow up, clinical and echocardiographic improvement parameters were similar in the two groups. Conclusion Those patients with severe Pulmonary Valve Stenosis with congestive right heart failure, especially those with pericardial effusion, ascites and cyanosis, represent an important technical and clinical challenge. They are a high-risk group with or without treatment. If they survive the procedure, they may still remain at a high risk in the first few days afterward. Maintaining their ventilator and inotropic support after balloon dilation may increase survival. However, excellent results can be obtained. © 2013 Wiley Periodicals, Inc.
Howard S Weber - One of the best experts on this subject based on the ideXlab platform.
-
initial and late results after catheter intervention for neonatal critical Pulmonary Valve Stenosis and atresia with intact ventricular septum a technique in continual evolution
Catheterization and Cardiovascular Interventions, 2002Co-Authors: Howard S WeberAbstract:Critical Pulmonary Valve Stenosis or atresia with intact ventricular septum is a rare congenital cardiac defect that can be technically difficult to alleviate in the catheterization laboratory. Over the past 10 years, several techniques and modifications with variable results have been advocated to facilitate the valvuloplasty procedure. This report describes a single operator's experience using various techniques in 28 neonates with critical Pulmonary Stenosis or atresia who were considered candidates for transcatheter intervention. The first two patients underwent a gradational balloon valvuloplasty approach that resulted in prolonged fluoroscopy exposure. Thereafter, a “snare assisted” umbilical artery approach was developed which facilitated the valvuloplasty procedure and resulted in significantly fewer balloons used and shorter fluoroscopy times. Early in our experience, stiff guidewire perforation of atretic Pulmonary Valves was used, whereas in our last two patients, a simplified perforation technique with a new 0.9-mm excimer laser catheter was used. Late echocardiographic and clinical follow-up evaluation in 27 patients demonstrates persistent gradient relief, resolution of tricuspid Valve insufficiency, and elimination of right to left shunting at the atrial level. Balloon valvuloplasty is the treatment of choice for critical Pulmonary Valve Stenosis or atresia with intact ventricular septum. When necessary, the use of umbilical artery “snare assistance” facilitates the valvuloplasty technique and shortens procedure time while laser perforation is currently preferable for perforation of the atretic Pulmonary Valve. Cathet Cardiovasc Intervent 2002;56:394–399. © 2002 Wiley-Liss, Inc.
-
initial and late results after catheter intervention for neonatal critical Pulmonary Valve Stenosis and atresia with intact ventricular septum a technique in continual evolution
Catheterization and Cardiovascular Interventions, 2002Co-Authors: Howard S WeberAbstract:Critical Pulmonary Valve Stenosis or atresia with intact ventricular septum is a rare congenital cardiac defect that can be technically difficult to alleviate in the catheterization laboratory. Over the past 10 years, several techniques and modifications with variable results have been advocated to facilitate the valvuloplasty procedure. This report describes a single operator's experience using various techniques in 28 neonates with critical Pulmonary Stenosis or atresia who were considered candidates for transcatheter intervention. The first two patients underwent a gradational balloon valvuloplasty approach that resulted in prolonged fluoroscopy exposure. Thereafter, a "snare assisted" umbilical artery approach was developed which facilitated the valvuloplasty procedure and resulted in significantly fewer balloons used and shorter fluoroscopy times. Early in our experience, stiff guidewire perforation of atretic Pulmonary Valves was used, whereas in our last two patients, a simplified perforation technique with a new 0.9-mm excimer laser catheter was used. Late echocardiographic and clinical follow-up evaluation in 27 patients demonstrates persistent gradient relief, resolution of tricuspid Valve insufficiency, and elimination of right to left shunting at the atrial level. Balloon valvuloplasty is the treatment of choice for critical Pulmonary Valve Stenosis or atresia with intact ventricular septum. When necessary, the use of umbilical artery "snare assistance" facilitates the valvuloplasty technique and shortens procedure time while laser perforation is currently preferable for perforation of the atretic Pulmonary Valve.
-
effectiveness of an umbilical artery snare assisted approach for critical Pulmonary Valve Stenosis or atresia in the neonate
American Journal of Cardiology, 1997Co-Authors: Howard S Weber, Stephen E CyranAbstract:Thirteen neonates with critical Pulmonary Valve Stenosis/atresia underwent successful transcatheter balloon valvuloplasty using an umbilical artery "snare assisted" approach. This technique simplifies the procedure and avoids femoral artery injury by using the umbilical artery, reduces fluoroscopy exposure, and eliminates the need for a gradational approach which reduces costs.
Endale Tefera - One of the best experts on this subject based on the ideXlab platform.
-
rebuttal percutaneous balloon dilation of severe Pulmonary Valve Stenosis in patients with cyanosis and congestive heart failure
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Endale Tefera, Ramon Bermudezcanete, Shakeel A. Qureshi, Lola RubioAbstract:Objectives This article reports outcomes of percutaneous balloon dilation in patients with severe Pulmonary Valve Stenosis, in particular in those treated late with cyanosis, congestive heart failure, and pericardial effusion. Background Percutaneous balloon dilation is the treatment of choice for Pulmonary Valve Stenosis. Although earlier intervention may produce better results, patients may present late with congestive heart failure and cyanosis. Methods Fifty-five patients who underwent Pulmonary Valve balloon dilation, were grouped into two groups, based on the presence or absence of congestive right heart failure and/or central cyanosis. Group I included 33 patients with severe Pulmonary Valve Stenosis, but without clinical evidence of congestive right heart failure in the form of liver enlargement, raised jugular venous pressure, and peripheral edema and/or central cyanosis and group II included 22 patients with severe Pulmonary Valve Stenosis and congestive right heart failure and/or central cyanosis. Their outcomes were compared. Results Doppler measured transvalvar pressure gradient decreased from 110.2 ± 34.0 mm Hg before to 52.5 ± 28.7 mm Hg in group I after dilation (P < 0.001), and from 138.4 ± 32.3 mm Hg to 53.9 ± 19.3 mm Hg in group II, (P < 0.001). Complications included ventricular tachycardia/fibrillation in three patients and severe bradycardia in one patient in group II. Twelve patients in group II developed clinical and radiologic evidence of reperfusion injury/Pulmonary edema within the first 24 hr of intervention and needed ventilation for 2–9 days. Three of these patients died from intractable Pulmonary edema. On follow up, clinical and echocardiographic improvement parameters were similar in the two groups. Conclusion Those patients with severe Pulmonary Valve Stenosis with congestive right heart failure, especially those with pericardial effusion, ascites and cyanosis, represent an important technical and clinical challenge. They are a high-risk group with or without treatment. If they survive the procedure, they may still remain at a high risk in the first few days afterward. Maintaining their ventilator and inotropic support after balloon dilation may increase survival. However, excellent results can be obtained. © 2013 Wiley Periodicals, Inc.
-
percutaneous balloon dilation of severe Pulmonary Valve Stenosis in patients with cyanosis and congestive heart failure
Catheterization and Cardiovascular Interventions, 2014Co-Authors: Endale Tefera, Ramon Bermudezcanete, Shakeel A. Qureshi, Lola RubioAbstract:Objectives This article reports outcomes of percutaneous balloon dilation in patients with severe Pulmonary Valve Stenosis, in particular in those treated late with cyanosis, congestive heart failure, and pericardial effusion. Background Percutaneous balloon dilation is the treatment of choice for Pulmonary Valve Stenosis. Although earlier intervention may produce better results, patients may present late with congestive heart failure and cyanosis. Methods Fifty-five patients who underwent Pulmonary Valve balloon dilation, were grouped into two groups, based on the presence or absence of congestive right heart failure and/or central cyanosis. Group I included 33 patients with severe Pulmonary Valve Stenosis, but without clinical evidence of congestive right heart failure in the form of liver enlargement, raised jugular venous pressure, and peripheral edema and/or central cyanosis and group II included 22 patients with severe Pulmonary Valve Stenosis and congestive right heart failure and/or central cyanosis. Their outcomes were compared. Results Doppler measured transvalvar pressure gradient decreased from 110.2 ± 34.0 mm Hg before to 52.5 ± 28.7 mm Hg in group I after dilation (P < 0.001), and from 138.4 ± 32.3 mm Hg to 53.9 ± 19.3 mm Hg in group II, (P < 0.001). Complications included ventricular tachycardia/fibrillation in three patients and severe bradycardia in one patient in group II. Twelve patients in group II developed clinical and radiologic evidence of reperfusion injury/Pulmonary edema within the first 24 hr of intervention and needed ventilation for 2–9 days. Three of these patients died from intractable Pulmonary edema. On follow up, clinical and echocardiographic improvement parameters were similar in the two groups. Conclusion Those patients with severe Pulmonary Valve Stenosis with congestive right heart failure, especially those with pericardial effusion, ascites and cyanosis, represent an important technical and clinical challenge. They are a high-risk group with or without treatment. If they survive the procedure, they may still remain at a high risk in the first few days afterward. Maintaining their ventilator and inotropic support after balloon dilation may increase survival. However, excellent results can be obtained. © 2013 Wiley Periodicals, Inc.
Brian A Scansen - One of the best experts on this subject based on the ideXlab platform.
-
a pilot study evaluating cutting and high pressure balloon valvuloplasty for dysplastic Pulmonary Valve Stenosis in 7 dogs
Journal of Veterinary Cardiology, 2019Co-Authors: Lauren E Markovic, Brian A ScansenAbstract:Abstract Introduction This case series describes early experience and technical aspects of cutting balloon dilation followed by high-pressure balloon Pulmonary valvuloplasty in dogs with dysplastic Pulmonary Valve Stenosis. Animals Seven client-owned dogs were enrolled in this study. Methods Dogs were prospectively enrolled based on echocardiographic diagnosis of severe Pulmonary Valve dysplasia, defined as marked Valve thickening with variable degrees of annular hypoplasia or subvalvar fibrous obstruction and a peak echocardiography-derived transPulmonary pressure gradient higher than 100 mmHg. Preinterventional and postinterventional hemodynamic data and transthoracic pressure gradients were obtained for all dogs. Recheck echocardiography varied in timing by client convenience, with maximum follow-up 35 months after intervention. Results No intraprocedural or periprocedural mortality was observed. The only major complication was partial avulsion of a cutting blade related to exceeding recommended burst pressure of the device, which was not associated with obvious clinical consequence. Invasive hemodynamic measurements demonstrated an average reduction of 46% in peak systolic right ventricular-to-Pulmonary artery pressure gradient (range, 31–77%). The echocardiographic results 24 h after procedure demonstrated an average reduction in pressure gradient of 43% (range, 20–66%), with late follow-up demonstrating an average reduction of 35% (range, 10–57%) compared with preprocedural echocardiography. Conclusions This procedure is a feasible therapeutic transcatheter intervention for dogs with dysplastic Pulmonary Valves and appears safe in this small cohort. The ideal selection criteria and rate of reStenosis for this procedure is under investigation, and long-term follow-up and a large, randomized, controlled study are necessary to demonstrate efficacy.
-
electrocardiography gated cardiac ct angiography can differentiate brachycephalic dogs with and without Pulmonary Valve Stenosis and findings differ from transthoracic echocardiography
Veterinary Radiology & Ultrasound, 2019Co-Authors: Eric T Hostnik, Brian A Scansen, Jaylyn D RhinehartAbstract:Pulmonary Valve Stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the Pulmonary trunk diameter to the aorta at different locations (aortic Valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECG-gated CTA both detected significantly greater Pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary Valve to aortic Valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and Pulmonary Valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the Pulmonary trunk and Pulmonary Valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment.
-
bidirectional flow across a perforate cor triatriatum dexter in a dog with concurrent Pulmonary tricuspid and mitral Valve dysplasia
Journal of Veterinary Cardiology, 2019Co-Authors: C M Hokanson, Jaylyn Rhinehart, Brian A ScansenAbstract:Abstract A 10-week-old male intact mixed breed dog presented for evaluation of suspected right-sided congestive heart failure. Echocardiographic imaging revealed a perforate cor triatriatum dexter (CTD), along with Pulmonary Valve Stenosis and tricuspid and mitral Valve dysplasia. In typical CTD cases, there is unidirectional blood flow across the dividing membrane, from the caudal into the cranial right atrial chambers. Owing to right-sided pressure alterations caused by the concurrent valvar defects, color Doppler imaging demonstrated bidirectional flow across the CTD membrane.
-
unilateral absence of an external jugular vein in two english bulldogs with Pulmonary Valve Stenosis
Journal of Veterinary Cardiology, 2017Co-Authors: E H Chapel, Brian A ScansenAbstract:Two English bulldogs referred for interventional palliation of severe Pulmonary Valve Stenosis were incidentally diagnosed with unilateral absence of an external jugular vein (left in one case, right in the other) by computed tomography and Doppler ultrasound. The right internal jugular vein also could not be visualized in the dog with absence of the left external jugular vein. Cervical venous anomalies can impact diagnostic or interventional venous catheterization procedures such as balloon Pulmonary valvuloplasty. Additionally, absence of an external jugular vein may impact central venous catheter placement. Absence of an external jugular vein should be considered in dogs when the external jugular vein cannot be easily palpated. Ultrasound or computed tomography may help identify jugular venous anatomy and confirm anomalies.
-
quantification of myocardial stiffness using magnetic resonance elastography in right ventricular hypertrophy initial feasibility in dogs
Magnetic Resonance Imaging, 2016Co-Authors: Juliana Serafim Da Silveira, Brian A Scansen, Peter A Wassenaar, Brian Raterman, Ning Jin, Richard D White, John D Bonagura, Chethan Eleswarpu, Arunark KolipakaAbstract:Introduction Myocardial stiffness is an important determinant of cardiac function and is currently invasively and indirectly assessed by catheter angiography. This study aims to demonstrate the feasibility of quantifying right ventricular (RV) stiffness noninvasively using cardiac magnetic resonance elastography (CMRE) in dogs with severe congenital Pulmonary Valve Stenosis (PVS) causing RV hypertrophy, and compare it to remote myocardium in the left ventricle (LV). Additionally, correlations between stiffness and selected pathophysiologic indicators from transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging were explored.
Joshua A Stern - One of the best experts on this subject based on the ideXlab platform.
-
echocardiographic assessment of right heart size and function in dogs with Pulmonary Valve Stenosis
Journal of Veterinary Cardiology, 2019Co-Authors: Lance C Visser, Satoko Nishimura, Maureen S Oldach, Catherine Belanger, Catherine T Guntherharrington, Joshua A Stern, Weihow HsueAbstract:Abstract Introduction/Objectives We sought to determine the prevalence and clinical significance of right heart remodeling and right ventricular (RV) dysfunction in dogs with Pulmonary Valve Stenosis (PS). We also sought to evaluate repeatability of several measurements of severity of PS, right heart size, and RV function in dogs with PS. Animals, materials and methods Several indices of right atrial (RA) size and RV size and function were prospectively evaluated in 48 dogs with PS. Regression analysis was used to determine if indices of right heart size and function were independently associated with maximum transPulmonary pressure gradient (max PG) and adverse clinical findings (exercise intolerance, syncope, or right heart failure). Eight dogs underwent a second echocardiogram performed by the same operator to assess repeatability of the echocardiographic indices, which was quantified by coefficient of variation (CV) and repeatability coefficient. Results Increased RA size (81%), increased RV wall thickness (83%), and decreased tricuspid annular plane systolic excursion (TAPSE [81%]) were common. Right atrial size, end-diastolic RV area, and RV wall thickness were independently associated with max PG. Decreased TAPSE was independently associated with adverse clinical findings. All indices except RA area (18.6%) and RV systolic velocity (20.7%) had CVs Conclusions Right heart remodeling and RV dysfunction are common in dogs with PS and are associated with echocardiographic and clinical severity. Results support the quantitative assessment of right heart size and function in dogs with PS.
-
non electrocardiographic gated computed tomographic angiography can be used to diagnose coronary artery anomalies in bulldogs with Pulmonary Valve Stenosis
Veterinary Radiology & Ultrasound, 2019Co-Authors: Catherine T Guntherharrington, Lance C Visser, Kathryn L Phillips, Samantha L Fousse, Joshua A SternAbstract:Coronary artery anomalies have been reported in Bulldogs and present an increased risk when performing balloon valvuloplasty. Identification of coronary anomalies has been reported using multidetector-row computed tomographic (MDCT) angiography with electrocardiographic gating. However, the utility of non-electrocardiographic-gated 16-row computed tomographic for MDCT for the identification of coronary artery anatomy or anomalies to the authors' knowledge has not been fully investigated. The purpose of this study was to evaluate the feasibility of non-electrocardiographic-gated computed tomographic (CT) angiography to identify coronary anomalies in Bulldogs with Pulmonary Valve Stenosis. In this prospective, observational study, Bulldogs with echocardiographically diagnosed Pulmonary Valve Stenosis, an echocardiographically derived transpulmonic pressure gradient >70 mm Hg, and a clinician recommendation for balloon valvuloplasty were included. Anesthetized dogs underwent a 16-row MDCT non-electrocardiographic-gated CT angiography. A board-certified veterinary radiologist and board-certified veterinary cardiologist reviewed the CT angiography studies and identified the coronary artery anatomy. When normal coronary artery anatomy was detected on CT angiography, a right ventricular outflow tract fluoroscopic angiogram was performed and evaluated during levophase to confirm normal coronary anatomy prior to balloon valvuloplasty. Dogs with coronary anomalies noted on CT angiography were recovered from anesthesia and balloon valvuloplasty was not performed. All dogs (10/10; 100%) had interpretable images from the non-electrocardiographic-gated CT angiography. Coronary anomalies were identified in six dogs based on non-electrocardiographic-gated CT angiography, five with type R2A anomaly and one had a single left coronary ostium. Four dogs had normal coronary anatomy based on non-electrocardiographic-gated CT angiography. Balloon valvuloplasty was performed without incident in these four dogs. We conclude that non-electrocardiographic-gated CT angiography represents a noninvasive method for diagnosing coronary anomalies in Bulldogs with Pulmonary Valve Stenosis.
-
echocardiographic evaluation of velocity ratio velocity time integral ratio and Pulmonary Valve area in dogs with Pulmonary Valve Stenosis
Journal of Veterinary Internal Medicine, 2018Co-Authors: Satoko Nishimura, Lance C Visser, Maureen S Oldach, Catherine Belanger, Catherine T Guntherharrington, Joshua A SternAbstract:Author(s): Nishimura, Satoko; Visser, Lance C; Belanger, Catherine; Oldach, Maureen S; Gunther-Harrington, Catherine T; Stern, Joshua A | Abstract: BackgroundVelocity ratio, velocity time integral (VTI) ratio, and Pulmonary Valve area indexed to body surface area (iPVA) are methods of assessment of Pulmonary Valve Stenosis (PS) severity that are less dependent on blood flow. Studies evaluating these methods are limited.ObjectivesTo determine the effects of butorphanol, atenolol, and balloon valvuloplasty (BV) on velocity ratio, VTI ratio, iPVA, mean PG, and max PG.AnimalsTwenty-seven dogs with PS (max PG g50 mm Hg).MethodsProspective study. All dogs underwent an echocardiogram at baseline, 5-minutes after administration of butorphanol (0.2-0.25 mg/kg IV), and 2-to-4 weeks after atenolol (1-1.5 mg/kg q12h). Twenty-one of these were evaluated 24-hours after BV.ResultsThere were no significant differences (P g .05) amongst any of the methods of assessment of PS severity after butorphanol. After atenolol, mean (SD) of mean (57.0 [21.0] mm Hg) and max PG (93.1 [33.8] mm Hg) were significantly decreased (P ≤ .047) compared with baseline (65.2 [26.2] mm Hg and 108 [44.4] mm Hg, respectively). After atenolol, there were no significant (P ≥ .12) differences in velocity ratio (0.29 [0.09]), VTI ratio (0.18 [0.05]), or iPVA (0.43 [0.16] cm2 /m2 ) compared with baseline (0.30 [0.09], 0.19 [0.09], 0.44 [0.17] cm2 /m2 , respectively).Conclusions and clinical importanceAtenolol might reduce mean and max PG but does not alter less flow-dependent methods of assessment of PS severity (velocity ratio, VTI ratio, and iPVA) in dogs with PS. Results support an integrative approach to assessment of PS severity that includes less flow-dependent methods, particularly in states of altered flow or right ventricular function.
-
high pressure balloon valvuloplasty for severe Pulmonary Valve Stenosis a prospective observational pilot study in 25 dogs
Journal of Veterinary Cardiology, 2018Co-Authors: Catherine Belanger, Lance C Visser, Satoko Nishimura, Maureen S Oldach, Catherine T Guntherharrington, Samantha L Fousse, Joshua A SternAbstract:Abstract Objectives We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe Pulmonary Valve Stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. Animals Twenty-five dogs. Methods Prospective observational study. Dogs with severe PS (echocardiographically derived trans-Pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20–24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50% or reduction into at least the moderate category of PS (50–79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. Results Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63% (39, 68); procedural success rate was 92% (23 dogs). Optimal results were achieved in 56% (14 dogs). There were no significant correlations between EDPG reduction and Valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary Valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = −0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. Conclusions In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.
