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Lola Rubio - One of the best experts on this subject based on the ideXlab platform.
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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.
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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.
Endale Tefera - One of the best experts on this subject based on the ideXlab platform.
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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.
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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.
Philipp Bonhoeffer - One of the best experts on this subject based on the ideXlab platform.
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extended application of percutaneous Pulmonary Valve implantation
Journal of the American College of Cardiology, 2009Co-Authors: Tarek S Momenah, Reida El Oakley, Khalid Al Najashi, Saad Khoshhal, Howaida Al Qethamy, Philipp BonhoefferAbstract:Objectives This study was designed to report a novel indication for percutaneous Pulmonary Valve implantation in patients with previous right ventricular outflow tract (RVOT) patch. Background Current indications for percutaneous Pulmonary Valve implantation are limited to patients who had Pulmonary Valve stenosis and/or regurgitation in a right ventricle-to-Pulmonary artery conduit. Percutaneous Pulmonary Valve implantation has not been previously reported in patients with severe Pulmonary Valve regurgitation following repair of tetralogy of Fallot (TOF) using RVOT patch. Methods After assessment of the RVOT patch in multiple projections, a catheter was placed in a distal Pulmonary artery branch. In patients with an RVOT patch, sizing of the narrowest diameter of the RVOT patch by manual inflation of a sizing balloon was performed; a stent was placed into the RVOT patch at the level of the narrowest area to anchor the stent and to create an artificial conduit to place the Melody Valve. The percutaneous Valve was then implanted. Results Seven females and 6 males with a mean age of 14.3 years and mean body weight 45 kg had successful percutaneous implantation of the Melody Valve. Four patients had previous repair of TOF using RVOT patch. All patients were discharged within 2 days after the procedure without complications. After a mean of 4 months follow-up all patients were alive and well. Transthoracic echocardiography showed competent Pulmonary Valve. Chest X-ray showed no stent migration or fracture. Conclusions Percutaneous Pulmonary Valve implantation can be performed in patients with Pulmonary Valve regurgitation, including those with previous RVOT patch using pre-stenting techniques, with satisfactory results.
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rescue surgery following percutaneous Pulmonary Valve implantation
European Journal of Cardio-Thoracic Surgery, 2008Co-Authors: Martin Kostolny, Johannes Nordmeyer, Victor Tsang, Carin Van Doorn, Alessandra Frigiola, Sachin Khambadkone, Marc R De Leval, Philipp BonhoefferAbstract:Objective: Percutaneous Pulmonary Valve insertion (PPVI) is an evolving alternative to surgical Pulmonary Valve insertion. The aim of this study is to review the acute complications of PPVI requiring emergency rescue surgery. Patients and methods: Between 09/2000 and 01/2007, 152 patients (pts), received a PPVI. Patient's charts were reviewed in retrospect. Results: Emergency rescue surgery (ERS) took place in 6 pts (3.9%). Indications for ERS were: homograft rupture two pts, dislodgment of the stented Valve in a dilated right ventricular outflow tract two pts, occlusion of the right Pulmonary artery one pt and compression of the left main coronary artery one pt. CardioPulmonary bypass was established through repeat sternotomy incision with femorofemoral cannulation in 2/6 pts. The stented Valve was removed in five and replaced with a homograft in three and a Valved conduit in two pts. One ruptured homograft was repaired leaving the stented Valve in situ. All patients survived, one sustained mild neurological impairment. Conclusion: Although some of the acute complications of PPVI were probably related to a learning curve (4 among the first 50 pts and 2 among the last 102 patients) the need for ERS is unlikely to be completely abolished. This experience highlights the importance of close collaboration between cardiologists and surgeons in these evolving technologies. Highly skilled and responsive surgical back up is necessary to support the introduction and to sustain institutional programmes such as PPVI.
Constantine Mavroudis - One of the best experts on this subject based on the ideXlab platform.
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tetralogy of fallot results of a Pulmonary Valve sparing strategy
The Annals of Thoracic Surgery, 2005Co-Authors: Robert D Stewart, Carl L Backer, Luciana Young, Constantine MavroudisAbstract:BACKGROUND: Our surgical strategy for repair of tetralogy of Fallot has focused on preserving the Pulmonary Valve. The purpose of this review was to identify Pulmonary Valve characteristics that mark the limits of this strategy. METHODS: From 1997 through 2004, 102 consecutive patients underwent repair of tetralogy of Fallot at a median age of 5.9 months. Twenty-five patients had a prior shunt. Eighty-two patients (80%) had Pulmonary Valve-sparing procedures, predominantly through a transatrial and transPulmonary approach (n = 52). Twenty patients had a transannular patch (20%). Intraoperative measurements included the Pulmonary Valve annulus size and the postoperative pressure ratio between the right and left ventricles. RESULTS: Eighty of 85 (94%) patients with z-score greater than -4 had a Pulmonary Valve-sparing procedure compared with 2 of 17 patients (12%) with Pulmonary Valve annulus z-scores less than -4 (p < 0.0001). All patients with a tricuspid Pulmonary Valve (n = 26) had a Pulmonary Valve-sparing procedure compared with 56 of 76 (74%) patients with a bicuspid Pulmonary Valve (p = 0.0016). Five patients with initial Pulmonary Valve-sparing operations required reoperation for residual stenoses; 4 Pulmonary Valve-sparing right ventricular outflow tract resections and 1 transannular patch. The only death occurred after reoperation elsewhere. Three of 9 patients (33%) who had a postoperative pressure ratio between the right and left ventricles greater than 0.7 after their initial Pulmonary Valve-sparing procedure required reoperation compared with 2 of 73 with postoperative pressure ratio between the right and left ventricles less than 0.7 (3%; p = 0.008). Fifteen of 25 patients (60%) with prior shunts had Pulmonary Valve-sparing procedures. CONCLUSIONS: A Pulmonary Valve-sparing approach to the repair of tetralogy of Fallot was applied successfully in 80% of patients. Significant markers for success were a measured Pulmonary annulus z-score of -4 or larger, a tricuspid Pulmonary Valve, and a postoperative pressure ratio between the right and left ventricles less than 0.7.
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tetralogy of fallot results of a Pulmonary Valve sparing strategy
The Annals of Thoracic Surgery, 2005Co-Authors: Robert D Stewart, Carl L Backer, Luciana Young, Constantine MavroudisAbstract:Background Our surgical strategy for repair of tetralogy of Fallot has focused on preserving the Pulmonary Valve. The purpose of this review was to identify Pulmonary Valve characteristics that mark the limits of this strategy. Methods From 1997 through 2004, 102 consecutive patients underwent repair of tetralogy of Fallot at a median age of 5.9 months. Twenty-five patients had a prior shunt. Eighty-two patients (80%) had Pulmonary Valve-sparing procedures, predominantly through a transatrial and transPulmonary approach (n = 52). Twenty patients had a transannular patch (20%). Intraoperative measurements included the Pulmonary Valve annulus size and the postoperative pressure ratio between the right and left ventricles. Results Eighty of 85 (94%) patients with z-score greater than −4 had a Pulmonary Valve-sparing procedure compared with 2 of 17 patients (12%) with Pulmonary Valve annulus z-scores less than −4 ( p p = 0.0016). Five patients with initial Pulmonary Valve-sparing operations required reoperation for residual stenoses; 4 Pulmonary Valve-sparing right ventricular outflow tract resections and 1 transannular patch. The only death occurred after reoperation elsewhere. Three of 9 patients (33%) who had a postoperative pressure ratio between the right and left ventricles greater than 0.7 after their initial Pulmonary Valve-sparing procedure required reoperation compared with 2 of 73 with postoperative pressure ratio between the right and left ventricles less than 0.7 (3%; p = 0.008). Fifteen of 25 patients (60%) with prior shunts had Pulmonary Valve-sparing procedures. Conclusions A Pulmonary Valve-sparing approach to the repair of tetralogy of Fallot was applied successfully in 80% of patients. Significant markers for success were a measured Pulmonary annulus z-score of −4 or larger, a tricuspid Pulmonary Valve, and a postoperative pressure ratio between the right and left ventricles less than 0.7.
Ali Dodgekhatami - One of the best experts on this subject based on the ideXlab platform.
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left coronary artery occlusion after percutaneous Pulmonary Valve implantation
The Annals of Thoracic Surgery, 2012Co-Authors: D Biermann, Jeanette Schonebeck, Marcus Rebel, Jochen Weil, Ali DodgekhatamiAbstract:Percutaneous Pulmonary Valve implantation (PPVI) is an attractive option for patients with Pulmonary Valve insufficiency or stenotic right ventricular outflow tracts. We present the case of a 26-year-old patient in which PPVI was used to treat d-transposition of the great arteries, uncommon coronary artery anatomy, and conduit stenosis that resulted from multiple operations on the right outflow. Days after discharge to home, she experienced acute chest discomfort correlating with ischemia noted on an electrocardiogram and elevated troponin levels. Coronary angiography confirmed mechanical compression of the left anterior descending coronary artery. The Valve was removed in an emergency operation and replaced with a biological conduit.
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comparative long term results of surgery versus balloon valvuloplasty for Pulmonary Valve stenosis in infants and children
The Annals of Thoracic Surgery, 2003Co-Authors: Claire Peterson, Johanneke J Schilthuis, Ali Dodgekhatami, Francois J Hitchcock, Erik J Meijboom, G B W E BenninkAbstract:Abstract Background We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for Pulmonary Valve stenosis in infants and children. Methods Results after surgical Pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 ± 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 ± 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, Pulmonary Valve insufficiency, and tricuspid Valve insufficiency were considered. Results Mean pressure gradient decreased significantly more in the surgical group (from 64.8 ± 30.8 mm Hg to 12.8 ± 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 ± 21.4 mm Hg to 21.5 ± 15.9 mm Hg after a mean of 5.4 years; p p p Conclusions Surgical relief of Pulmonary Valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated Pulmonary Valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.
