Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations—Part II
Abstract
:1. Introduction
2. Pulmonary Stenosis
2.1. Development of Infundibular Stenosis
2.2. Electrocardiographic Changes following BPV
2.3. Changes in Right Ventricular Filling
2.4. Role of Balloon/Annulus Ratios on the Results of BPV
2.5. Double Balloon vs. Single Balloon BPV
3. Aortic Stenosis
3.1. Causes of Aortic Insufficiency
3.2. Trans-Umbilical Venous Approach for BAV
3.2.1. Additional Procedural Details
3.2.2. Comments
4. Aortic Coarctation
4.1. Aortic Remodeling
4.1.1. Native Aortic Coarctation
4.1.2. Post-Surgical Re-Coarctation
4.2. Biophysical Response of Coarcted Aortic Segment to Balloon Angioplasty
5. Summary and Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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1. Consider the possibility of development of infundibular obstruction after BPV in all patients with severe valvar PS |
2. Perform careful pressure pullback recordings across the pulmonic valve and RV outflow tract both prior to and 15 min after BPV *. |
3. Perform RV cine-angiography and scrutinize these angiograms for infundibular obstruction both before and 15 min after valvuloplasty *. |
4. Use a valvuloplasty balloon that will result in a B/A ratio of 1.2 to 1.25 [9,10]. |
5. Use a double-balloon technique when the pulmonary valve annulus is too large to dilate with a commercially available single balloon. When a double balloon technique is used, the effective diameter of both balloons together should be used for calculation of the B/A ratio. Effective balloon diameter may be calculated by the formula: 0.82(D1 + D2) [11,12]. |
6. If pulmonary valve dysplasia is present, a B/A ratio as high as 1.5 may be necessary for effective relief of pulmonary valve obstruction [13]. |
7. Balloons larger than 1.5 times the size of the pulmonary valve annulus should not be used because such large balloons may damage the right ventricular outflow tract muscle [14]. In addition, balloons more than 1.5 times the size of the pulmonary valve annulus did not produce better immediate or intermediate-term results when compared with the subgroup in whom a B/A ratio of 1.2 to 1.4 was achieved during balloon valvuloplasty [15,16] and the extra-large balloons may precipitate an infundibular reaction. |
8. If angiographic (Figure 2A), pressure (Figure 1) and/or echo-Doppler (Figure 3B) data suggest, significant residual infundibular obstruction, beta blocker drug therapy may be necessary; we recommend it if the residual gradient is more than 50 mmHg [2,6]. |
9. If results of follow-up echo-Doppler or catheterization and angiographic studies performed 6 months to 1 year after balloon valvuloplasty show residual infundibular gradients ≥ 50 mm Hg, then surgical resection of the infundibular muscle may be considered. If there is significant residual valvar obstruction, repeat BPV with adequately sized balloon(s) would be our therapeutic choice [8]. |
Number of Patients Needing Repeat BPV | Number of Patients with Gradient > 30 mmHg | |
---|---|---|
Group I (B/A ratio < 1.0) | 4 | 6 |
Subgroup IIA (B/A ratio of 1.01 to 1.2) | 1 | 2 |
Subgroup IIB (B/A ratio of 1.21 to 1.4) | 0 | 0 |
Subgroup IIC (B/A ratio > 1.41) | 0 | 0 |
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Rao, P.S. Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations—Part II. J. Cardiovasc. Dev. Dis. 2023, 10, 288. https://doi.org/10.3390/jcdd10070288
Rao PS. Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations—Part II. Journal of Cardiovascular Development and Disease. 2023; 10(7):288. https://doi.org/10.3390/jcdd10070288
Chicago/Turabian StyleRao, P. Syamasundar. 2023. "Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations—Part II" Journal of Cardiovascular Development and Disease 10, no. 7: 288. https://doi.org/10.3390/jcdd10070288