Balloon aortic valvuloplasty is often used as a palliative measure or as a bridge to transcatheter aortic valve replacement in the management of aortic stenosis in high risk or inoperable patients. Severe aortic steno...Balloon aortic valvuloplasty is often used as a palliative measure or as a bridge to transcatheter aortic valve replacement in the management of aortic stenosis in high risk or inoperable patients. Severe aortic stenosis coexisting with coronary artery dis-ease is not uncommon. In these circumstances, adjuvant percutaneous coronary intervention may be warranted. The safety and efficacy of combined valve and coronary intervention strategies has been recently studied. An increased incidence of complications when both procedures are performed in the same setting may throw new challenges. We report a case of fatal acute stent thrombosis following balloon aortic valvuloplasty and percutaneous coronary intervention.展开更多
Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous ...Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9％)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7％) had increased after follow-up (△P ＞ 50 mm Hg) . Four of 8 (50.0％) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0％) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.展开更多
Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current re...Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current report aimed to study the invasive hemodynamics of se- vere AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamies were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients （82 ~ 6 years, 52% male） had post-BAV aortic valve area index （AVAi） significantly increased and mean pressure gradient （MPG） significantly reduced. During the follow-up of 0.9 （maximum 3.3） years, those with post-BAV AVAi 〈 0.6 cm2/m2 compared with the AVAi _〉 0.6 cm2/m2 group had significantly higher mortality （60% vs. 28%, log-rank P = 0.02）, even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR： 5.58, 95% confidence interval （CI）： 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm^2/m^2 （OR： 3.81, 95% CI： 1.33-10.89, P = 0.01）. Pre-BAV AVAi 〉 0.39 cm^2/m^2 could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.展开更多
BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during...BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous gra...BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.展开更多
Objectives To introduce ourexperience in treatment of ventricular septal defectswith aortic valve insufficiency. Methods A total of147 cases was involved in a nine-year retrospectivestudy. Age ranged from 5 months to ...Objectives To introduce ourexperience in treatment of ventricular septal defectswith aortic valve insufficiency. Methods A total of147 cases was involved in a nine-year retrospectivestudy. Age ranged from 5 months to 15 years (mean,7.60± 4.12 years). All had been diagnosed by thor-ough history, physical examinations, chestroentgenogram, two -dimensional echocardiogram.Some 103 patients had taken catheterization and an-giocardiography. 91 (61.9%) cases underwent theprocedure of VSD closure, 31 (21.08%) had aorticvalvuloplasty simultaneously, and 25 (17.02%) wereperformed VSD closure plus aortic valve replacement.Results Among the 147 patients, 137 (93.19%) havefully recovered, 6 (4.08%) improved, and 4 patientsdied (2.73%). Conclusions As soon as being diag-nosed as subarterial VSD, surgical interventionshould be recommended at an early date. The cases ofperimembranous VSD also need close follow-up. OnceAI occurs, operations should be taken in time. Thecases without AI ought to accept treatment duringschool age.展开更多
BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This...BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.展开更多
Objective:Ventricle septal defect(VSD)is commonly associated with aortic regurgitation and aortic leaflet prolapse due to anatomic and hemodynamic factors.The concomitant intervention of the aortic valve during VSD re...Objective:Ventricle septal defect(VSD)is commonly associated with aortic regurgitation and aortic leaflet prolapse due to anatomic and hemodynamic factors.The concomitant intervention of the aortic valve during VSD repair remains one of the major concerns.Moreover,little is known about the structure and hemodynamic change in the presence of postoperative progressive AR after VSD repair.Methods:From August 2012 to February 2019,VSD patients with aortic regurgitation who underwent VSD surgical repair with or without aortic valve intervention in our institution were retrospectively reviewed.Preoperative echo and postoperative echo in the followup were collected and compared.Results:The mean age of the patients on VSD repair was 3.2.Those with postoperative progressive aortic regurgitation showed significantly increased right atrium,mean pulmonary artery,valve flow velocity,and A-wave velocity,and significantly reduced right ventricle outflow tract and descending aorta flow velocity(P<0.05).Additionally,compared with no AR intervention,aortic valvuloplasty during VSD repair predispose patients to have progressive AR(P<0.05).Conclusion:There was augmented capacity in the right-heart system and increased valvular flow velocity in the left-heart system in VSD patients combined with postoperative AR.Additional aortic valvuloplasty or aortic valve replacement during surgical VSD repair might not be necessary,especially for those with no or mild AR preoperatively.Aortic valve replacement,if required,is a more appropriate alternative in halting postoperative AR progression than aortic valvuloplasty.展开更多
文摘Balloon aortic valvuloplasty is often used as a palliative measure or as a bridge to transcatheter aortic valve replacement in the management of aortic stenosis in high risk or inoperable patients. Severe aortic stenosis coexisting with coronary artery dis-ease is not uncommon. In these circumstances, adjuvant percutaneous coronary intervention may be warranted. The safety and efficacy of combined valve and coronary intervention strategies has been recently studied. An increased incidence of complications when both procedures are performed in the same setting may throw new challenges. We report a case of fatal acute stent thrombosis following balloon aortic valvuloplasty and percutaneous coronary intervention.
文摘Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9％)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7％) had increased after follow-up (△P ＞ 50 mm Hg) . Four of 8 (50.0％) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0％) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.
文摘Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current report aimed to study the invasive hemodynamics of se- vere AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamies were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients （82 ~ 6 years, 52% male） had post-BAV aortic valve area index （AVAi） significantly increased and mean pressure gradient （MPG） significantly reduced. During the follow-up of 0.9 （maximum 3.3） years, those with post-BAV AVAi 〈 0.6 cm2/m2 compared with the AVAi _〉 0.6 cm2/m2 group had significantly higher mortality （60% vs. 28%, log-rank P = 0.02）, even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR： 5.58, 95% confidence interval （CI）： 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm^2/m^2 （OR： 3.81, 95% CI： 1.33-10.89, P = 0.01）. Pre-BAV AVAi 〉 0.39 cm^2/m^2 could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.
文摘BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
文摘Objectives To introduce ourexperience in treatment of ventricular septal defectswith aortic valve insufficiency. Methods A total of147 cases was involved in a nine-year retrospectivestudy. Age ranged from 5 months to 15 years (mean,7.60± 4.12 years). All had been diagnosed by thor-ough history, physical examinations, chestroentgenogram, two -dimensional echocardiogram.Some 103 patients had taken catheterization and an-giocardiography. 91 (61.9%) cases underwent theprocedure of VSD closure, 31 (21.08%) had aorticvalvuloplasty simultaneously, and 25 (17.02%) wereperformed VSD closure plus aortic valve replacement.Results Among the 147 patients, 137 (93.19%) havefully recovered, 6 (4.08%) improved, and 4 patientsdied (2.73%). Conclusions As soon as being diag-nosed as subarterial VSD, surgical interventionshould be recommended at an early date. The cases ofperimembranous VSD also need close follow-up. OnceAI occurs, operations should be taken in time. Thecases without AI ought to accept treatment duringschool age.
基金supported by National Key R & D Plan(2017YFC1104202).
文摘BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.
基金supported by the Project of Guangdong Provincial Clinical Research Center for Cardiovascular disease(No.2020B1111170011)Guangdong Special Funds for Science and Technology Innovation Strategy,China(Stability Support for Scientific Research Institutions Affiliated to Guangdong Province-GDCI 2021)Guangdong Peak Project(No.DFJH201802)
文摘Objective:Ventricle septal defect(VSD)is commonly associated with aortic regurgitation and aortic leaflet prolapse due to anatomic and hemodynamic factors.The concomitant intervention of the aortic valve during VSD repair remains one of the major concerns.Moreover,little is known about the structure and hemodynamic change in the presence of postoperative progressive AR after VSD repair.Methods:From August 2012 to February 2019,VSD patients with aortic regurgitation who underwent VSD surgical repair with or without aortic valve intervention in our institution were retrospectively reviewed.Preoperative echo and postoperative echo in the followup were collected and compared.Results:The mean age of the patients on VSD repair was 3.2.Those with postoperative progressive aortic regurgitation showed significantly increased right atrium,mean pulmonary artery,valve flow velocity,and A-wave velocity,and significantly reduced right ventricle outflow tract and descending aorta flow velocity(P<0.05).Additionally,compared with no AR intervention,aortic valvuloplasty during VSD repair predispose patients to have progressive AR(P<0.05).Conclusion:There was augmented capacity in the right-heart system and increased valvular flow velocity in the left-heart system in VSD patients combined with postoperative AR.Additional aortic valvuloplasty or aortic valve replacement during surgical VSD repair might not be necessary,especially for those with no or mild AR preoperatively.Aortic valve replacement,if required,is a more appropriate alternative in halting postoperative AR progression than aortic valvuloplasty.
