Archive for the ‘Mitral Stenosis’ Category

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: The Decision To Refer Patients for Mitral CBV

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: The Decision To Refer Patients for Mitral CBVThe presence of complex or multiple severe valve lesions will usually require surgical treatment. Simply increasing the mitral valve area in a patient with complex valve lesions may not effectively alter the patients hemodynamic or clinical status. Evaluation of mitral valve morphology including calcification, pliability, and the severity of subvalvular disease may also help to anticipate the degree of increase of mitral valve area. Read the rest of this entry »

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Complications of Mitral CBV

Complications of Mitral CBV
As with all therapeutic catheter interventions, the mitral CBV carries risks of potential complications, not all of which have yet actually been encountered. Current experience shows that the most serious complications of death, embolism, cardiac perforation with tamponade, tears of diseased and normal valves, and infective endocarditis have been reported. The occurrence of important complications such as atrial septal defects, acute mitral regurgitation, inadequate dilation, or early restenosis may be related to several factors. These factors include the particular techniques and the equipment used, the patients selected for the procedure, and the operators experience with CBV Long-term studies with clinical and repeat hemodynamic determinations will be needed to evaluate these problems. Read the rest of this entry »

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Early Results of Mitral CBV

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Early Results of Mitral CBVIt has been emphasized that as the procedure is changing, the results of various techniques should be reported separately. In comparison, reports using only the double-balloon technique have shown that the average mitral valve area before CBV ranged from 0.7 to 1.0 cm2 and increased up to 2.0 to 2.2 cm2 after CBV In both of these series the increases in valve areas were also demonstrated by Doppler echocardiography and confirmed by repeated cardiac catheterization six to 12 weeks after the procedure.
The larger increase in calculated valve area and the smaller residual gradients after double-balloon CBV suggest that this procedure, although more technically demanding, usually achieves wider opening of the mitral valve commissures. fully
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Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Mechanism by which CBV Increases Mitral Valve Areas

Double-balloon mitral CBV*® can significantly increase mitral valve areas without introducing very large, 25-mm diameter balloons. The two balloon catheters can be introduced using one or two transseptal atrial punctures. Long guide wires can be placed in the left ventricle or out into the descending aorta. The two balloons are positioned across the mitral valve and inflated simultaneously. One advantage of using the double-balloon technique is that the larger balloons can be chosen to match each patients mitral valve annulus size to open the mitral commissures without overdilating the mitral valve annulus. Read the rest of this entry »

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Current Techniques of Mitral CBV

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Current Techniques of Mitral CBVIn this technique the dilatation balloon was also introduced transseptally over a long exchange guide wire that had been placed across the atrial septum and mitral valve and then into the left ventricle or out into the descending aorta.
An alternative retrograde technique has also been proposed. The transseptal catheterization is performed as usual, and long guide wires, placed into the femoral artery and aorta, are “snared” and pulled out the femoral vein. The same wire then traverses the femoral artery, the aorta, the left ventricle, the left and right atrium, and the femoral vein. Each dilatation balloon catheter is then placed transarterially, positioned retrograde across the mitral valve, and inflated. Read the rest of this entry »

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis: Diagnosis of Mitral Stenosis

The ECG of patients who are in sinus rhythm may show left atrial enlargement. Atrial fibrillation and right ventricular hypertrophy are common. The chest x-ray film shows left atrial enlargement; pulmonary venous congestion and an increased cardiothoracic ratio may also be present. On echocardiography, the typical signs are a thickened mitral valve and restricted mitral valve motion. Doppler echocardiography can show the presence of a significant mitral valve gradient and a reduced mitral valve area. The presence and severity of other valve abnormalities, including mitral regurgitation and tricuspid and aortic valve disease, can also be demonstrated on Doppler echocardiography, which provides useful screening information in planning diagnostic cardiac catheterization and possible intervention. Supervision and interpretation of these procedures by experienced echocardiographers can yield excellent data that have a known correlation with direct hemodynamic determinations. More info
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Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral Stenosis

Catheter Balloon Valvuloplasty Treatment of Adult Patients with Mitral StenosisSince its introduction in 1984, mitral catheter balloon valvuloplasty (CBV) has become recognized as a promising investigational treatment that could become an alternative to surgical commissurotomy in selected patients with mitral valve stenosis. Early reports documented the clinical and hemodynamic benefits of CBV as well as the expected procedure-related risks. The increasing interest in mitral CBV techniques has resulted in broadening application of these procedures to adult patients. Therefore, this review summarizes the clinical diagnosis of mitral stenosis, the current techniques of performing mitral CBY the immediate hemodynamic and clinical results, and, more important, the potential risks and benefits of CBV in various types of patients who might be referred for this treatment. read more
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