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Ross procedure is used in young adults with congenital aortic stenosis. Over time, patients may develop autograft insufficiency and RV-PA homograft dysfunction. 42F with congenital aortic stenosis s/p aortic valvotomy followed by percutaneous valvuloplasty and Ross procedure presented with

A B S T R A C T Introduction and objectives: The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3-dimensional transthoracic echocardiography. Methods: We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 (11.5)) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72 h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemody- namic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. Results: The 3-dimensional parameters of the mitral valve stenosis patients before and 72 h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm 2 ; 1.8 (0.2) cm 2 (P

Accurate echocardiographic evaluation of the pulmonary valve is technically difficult because of its close proximity to the left lung, which often limits decision making. Pulmonary valvotomy is the intervention of choice for symptomatic pulmonary valve stenosis, but fluoroscopy lacks appropriate real time anatomic detail. In this report, we present a case where direct imaging of the pulmonary valve with live/real time three-dimensional transesophageal echocardiography (3DTEE) aided in accurate evaluation and was then used to help guide and monitor successful valvuloplasty of a stenotic pulmonary valve bioprosthesis. We demonstrate that even in cases where two-dimensional (2D) evaluation of the pulmonary valve is difficult, the use of live/real time 3DTEE allows for accurate evaluation of bioprosthetic pulmonary valve structure and function, and enhances the precision and monitoring of percutaneous valvuloplasty.

Background: For children who require aortic valve replacement, the pulmonary autograft may be the ideal substitute. However, re-operations for conduit exchange in the pulmonary position are inevitable. In addition, re-operations on the autograft may be necessary due to dilatation and neo-aortic insufficiency. We sought to assess predictors for re-intervention in an international Ross-operated paediatric population. Methods: Data of 152 children below 16 years of age at the time of the Ross operation were analysed using Cox proportional hazard modelling. Mean follow-up time was 6.1 +/- 4.2 years. Results: The median age at the time of the Ross operation was 10.1 years (range 54 days to 15 years). Early mortality was 2.6%. Survival at 5 and 10 years was 93.9 +/- 2.0% and 90.4 +/- 3.1%, respectively. Seven patients required autograft re-intervention (explantation n = 6 and reconstruction n = 1). Freedom from autograft re-intervention at 5 and 10 years was 99.3 +/- 0.7% and 95.5 +/- 2.7%, respectively. Prior endocarditis (p = 0.061), prior aortic regurgitation ( p = 0.061) and longer follow-up time (p = 0.036) emerged as risk factors for autograft re-intervention. Seventeen patients required 36 conduit re-interventions (replacement n = 16, percutaneous valvuloplasty n = 10). Freedom from conduit re-intervention at 5 and 10 years was 89.3 +/- 2.9% and 79.6 +/- 6.1%, respectively. Implantation of an aortic homograft (p = 0.013), and smaller conduit size (p = 0.074) emerged as risk factors for conduit re-intervention. Conclusions: There is a consistent need for conduit re-intervention following the Ross operation in children. Re-interventions on the autograft are rare within the first decade after surgery. However, the number of autograft re-interventions may increase after the first decade, since longer follow-up time is a risk factor for autograft failure. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

In a 23-year-old patient with congenital stenosis of the aortic valve the pressure gradient could be reduced from 80 to 35 mm Hg using percutaneous balloon aortic valvuloplasty. The systolic pressure in the left ventricle fell from 200 to 165 mm Hg. A pre-existing mild aortic insufficiency did not worsen. In a 44-year-old female patient retrograde passage of a balloon catheter across the aortic valve failed due to technical reasons. At the present time percutaneous balloon aortic valvuloplasty in adults is more difficult than pulmonary valvuloplasty. It can, however, be considered, prior to surgery, in suitable patients with noncalcified valves.

A case is described in which a patient with a Carpentier-Edwards annuloplasty ring developed mitral stenosis and was treated with percutaneous mitral valvuloplasty. Possible mechanisms for the development of mitral stenosis are briefly discussed.

We report a case of a 58-year-old woman with rheumatic mitral stenosis scheduled for percutaneous valvuloplasty. Prior left and right ventricular angiograms showed multiple diverticula at left ventricular apical and diaphragmatic walls and right ventricular diaphragmatic wall. Chest x-ray and echocardiogram were normal. Magnetic resonance imaging was concordant with catheterization findings and ruled out other cardiac malformations. The risk of ventricular perforation changed our indication of percutaneous valvuloplasty in favor of open heart commissurotomy.

In this paper we present the results obtained in-virro with a balloon for percutaneous valvuloplasty that had been fenestrated in its proximal portion so that blood flow can be obtained distally while the balloon remains inflated during the valvuloplasty procedure. The study was conducted in a test chamber specially built for that purpose. Preliminary results obtained with one fenestration of approximately 2mm2 in surface area yielded an average of 280.60 ml/min when a stroke rate of 60 beats per minute, and a stroke volume of 5cc per stroke were used.

A 62-year-old woman with disabling mitral prosthetic stenosis underwent percutaneous balloon valvuloplasty. The transvalvular gradient preoperatively was 22 mm Hg and was reduced to 6 mm Hg after the valvuloplasty. the valve area was increased from an initial value of 0.77 cm2 to 1.53 cm2. No complications occurred related to the Further studies are necessary to ascertain the indications and long-term results of percutaneous valvuloplasty on bioprosthesis in the mitral position.

Percutaneous balloon valvuloplasty has been used as treatment for native valvular stenosis in the mitral, aortic, pulmonary and tricuspid positions. 1–4 It has also been used as palliative therapy for stenotic bioprosthetic valves.5–8 In this study we present the immediate results and midterm follow up of percutaneous balloon valvuloplasty of 5 bioprosthetic valves in different positions.

Percutaneous aortic valvuloplasty is a palliative treatment for patients with calcific aortic stenosis who would be poor candidates for surgical treatment. The results and associated complications of this procedure were analysed in a series of 47 patients in which different types of dilating catheters were used. In 25 patients a single balloon (19 mm) was used (group A), in 13 patients a bifoil balloon (2 x 15mm) (group B), and in the remaining nine patients (group C) a trefoil balloon (3 x 10mm) was used. An increase in aortic valve area was achieved in all patients. The results obtained with the bifoil balloon were better than with the other types of balloon catheter, with an increase in aortic area of + 118% vs. + 74% (monofoil) and + 76% (trefoil) (P less than 0.05). The tolerance of the inflation procedure was also better with this type of balloon, as it allowed for shorter inflation and deflation times. These results show that balloon aortic valvuloplasty, when indicated, is best performed with a bifoil balloon dilating catheter, and undue complications usually do not occur.

An 88-year-old patient undergoing percutaneous aortic balloon valvuloplasty of a tricuspid aortic valve is described. The patient had mild aortic regurgitation prior to the procedure but developed severe aortic regurgitation after balloon dilatation of the valve. At the time of surgery there was no anatomic disruption of the valve or supporting structures. Development of severe aortic incompetence following balloon valvuloplasty has not been previously reported.

Recently, percutaneous balloon dilatation has been successfully used for treatment of congenital aortic and pulmonary valvular stenoses.1 We report the first case of percutaneous valvuloplasty of a severely stenosed porcine bioprosthetic valve.

No Instituto Dante Pazzanese de Cardiologia, as valvoplastias percutâneas para as valvas mitral e aórtica tiveram início em agosto de 1987. Foram realizados 37 procedimentos, sendo 26 para a mitral (VMP) e 1 para a aórtica (VAP). Nas 26 VMP, obteve-se sucesso 14 vezes, tendo 4 complicações. Em 3 pacientes, o sucesso não foi total, sendo que uma paciente com insuficiência mitral recusou cirurgia, outro foi operado e o terceiro está assintomático, mas não houve melhora da área valvar e das pressões, e deve ser reestudado para posterior avaliação. Os 9 pacientes restantes foram operados, sendo realizadas 6 comissurotomias e papilarotomias e 3 substituições valvares. A indicação cirúrgica se deu por tamponamento cardíaco em 1 caso, rotura de músculo papilar com conseqüente insuficiência em outro, 1 caso de baixo débito, punção da aorta em 4 casos e não passagem do cateter para o átrio esquerdo em 2 com suspeita de tamponamento não confirmada. O paciente submetido a VAP obteve melhora imediata do gradiente, mas faleceu 1 mês após, em insuficiência cardíaca. As valvoplastias percutâneas têm apresentado uma alternativa no tratamento das lesões valvares e são uma opção, principalmente para casos de valvas não calcificadas e com o aparelho subvalvar não comprometido. Devem ser lembradas nos casos em que a cirurgia é de alto risco, como em idosos, pneumopatas e nefropatas. Since August 1987, at the Instituto Dante Pazzanese de Cardiologia (IDPC) percutaneous mitral and aortic valvuloplasty was performed in 27 patients. In 26 for mitral and in 1 for aortic valve disease. In 26 patients mitral valvuloplasties success was accomplished in 14 patients. From those we had some complications in 4. The success was not total in 3 patients. One patient with mitral insufficiency refused surgery; the second one underwent surgery, and the third one is assymptomatic but without increase in valve area or drop in the gradient and will be reviewed. The last 9 patients underwent surgery. Six underwent commissurotomy and papilotomy and 3, valve replacement. The surgical indications were: cardiac tamponade in one, papilary muscle rupture in another one, low cardie output in 1 and puncture of the aorta in 4 cases. The catheter did not reach the left atrium in the last 2 cases and the hypothesis of cardiac tamponade was suspected, but not confirmed. The patient who underwent aortic valvuloplasty had the gradient dropped, but died one month later, in heart failure. Percutaneous valvuloplasty is an alternative treatment for patients with mitral or aortic valve stenosis without calcification or alterations of the subvalvar apparatus, mainly in those cases in which the surgery is of high risk like the elderly, in patient with renal and chronic lung diseases.

Percutaneous balloon valvuloplasty is useful for treatment in some patients with valvular stenosis, including those with severe calcification of the valve. 1–4 One case of dilatation of a tricuspid bioprosthetic valve was reported, 4 but none at other positions has been reported. We report the performance and the angiohemodynamic effects of in vivo dilatation in 2 patients with stenotic bioprosthetic valves in the mitral position.