Saad Al Kasab

PERCUTANEOUS DOUBLE-BALLOON MITRAL VALVOTOMY FOR RHEUMATIC MITRAL-VALVE STENOSIS

Percutaneous transatrial mitral valvotomy with a double-balloon technique produced striking symptomatic improvement in 7 of 9 patients with severe mitral stenosis. In 7 patients the mitral valve area (Gorlin formula) increased significantly and the mitral end-diastolic gradient fell significantly. Similar improvements were noted in follow-up haemodynamic studies at 6 weeks. There were no procedure-related complications. It is concluded that percutaneous double-balloon mitral valvotomy may be an alternative to surgical treatment for mitral stenosis.

β-Adrenergic receptor blockade in the management of pregnant women with mitral stenosis

Twenty-five pregnant women with symptomatic mitral valve stenosis (mean valve area, 1.1 +/- 0.25 cm2) were managed by initiation or modification of beta-adrenergic receptor blockade with the use of either propranolol or atenolol. Significant improvement of symptoms occurred in 23 patients (92%) (p less than 0.01); the mean maternal heart rate was reduced significantly from 86 +/- 4 to 78 +/- 5 beats/min (p less than 0.0001). The overall fetal heart rate ranged between 130 to 150 beats/min during treatment. Only two patients required urgent closed mitral valvotomy, after pulmonary edema developed as a result of poor compliance to beta-blockade. All patients were safely delivered of infants at term. Fetal heart rates ranged between 120 to 140 beats/min at delivery. There was no maternal or fetal death. Pregnant woman with symptomatic mitral valve stenosis can be safely managed with beta-blockade, giving significant reduction in the incidence of pulmonary edema with no unwanted neonatal side effect.

Mechanism of mitral valve area increase by in vitro single and double balloon mitral valvotomy

The mechanism of mitral valve area increase by double balloon mitral valvotomy in vitro has not been defined, nor have the mitral valve area results achieved by single versus double balloon mitral valvotomy technique been compared. After a selection of 29 intact mitral valves excised at cardiac surgery from patients with a mitral valve area less than or equal to 1.5 cm2 was made, double balloon mitral valvotomy was attempted in 14 valves using two 20-mm diameter balloon catheters (group 1) and single balloon mitral valvotomy using a 20-mm balloon was undertaken in 15 valves (group 2). In group 1 the mitral valve area increased from 0.9 +/- 0.03 to 1.9 +/- 0.05 cm2 (mean +/- standard error of the mean) (p less than 0.001), with a mean anterior commissural split of 5.3 +/- 0.2 mm and a posterior split of 4.1 +/- 0.2 mm. Following single balloon valvotomy (group 2), the mean mitral valve area increased from 0.8 +/- 0.03 to 1.2 +/- 0.03 cm2 (p less than 0.001), with the mean anterior commissural split being 2.6 +/- 0.2 mm and the posterior 2.1 +/- 0.2 mm. Ten mitral valves from group 2 underwent a second dilatation using the double balloon technique and the mitral valve area increased further from 1.2 +/- 0.06 to 1.9 +/- 0.06 cm2 (p less than 0.001). Overall, commissural splitting occurred preferentially in calcified commissures (81%), as opposed to only 56% of noncalcified commissures. Commissural splitting is the manner in which mitral valve area increases after double balloon mitral valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

One-year follow-up after percutaneous double balloon mitral valvotomy.

Abstract To determine the long-term results after double balloon mitral valvotomy and the incidence of restenosis, 41 consecutive patients were restudied 1 year after successful balloon mitral valvotomy for severe symptomatic rheumatic mitral stenosis. There were 27 female and 14 male patients, mean age 26 ± 9 years.

Percutaneous double balloon pulmonary valvotomy in adults: One- to two-year follow-up

Abstract Percutaneous balloon catheter dilatation of the pulmonary valve has become a widely accepted therapeutic alternative to surgical valvotomy: immediate and shortterm clinical and hemodynamic improvements have been documented. 1–4 This study evaluates 1- to 2-year followup results in the first consecutive series of adult patients with congenital pulmonary valve stenosis (PS) to undergo percutaneous double balloon pulmonary valvotomy.

Percutaneous double balloon valvotomy for rheumatic tricuspid stenosis

Abstract We attempted. tricuspid balloon valvotomy in 4 selected consecutive symptomatic patients (2 male and 2 female) (mean age 41 years), with severe tricuspid stenosis (TS) and mild mitral valve disease. The immediate and short-term results are reported. To define the ph

Comparison of results of percutaneous balloon mitral valvotomy using single and double balloon techniques

siologic effects of balloon tricuspid valvdtomy, we studied the cardiac output of these patients at rest and during treadmill exercise, both before and after the procedure.

Provocation and amplification of the transvalvular pressure gradient in rheumatic tricuspid stenosis.

Abstract This study compares the mitral valve area results achieved in balloon mitral valvotomy, using either a single 20-mm diameter balloon catheter, or a combination of 2 balloon catheters 18 + 20 or 20 + 20 mm in diameter.

Left Atrial Systolic Antegrade Flow in Patients With Mitral Regurgitation: A Pulsed Doppler Sign Displayed by Color Flow Imaging

A low cardiac output and high compliance of the systemic venous system may mask a resting tricuspid diastolic gradient in patients with significant rheumatic tricuspid stenosis. Thirty-three patients (mean age 28 +/- 10 years) with rheumatic tricuspid stenosis evidenced by 2-dimensional echocardiography (doming and restricted motion of all 3 tricuspid valve leaflets) were studied to expose occult and to amplify borderline and basal tricuspid valve gradients. At cardiac catheterization, the right atrium and right ventricular pressures were recorded simultaneously in the basal state, after intravenous infusion of 200, 400, 500, 700 or 1,000 ml of normal saline until a mean right atrial pressure of 12 mm Hg was achieved, and after 0.6 mg of intravenous atropine. Eleven patients (33%) had a mean tricuspid diastolic gradient of greater than 2 mm Hg at rest (group 1). After 483 +/- 240 ml of saline infusion, the mean tricuspid diastolic gradient increased from 5 +/- 2 to 9 +/- 3 mm Hg (p less than 0.001), secondary to a marked rise in right atrial pressure from 8 +/- 3 to 12 +/- 2 mm Hg (p less than 0.001). Concomitantly, there was no increase in right ventricular end-diastolic pressure, although the heart rate increased from 76 +/- 13 to 79 +/- 12 beats/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of results of percutaneous balloon mitral valvotomy using consecutive single (25 mm) and double (25 mm and 12 mm) balloon techniques.

Twenty-two patients with severe mitral regurgitation were observed to have turbulent systolic antegrade flow on pulsed Doppler mapping of the left atrium. All were studied by color flow imaging to delineate the mechanism of this peculiar flow. Pulsed Doppler findings of an eccentric regurgitant flow in one side, an antegrade systolic flow with slightly delayed onset in the other side, and a low velocity flow near the posterior wall, were consistant with the theory of a large eccentric regurgitant jet swirling in the left atrium. Color flow imaging confirmed this mechanism in all patients. Nineteen patients had flail mitral valve with a positive predictive value of 86%. The other three patients had deformed rheumatic mitral valve. The severity of mitral regurgitation was confirmed in all 16 patients studied by left ventricular cineangiography. We have shown that the antegrade systolic left atrial flow is the result of the swirling of a large regurgitant eccentric jet, is commonly observed with flail mitral valve, can occur in patients with deformed rheumatic mitral valve without flail leaflet, and most significantly indicates the presence of severe mitral regurgitation.