Zuhdi Lababidi

Percutaneous balloon aortic valvuloplasty: Results in 23 patients

Percutaneous balloon aortic valvuloplasty (BAV) was performed in 23 consecutive patients with valvular aortic stenosis with no associated cardiac defects. The patients were 2 to 17 years old and were referred from 12 hospitals in 4 states. The balloon was positioned across the aortic valve and inflated to pressures of 80, 100, then 120 psi. Each inflation lasted 5 to 10 seconds. The arterial and venous catheters were connected together outside the groin to avoid excessive increase in left ventricular pressure during total aortic valve occlusion with the inflated balloon. Peak systolic aortic valve pressure gradient and cardiac output were measured before and 15 minutes after BAV. There was no significant change in cardiac output, but all patients had a lessened gradient. The gradient before BAV was 113 ± 48 mm Hg, decreasing to 32 ± 15 mm Hg after BAV (p < 0.01). The left ventricular peak systolic pressure decreased from 221 ± 54 to 149 ± 21 mm Hg (p < 0.01). No aortic regurgitation was noted in 13 patients and very mild aortic regurgitation was noted in 10 patients after BAV. The balloons were 10 to 20 mm in diameter, chosen at least 1 mm smaller than the diameter of the aortic valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. Six patients had repeat cardiac catheterization studies 3 to 9 months after BAV. In none was there a significant change in peak systolic aortic valve pressure gradient or cardiac output compared with the study immediately after valvuloplasty.

Transluminal balloon coarctation angioplasty: Experience with 27 patients

Transluminal balloon angioplasty (BA) was performed in 27 consecutive patients with coarctation of the aorta (COA), including 7 infants with preductal COA, 7 patients with restenosed COA after surgical repair, and 13 older children and 1 adult with unoperated COA. The patients were 4 days to 27 years old. The balloon was positioned across the COA and inflated sequentially to pressures of 100 and 120 psi, each inflation lasting for 5 to 10 seconds. Peak systolic pressure gradient (PSG) across the COA was recorded and an aortogram was performed before and immediately after BA. PSG also was recorded during follow-up studies performed in 13 patients 3 to 24 months after BA. BA was performed without complications in each patient. Immediately after BA, the mean PSG was reduced from 49 +/- 21 to 10 +/- 7 mm Hg (p less than 0.01), and the mean COA diameter increased from 3.9 +/- 1.4 to 9.6 +/- 3.6 mm (p less than 0.01). After a follow-up period of 3 to 24 months, the mean PSG remained low (15 +/- 11 mm Hg) and the mean COA diameter increased to 10.5 +/- 4.6 mm. BA can be performed safely. It can be a useful palliative treatment in seriously ill infants with COA.

Percutaneous Balloon Aortic Valvuloplasty

Percutaneous balloon aortic valvuloplasty was performed on 37 consecutive patients with congenital valvular aortic stenosis. The patients were 2–22 years old (29 males and 8 females). Three patients had postoperative aortic restenosis and 34 had native aortic stenosis. The only patients that were excluded from the study were the following: 1) neonates with critical aortic stenosis and cardiac myopathy who may not tolerate prolonged catheter manipulation in the left ventricle, 2) children with severe aortic regurgitation, and 3) adults with calcific aortic stenosis.

Depression in Children and Adolescents with Cardiovascular Symptomatology: The Significance of Chest Pain

The study reports on 100 children and adolescents evaluated in a pediatric cardiology department. The results state that 13% of the population met the criteria for Major Depressive Disorder based on DSM III. There were four patients who were referred because of chest pain. All of them were found to be free from cardiovascular disorders, but all were found to be in the depressed group. The authors emphasize the importance of chest pain in differential diagnosis of childhood depression. Journal of the American Academy of Child Psychiatry , 21, 2:187–189, 1982.

Interventional Pediatric Cardiac Catheterization

Interventional cardiology and invasive cardiovascular procedures have grown substantially over the last 2 decades as a result of the outstanding technical advances in catheter equipment and design. The remarkable evolution of new catheter designs resulted in the production of sophisticated and elaborate therapeutic instruments that can be used by the invasive cardiologist for the treatment of various congenital cardiac diseases. Interventional cardiology can no longer be ignored by the invasive pediatric cardiologist who does not perform therapeutic procedures. This is particularly true in neonates with certain congenital cardiac defects that require transcatheter treatment as soon as accurate diagnosis is established in the catheterization laboratory. A therapeutic procedure in such cases should be complementary to diagnostic cardiac catheterization in the same setting.

Surgical Evaluation of Percutaneous Transluminal Balloon Angioplasty and Valvuloplasty in Congenital Cardiovascular Anomalies

Percutaneous transluminal bal loon angioplasty and valvuloplasty procedures for treatment of congeni tal cardiovascular anomalies were performed in 109 consecutive pa tients. Forty-two patients had balloon pulmonary valvuloplasty: the mean peak systolic gradient was reduced from 80 ± 35 mmHg to 23 ± 15 mmHg (p < 0.01). Thirty-seven pa tients had balloon aortic valvulo plasty : the mean gradient was re duced from 105 ± 43 mmHg to 28 ± 15 mmHg (p < 0.01). Thirty pa tients had balloon aortic coarctation angioplasty: the mean gradient was reduced from 47 ± 3.9 mmHg to 9.2 ± 1.3 mmHg (p < 0.01). Follow-ups of percutaneous balloon pulmonary valvuloplasty results in 15 patients (mean of 9.1 ± 1.2 months), of per cutaneous balloon aortic valvulo plasty in 17 patients (mean of 11.6 ± 1.9 months), and of percutaneous balloon aortic coarctation angio plasty in 14 patients (mean of 13 ± 4 months) revealed that gradients re mained significantly reduced (p < 0.01) in all groups. Elective op eration was performed upon 14 pa tients following percutaneous transluminal balloon procedures, and pulmonary valves were noted to be opened by commissural splitting, cusp tear, or cusp avulsion from the annulus. Aortic valves had commis sural splitting, and coarctation sites had intimal tears. No deaths oc curred. Percutaneous transluminal balloon valvuloplasty and angioplasty can aid in palliating selected congeni tal cardiovascular anomalies and de lay the time within which operative treatment is required.