Percutaneous transluminal balloon dilatation in discrete subaortic stenosis

Versatility of Inoue balloon catheter

Inoue rubber nylon single balloon catheter is being used worldwide for performing balloon mitral valvuloplasty (BMV). The popularity of Inoue balloon is attributed to its self-positioning configuration, size-adjustability, rapid inflation-deflation sequence and the ease of performance. We report its use in performing various non-mitral interventions. Its utility in treating patients with mitral stenosis and combined mitral and tricuspid stenosis is well established. Seventeen patients with valvular pulmonic stenosis (age 32+/-16 years; 11 males and 6 females) achieved significant reduction of peak systolic gradient (PSG) from 125+/-28 to 32+/-16 mmHg (P<0.005). Four patients with inferior vena-cava obstruction (age 20-48 years; 3 males and 1 female) derived symptomatic benefit following successful dilatation. Inoue balloon was used to create percutaneous pericardial window in four cases (age 43-68 years; 2 males and 2 females) of recurrent pericardial collection secondary to carcinoma lung/breast, thus alleviating the symptoms of tamponade. One patient each with coarctation of aorta (32 years, male), discrete subaortic membrane (16 years, female), and critical valvular aortic stenosis (13 years, male) derived immediate hemodynamic improvement with Inoue balloon dilatation. No major complications were encountered. We conclude that Inoue balloon can be used to successfully manage various stenotic lesions.

Percutaneous balloon dilatation of subaortic membrane using an Inoue balloon

Left ventricular outflow tract obstruction caused by a discrete subaortic membrane in a young female was successfully dilated using an Inoue balloon catheter. The Inoue balloon catheter was used in a retrograde manner via the femoral artery.

"Acquired" subvalvular aortic stenosis after repair of a ventricular septal defect

Of 353 children who underwent surgical repair of a congenital heart defect, including closure of a ventricular septal defect (VSD), 12 patients (four with tetralogy of Fallot, five with a VSD, and three with a double-outlet right ventricle) developed subaortic stenosis, which was diagnosed one to six years after the surgical procedure. Five patients required surgical treatment of the subaortic stenosis, and one required percutaneous balloon angioplasty. Postsurgical subaortic stenosis appears to be an uncommon progressive acquired disease.

Echocardiographic determinants of outcome after percutaneous transluminal balloon dilatation of discrete subaortic stenosis

Eleven patients (seven females and four males; age 4 to 24 years) with discrete subaortic stenosis (DSS) diagnosed on echocardiography were subjected to balloon dilatation. The site of the obstruction was 1 to 8 mm below the aortic valve. On the basis of echocardiographic appearance, the patients could be divided into three groups. Group I patients had a uniformly thin (1 to 3 mm) obstructing "membrane" (n = 7). Group II patients had a thin obstructing "membrane" present at the tip of a thick bulge from the interventricular septum (n = 2) (intermediate form). Group III patients had an obstruction caused by a thick ridge of tissue (6 to 8 mm thick, n = 2). Maximum inflatable diameter of the balloon used was less than or equal to the aortic valve anulus. After balloon dilatation in group I, the gradients across the obstruction fell from 86.6 +/- 16.9 mm Hg to 24.0 +/- 13.1 mm Hg. Relief of obstruction persisted on follow-up of 3 to 24 months (gradient 28.8 +/- 15.7 mm Hg). In group II patients gradients fell from 116 and 40 mm Hg to 58 and 20 mm Hg, respectively immediately after balloon dilatation. On follow-up of 6 and 9 months the gradients have increased to 76 and 32 mm Hg, respectively. In group III the gradients fell from 64 and 70 mm Hg to 15 and 16 mm Hg, respectively, immediately after balloon dilatation, which increased to 58 and 60 mm Hg, respectively, within 24 hours and persisted around that level at 3 months' follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis

This study presents the findings in 33 patients with discrete subaortic stenosis who were treated by percutaneous balloon dilation and were followed up for 2 months to 6.2 years (mean 34 +/- 21 months). The mean age was 13 +/- 11 years; 10 (30%) were female and 23 (70%) male. Associated malformations were observed in nine patients (27%). All patients underwent noninvasive studies and cardiac catheterization. The mean value to membrane distance was 4.5 +/- 2 mm/m2. After balloon dilation, the pressure gradient from the left ventricle to the aorta decreased from 68 +/- 30 to 20 +/- 13 mm Hg (p less than 0.00001); there were no significant changes in the degree of aortic regurgitation. A fluttering and widely mobile remaining membrane was clearly visualized after dilation. Better immediate results were obtained in patients with a smaller baseline gradient, a larger aortic anulus and a longer valve to membrane distance. Serial follow-up echographic studies were available in 30 patients, and 18 hemodynamic reevaluations were performed in 13 patients. However, seven patients who demonstrated restenosis underwent redilation at a mean of 29 +/- 17 months after the first dilation. Redilation in six of the seven patients obtained benefits similar to those observed at the first dilation. Only one patient with unsuccessful redilation required surgery. The mean value of the last explored residual gradient (on hemodynamic or Doppler study) in the remaining 32 patients was 21 +/- 10 mm Hg. No significant changes were observed in the angiographic evolution of aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon dilation of postsurgical subaortic obstruction

Two children aged 10 and 5.5 years underwent balloon dilation for postsurgical subaortic obstruction. The outcome and the role of this procedure are discussed.

Transluminal balloon dilatation for discrete subaortic stenosis in adults and children: early and intermediate results

Seven patients (four adults, three children) with discrete subaortic membranous stenosis underwent balloon dilatation using a single or double balloon technique with reduction in systolic gradient across the membrane from 100.42 +/- 19.23 to 29.14 +/- 12.54 mmHg (P less than 0.001). Echocardiography demonstrated thin membranes in all the patients and postprocedure torn fragments could be visualized. The excellent hemodynamic benefits are sustained during 4-24 months follow-up. The results indicate that transluminal balloon dilatation can be a safe and effective treatment for thin subaortic membrane.