Balloon Occlusion

We sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans. Ten subjects with single-vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low-pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia-induced diastolic dysfunction was seen 1 minute after RP (end-diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, P<0.001) and BO (end-diastolic pressure [mm Hg]: 8.1±4.0 versus 8.7±4.0, P=0.03). Impairment of systolic ...

Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and one of the major causes of mortality in women in developing countries. According to the Central Statistical Office, in 2006, in Poland 540 maternal peripartum deaths were noted, 34.7% of which due to PPH. Therefore, active postpartum management should be the main goal in contemporary obstetrics. Some PPH management algorithms have been proposed by the World Health Organization, the American College of Obstetricians and Gynecologists and Polish Gynecological Society. In the event of unsuccessful conventional management of PPH (uterotonics, curettage, etc.) a new technique, intrauterine Bakri balloon tamponade, has been recently proposed. The current paper presents two case reports where this method has been successfully applied.

To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder. 236 consecutive patients with a significant ASD (age 6 months to 46 years, median 5 years; body weight 6.5-79 kg, median 18 kg) were considered for transcatheter closure with the Amplatzer septal occluder; 18 patients with defects that were too large or with a deficient inferior margin were excluded from attempted transcatheter closure after initial transthoracic (4) or transoesophageal echocardiography (14). At cardiac catheterisation, devices were not implanted in 18 patients because the stretched diameter of the ASD was too large (4), the device was unstable (4), compromised the mitral valve (1), or obstructed the upper right pulmonary vein (1); eight patients with additional systemic or pulmonary vein anomalies (5) or a Qp:Qs less than 1.5 (3) were excluded after angiographic and haemodynamic assessment. Thus ASD closure was done successfully i...

Different devices have been used for percutaneous closure of ventricular septal defects (VSDs). Over the past 6 months, we have used the Amplatzer duct occluder for VSDs associated with tunnel-shaped aneurysm in three patients here at our institution. Due to the anatomic resemblance between such VSDs and the duct occluder, we selected this device for percutaneous closure. There was trivial residual shunt in one patient. All three patients tolerated the procedure well and there were no untoward complications.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular technique that allows for temporary occlusion of the aorta in patients with severe, life-threatening, trauma-induced noncompressible hemorrhage arising below the diaphragm. REBOA utilizes a transfemoral balloon catheter inserted in a retrograde fashion into the aorta to provide inflow control and support blood pressure until definitive hemostasis can be achieved. Initial retrospective and registry clinical data in the trauma surgical literature demonstrate improvement in systolic blood pressure with balloon inflation and improved survival compared to open aortic cross-clamping via resuscitative thoracotomy. However, there are no significant reports of anesthetic implications and perioperative management in this challenging cohort. In this narrative, we review the principles, technique, and logistics of REBOA deployment, as well as initial clinical outcome data from our level-1 American College of Su...

Purpose: This study was designed to assess the balloon sizing maneuvers and deployment of an Amplatzer Septal Occluder (ASO). In addition, intraprocedural balloon sizing was compared with off-line intracardiac echocardiographic measurements. Methods: The intracardiac ...

The discrepancy between angiographic success and microvascular perfusion has been recognized for some time. In the face of an open artery, the degree of microvascular perfusion determines post-infarct prognosis. Despite successful epicardial recanalization, tissue perfusion may ...

Coiling of a wide-necked basilar tip aneurysm can be accomplished in selected cases by placing a single Neuroform stent horizontally across the aneurysm neck via a posterior communicating artery approach rather than by placing 2 stents in a Y configuration via a basilar artery approach.

The objective of this systematic review and meta-analysis was to determine the effect of REBOA, compared to resuscitative thoracotomy, on mortality and among non-compressible torso hemorrhage trauma patients. Relevant articles were identified by a literature search in MEDLINE and EMBASE. We included studies involving trauma patients suffering non-compressible torso hemorrhage. Studies were eligible if they evaluated REBOA and compared it to resuscitative thoracotomy. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. We conducted meta-analysis using random effect models. We included three studies in our systematic review. These studies included a total of 1276 patients. An initial analysis found that although lower in REBOA-treated patients, the odds of mortality did not differ between the compared groups (OR 0.42; 95% CI 0.17-1.03). Sensitivity analysis showed that the risk of mortality was significantly l...

The purpose of this study was to evaluate the feasibility and safety of renal artery angioplasty and stenting utilizing a distal protection device to reduce the risk of intraprocedural artery embolism and avoid deterioration of the renal function. Fifty-six hypertensive patients (32 men; ...

Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for descending thoracic aortic aneurysms (TAA). However, not all patients with TAA can be treated with the endovascular technique. Insufficient proximal and/or distal sealing zone is the most common reason for open surgery in these patients. If the distal sealing zone above the celiac axis is too short, several endovascular alternatives are possible; hybrid procedures with TEVAR and open by-pass to the celiac artery, custom made stent-grafts with scallop or fenestration for the celiac artery, or intentional coverage of the celiac artery. In the latter case, adequate collateral supply to the upper gastrointestinal tract is crucial. Collateral arteries joining the celiac and the superior mesenteric arteries are well characterized in patients with chronic celiac stenosis or occlusion. Are these collateral pathways sufficient also for sudden iatrogenic closure of the celiac artery? By performing a preoperative angiog...

Some controversy exists regarding the safety of endoaortic balloon clamping in minimal access isolated mitral valve surgery (MIMVS). The aim of this European multicenter study was to analyze the results in 10 experienced centers and compare the outcomes with published data. The most recent 50 consecutive MIMVS cases from10 European surgeons who had performed at least 100 procedures were prospectively collected and retrospectively analyzed. All procedures were performed through right minithoracotomy with femoral cannulation and endoaortic balloon occlusion. In-hospital and 30-day outcomes were studied. Mortality and stroke rates were compared with published median sternotomy and MIMVS outcomes. Mean age was 63.2 ± 12.5 years, 289 (57.8%) were male, mean logistic European system for cardiac operative risk evaluation was 6.1 ± 6.2, and 53 (10.6%) procedures had cardiac reoperations. Concomitant procedures were performed in 126 (25.9%) cases. Three patients (0.6%) required conversion to...

Isolated congenital diaphragmatic hernia defect allows viscera to herniate into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. Antenatal measurement of lung size and liver herniation can predict survival after birth. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion (FETO) under local anesthesia. This in utero treatment requires a second intervention to reestablish the airway, either before birth or at delivery. To describe our experience with in utero endotracheal balloon removal. This is a retrospective analysis of prospectively collected data on consecutive patients with congenital diaphragmatic hernia treated in utero by FETO from 3 centers. Maternal and pregnancy-associated variables were retrieved. Balloon removal attempts were categorized as ...

Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, different perfusion strategies and aortic clamping techniques are available. However each approach carries specific advantages and drawbacks. This retrospective study analyses our experience in right minithoracotomy MVS with different arterial perfusion and aortic clamping strategies, highlighting the results of a patient tailored approach. Between March 2009 and March 2014, 460 patients with a full preoperative work-up that included also aortoiliac-femoral axis' screening underwent right minithoracotomy MVS. One hundred and eight were redo cases (23.5%), 63 had aortoiliac atheromatous disease or significant tortuosity (13.7%), and 38 had chronic obstructive pulmonary disease (8.3%). Based on anatomy and comorbidities, each patient was allocated to the most appropriate of 3 approaches: femoral arterial cannulation with endoaortic balloon (P+EB) (247, 53.7%) or with transthoracic clamp (...

OBJECTIVESThe aim of the study was to assess the safety and efficacy of the Amplatzer ductal occluder (ADO) in transcatheter occlusion of patent ductus arteriosus (PDA).BACKGROUNDTranscatheter closure of small to moderate sized PDAs is an established procedure. The ADO is a self-expandable device with a number of salutary features, notably its retrievability, ease of delivery via small 5F to 7F catheters and a range of sizes suitable even for the larger PDAs.METHODSBetween November 1997 and August 1999, the ADO was successfully implanted in 205 of 209 patients with PDA. The inclusion criteria for this device occlusion method were patients with clinical and echocardiographic features of moderate to large PDA, weighing ≥3.5 kg as well as asymptomatic adolescents and adults with PDA measuring ≥5.0 mm on two-dimensional (2D) echocardiogram. Occlusion was achieved via the antegrade venous approach. Follow-up evaluations were performed with 2D echocardiogram, color-flow mapping and Dopple...

Sixty patients with stable angina and significant coronary artery disease planned for elective percutaneous coronary intervention were split in two groups. In all patients two balloon inflations of 60 seconds were performed, the first for balloon dilatation of the lesion (first episode), ...

1. Ital Heart J. 2002 Oct;3(10):620-1. Transcatheter closure of a stabilized post-infarction apical muscular septum defect as an alternative to surgical repair. Zanchetta M, Onorato E, Rigatelli G, Pedon L, Barbiero M, Zennaro M, Rigatelli G, Maiolino P. ...