Percutaneous transluminal valvuloplasty in calcific aortic stenosis: the double balloon technique.

The double balloon technique for aortic valvuloplasty using a combined brachial and femoral artery approach with readily available angioplasty equipment is described. Online hemodynamic assessment of the patient during the procedure was provided by continuous, reflective spectorphotometric monitoring of the pulmonary artery mixed venous oxygen saturation and the arterial pressure in the femoral sheath. Successful valvuloplasty was achieved in 10 patients with the transaortic peak-to-peak systolic gradient reduced from 77.6 +/- 28 to 27.8 +/- 15 mmHg (P less than 0.001), the mean gradient from 62.0 +/- 24 to 26.0 +/- 15 mmHg (P less than 0.0007), and the aortic valve area increased from 0.56 +/- 0.3 to 1.03 +/- 0.6 cm2 (P less than 0.05). No significant complications were encountered. The double balloon technique for aortic valvuloplasty is an acceptable alternative method to the single balloon technique.

Coronary angioplasty in patients who undergo multiple vessel angioplasties, and in patients who have multivessel coronary disease.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in patients who underwent multiple vessel angioplasties (MVA) and in patients with multivessel coronary disease (MCD). There were 235 MVA patients who underwent 255 procedures during which 600 lesions were dilated. Two lesions were dilated in 75% of cases, and three lesions in 16% of cases. 93% of the lesions were successfully dilated and 91% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.5% incidence of transmural infarction, and a 2.4% emergency surgery rate. Significant complications occurred in 13 patients (4.6%). A clinically apparent restenosis occurred in 51 patients (24%) with a repeat PTCA performed in 25/26 patients (96%), elective surgery in 14 patients, and the remainder were treated medically. 82% of patients remain clinically improved more than one year after a successful PTCA. There were 331 MCD patients who underwent 387 procedures during which 662 lesions were dilated. One lesion was dilated in 47% of cases, two lesions in 39% of cases, three lesions in 9% of cases, and four or more lesions in 5% of cases. 91% of the lesions were successfully dilated, and 90% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.1% incidence of transmural infarction, and a 3.9% emergency surgery rate. Significant complications were encountered in 35 patients (9%). A clinically apparent restenosis occurred in 46 patients (21%) with a repeat PTCA performed in 29/31 patients (94%), elective surgery in nine patients, and the remainder were treated medically. 86% of patients remain clinically improved more than one year after a successful PTCA. PTCA can be performed in carefully selected patients undergoing MVA, and in MCD patients with a good success rate, a low complication rate, and a satisfactory long term benefit. However, a large clinical trial would be most beneficial in establishing PTCA's role in the treatment of extensive coronary disease.

Complex coronary angioplasty in patients with prior coronary artery bypass surgery, in situations utilizing multiple coronary angioplasties, and in coronary occlusions.

Coronary artery bypass surgery not only provides symptomatic relief but also may prolong life in a significant percentage of patients. Repeat bypass surgery succeeds in providing symptomatic relief in a lesser number of patients, but it is associated with a higher morbidity and mortality than primary operations. Angioplasty, an interventional, therapeutic catheter technique, is applicable to a large number of patients who have undergone bypass surgery and who are sufficiently symptomatic to require consideration of another revascularization procedure. The gratifying results of successful lesion dilatation coupled with clinical improvement of the patient, the acceptable mortality and morbidity statistics, and the long-term symptomatic relief are comparable to those for repeat coronary bypass graft surgery. In addition, technologic advances in angioplasty equipment, as well as more knowledgeable interventionists, will enable more lesions to be successfully reached, traversed, and dilated with, it is hoped, a lower morbidity and mortality. We would estimate that 30 to 50 per cent of those patients requiring repeat revascularization operations today can undergo an angioplasty procedure with at least comparable clinical results and better morbidity and mortality statistics than those achieved with repeat bypass surgery. Selected patients underwent transluminal coronary angioplasty of varying combinations of arterial and/or vein graft stenoses. A multiple dilatation procedure was defined as successful when dilatation was achieved in all lesions in which it was attempted or when the considered-critical stenosis was dilated successfully and the patient was clinically improved. Angioplasty was successful in 93 per cent of all lesions in which it was attempted, and these successful dilatations produced a clinical improvement in 92 per cent of the patients. No complication whatsoever was experienced in 81 per cent of cases. The complications encountered included a 1.3 per cent mortality rate, a myocardial infarction rate of 6.9 per cent (3.0 per cent per lesion attempted), and an emergency surgery rate of 2.6 per cent (1.1 per cent per lesion attempted). Follow-up data show that a sustained clinical improvement was obtained in 96.8 per cent of the patients in whom the procedure was successful (with or without a repeat angioplasty). These data indicate that multiple coronary angioplasties can be performed during the same procedure, that clinical improvement can be achieved, and that the complication rate is acceptable.(ABSTRACT TRUNCATED AT 400 WORDS)