[Percutaneous transluminal angioplasty of the vena cava inferior]. / Angioplastía transluminal percutánea de la vena cava inferior.

We describe a 65-years-old female, with percutaneous balloon angioplasty (PBA) of inferior vena cava. The patient had massive calcification of the right atrium, the tricuspid anulus as well as obstruction of the tricuspid valve (percutaneous tricuspid valvuloplasty was performed 2.5 years before). The only predisposing factor for calcification was, a cerebral-right atrial shunt (cerebral cysticercosis) for 32 years. PBA was performed. We discuss some events that occurred after dilatation. We describe the technique in this uncommon case. We conclude that percutaneous balloon angioplasty is another alternative to surgical repair in inferior vena cava obstruction.

[Percutaneous mitral commissurotomy with Inoue's technic and pregnancy. The initial experience in Mexico]. / Comisurotomía mitral percutánea con técnica de Inoue y embarazo. Experiencia inicial en México.

From March 1986 to January 1993, we performed percutaneous balloon mitral commissurotomy (PBMC) in ninety-one patients with rheumatic mitral stenosis, two of them during pregnancy. The gestational age at the time of valvotomy was thirty and twenty-seven weeks respectively. Balloon Inoue technique in both cases resulted in improvement in mitral valve area (0.8 vs 1.6 and 0.7 vs 1.9 cm2) and in mean mitral gradient (19 vs 4 and 12 vs 0 mm Hg) immediately after dilation, without residual atrial septal defect or mitral insufficiency. There were no complications. The estimated radiation exposure to the fetus was of 6.4 minutes of fluoroscopy and 6 seconds of angiography. To limit of X-ray irradiation, we used color Doppler echocardiography during dilatation in both cases. The subsequent course of gestation was uncomplicated and normal babies were delivered in both cases. Fetus protection against ionising radiation was assured by lead mantles. In the follow-up the mitral valve area was 1.7 and 2.1 cm2, 15 and 4 months later respectively. PBMC can be performed safely during pregnancy and is effective in increasing the valvular area and relieving symptoms. It offers an excellent alternative for the pregnant patients, with severe mitral stenosis. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.

[Percutaneous transluminal angioplasty in aortic coarctation in adolescents and adults. Mid-term results]. / Angioplastía transluminal percutánea de coartación aórtica en adolescentes y adultos. Resultados a mediano plazo.

From October 1985 to February 1992 we performed 80 percutaneous transluminal angioplasty (PTA) in 76 patients with coarctation of the aorta (CoAo). Sixteen of them with ages ranging from 12 to 62 years (mean = 21.1). We describe the experience in these cases. Fifteen with native and one with post-surgical coarctation. The gradient decreased from 72 +/- 33 to 18 +/- 17 mmHg immediately after dilation, in the follow-up (1 to 69 months m = 25) was 23 +/- 20 mmHg. In one patient we performed simultaneously angioplasty of CoAo and mitral valvuloplasty with excellent results in both lesions. We redilated two cases for residual gradient successfully. We had one failure in a patient with long coarctation. He needed surgery. In the initial experience we had one severe complication (cerebral stroke). No deaths or aneurysms. In conclusion we believe that PTA is an adequate alternative in adolescents and adults with native or post-surgical coarctation of the aorta with minimum incidence of complications.

[Ruptured aneurysm of the aortic sinus of Valsalva: clinical course, diagnosis, and treatment]. / Aneurisma roto del seno de Valsalva aórtico: evolución, diagnóstico y tratamiento.

The authors present the clinical cases of 5 patients, with rupture of the aortic Valsalva's sinus aneurysm open to the right chambers, diagnosed clinically, echocardiographically and hemodynamically in the past eight months. Among them, four were males, and one female. Three were treated surgically successfully, one patient refused surgery and another had a sudden death before surgery. The patients showed arteriovenous blood flow shunt, three from the aorta to the right ventricle, and two to the right atrium. One case was associated to an atrial septal defect, and tricuspid insufficiency in another. The authors added a sixth case: a woman, with rupture of the aortic Valsalva's sinus open to the right ventricle, aortic insufficiency and diaphragmatic subaortic stenosis. The authors discuss the embryologic origin of the formation and rupture of the Valsalva's sinus aneurysm as well as the factors that contribute to it's rupture, the natural history of the illness, it's classification, association with other heart disease as well as diagnosis and treatment.

The intraaortic counterpulsation balloon in cardiac surgery. The importance of opportune indication.

The results with the use of this device in patients who develop Low Cardiac Output Syndrome after cardiac surgery with extracorporeal circulation are analyzed. Special emphasis is given to the development of the opportune indication of this procedure, on the basis of a comparison of the results of the first few years to the most recent ones. Finally, the advantages of the prophylactic use of the Intraaortic Balloon Pump are commented.

[Valvuloplasty with balloon catheter in biologic prosthesis. Reality or illusion]. / Valvuloplastía con cáteter de globo en prótesis biológicas. Realidad o ilusión.

We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.

[Transcatheter percutaneous commissurotomy in rheumatic mitral stenosis]. / Comisurotomía percutánea transcateterismo en la estenosis mitral reumática.

Percutaneous transcatheter balloon mitral commissurotomy was performed in an 11 year old girl. The atrial septum was perforated and an 8 mm angioplasty balloon was advanced the atrial septal perforation was then dilated to allow passage of 25 mm balloon valvuloplasty catheter across the mitral annulus. Transmitral balloon inflation acutely decreased the end diastolic transmitral gradient (23 mm Hg to 2 mm Hg). Immediate gradient reduction was associated with increases in cardiac output (3.4 to 5.3 L/min). Murmur intensity diminished immediately post-commissurotomy. Balloon commissurotomy did not produced mitral regurgitation. Five weeks later, follow-up catheterization was performed and did not show change in mitral valvular gradient (2 mmHg). Clinical improvement was evident.

[Percutaneous transluminal angioplasty in aortic coarctation. Report of a case]. / Angioplastía transluminal percutánea en coartación aórtica. Informe de un caso.

We describe the first case in our hospital of percutaneous transluminal angioplasty in a 16 years old boy with congenital coarctation of the aorta. The technique, hemodynamic findings, angiography before and after dilation and the advantages in comparison with the conventional cardiac surgery were analyzed. In our case the gradient decreased from 60 mmHg to 28 mmHg. We conclude that this procedure is an alternative treatment for patients with congenital coarctation of the aorta.

[Transcatheter pulmonary valvuloplasty]. / Valvuloplastía pulmonar transcateterismo.

We describe the first case of balloon pulmonary valvuloplasty performed in this country. This 12 year old girl had a transvalvular gradient of 94 mmHg and after the procedure it improved to 20 mmHg. Four months later, cardiac catheterization did not show any significative change in pulmonary valvular gradient (26 mmHg). We describe the technique, hemodynamic findings, complications, and advantages of this procedure. We also review the literature. We consider that balloon valvuloplasty should be the first choice procedure in the treatment of patients with congenital pulmonary valve stenosis.