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Balloon Diameter (balloon + diameter)

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Medical Sciences	100%

Selected Abstracts

COMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONES

DIGESTIVE ENDOSCOPY, Issue 4 2004
Hiroshi Nakagawa
Background:, Endoscopic papillary balloon dilatation (EPBD) is one of the methods to remove bile duct stones. EPBD might preserve the function of the sphincter of Oddi despite the potential risk of acute pancreatitis. There are only a few reports of EPBD reducing the risk of acute pancreatitis and, at same time, preserving the function of the sphincter of Oddi. Methods:, We performed EPBD for bile duct stone removal in 60 patients using two balloons with different diameters. Patients were randomized to EPBD with a 6 mm balloon (n = 30) or an 8 mm balloon (n = 30). In both groups, isosorbide dinitrate (ISDN) was infused in a rate of 5 mg/h while low pressure EPBD were being performed. The pressure of the sphincter of Oddi was observed before and after the EPBD procedures. Also, serum amylase level after EPBD was observed for both groups. Results:, Serum amylase level of the 6 mm group was signi,cantly higher than that of the 8 mm group (P < 0.05). Acute pancreatitis occurred in two patients ( 6.7%) in the 6 mm group whereas no case was observed for the 8 mm group. The rates of duct clearance were 93% in the 6 mm group and 100% in the 8 mm group. Stone removals were dif,cult in seven cases with 6 mm balloon dilatations due to the narrow ori,ces of the papilla. In the 6 mm group, there was no signi,cant difference between the basal sphincter of Oddi pressure (BSOP) and the phasic sphincter of Oddi pressure (PSOP) before and after EPBD. However in the 8 mm group, the BSOP observed after the EPBD procedure was signi,cantly higher than BSOP before the treatments. Within this group, BSOP values after EPBD were preserved by approximately 80% of the BSOP values before the treatments. In contrast, there was no signi,cant difference in PSOP before and after the treatments. Regarding the stone numbers, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with less than two stones. Also, as for stone size, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with stones of less than 6 mm in diameter. Conclusion:, We are now conducting EPBD with ISDN infusion using a 6 mm balloon for a patient who has less than two stones with size not exceeding 6 mm in diameter. An 8 mm balloon is used for a patient with more than two stones or a stone greater than 6 mm in size. [source]

Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in Children

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2008
J. STEINBERG M.D.
The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. Methods: From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6,41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8,13.0) years. Balloon diameter was 75,133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. Results: In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter ,100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. Conclusion: Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange. [source]

Circumferential Ultrasound Ablation for Pulmonary Vein Isolation: Analysis of Acute and Chronic Failures

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2002
WALID SALIBA M.D.
Circumferential Ultrasound Ablation for PV Isolation.Introduction: In patients undergoing circumferential isolation of the pulmonary veins with an ultrasound ablation system, we analyzed the temperatures achieved while delivering circumferential ostial lesions in the pulmonary veins. We also reviewed the angiograms obtained during the procedure and identified anatomic variants that could be responsible for ineffective lesion formation. Methods and Results: During the early clinical use in 33 patients, a total of 85 veins were ablated. A mean of 16.9 ± 12.3 ablations were delivered per patient, and a mean of 6.7 ablations per vein were applied. Entry block was assessed by placing a deflectable octapolar or a circular catheter in the vein. The following anatomic characteristics and technical limitations were identified as possible reasons for ineffective energy delivery: (1) funnel-shaped ostium; (2) ostial diameter larger than the balloon diameter; (3) inability to deliver the catheter to the right inferior or other vein ostia; (4) ostial instability; (5) early branching of the vein; and (6) eccentric position of the ultrasound transducer in the vein. In patients with recurrence of atrial fibrillation, 40% of the ostial lesions reached a temperature > 60°C. However, in patients cured by the ablation, 64% of the ostial lesions reached a temperature > 60°C (P < 0.06). At least 12 of the 20 chronic recurrences could have been related to technical limitations of the first system. Duration of atrial fibrillation and eccentric deployment of the ultrasound transducer were more frequent in patients with recurrence of arrhythmias at follow-up. Conclusion: Ostial anatomy of the veins may affect delivery of ultrasound energy to achieve circumferential lesions. Energy delivery at the ostium with a temperature > 60°C may be important to maximize success. Reconfiguration of the system to overcome the shortcomings identified in the initial experience could increase its performance. [source]