Effect of balloon size and stepwise inflation technique on the acute results of inoue mitral commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

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Multi- and In-Stabilities in Gas Partitioning Between Nanoporous Materials and Rubber Balloons

10.26434/chemrxiv.7135928.v1 ◽

2018 ◽

Author(s):

Cory Simon ◽

carlo carraro

Keyword(s):

Thermodynamic Equilibrium ◽

Stable States ◽

Temperature Changes ◽

Adsorbed Gas ◽

Rubber Balloon ◽

Balloon Size ◽

Metal Organic ◽

Balloon Experiment ◽

Adsorbent System ◽

Balloon System

<div>In the two-balloon experiment, two rubber balloons are connected and allowed to exchange gas. Owing to the non-monotonic relationship between the radius of the balloon and the pressure of gas inside of it, the two-balloon system presents multi- and in-stabilities.</div><div><br></div><div>Herein, we consider a two-adsorbent system, where two different adsorbents are allowed to exchange gas. We show that, for rigid adsorbents, the thermodynamic equilibrium state is unique.</div><div><br></div><div>Then, we consider an adsorbent-balloon system, where an adsorbent exchanges gas with a rubber balloon. This system can exhibit multiple states at thermodynamic equilibrium-- two (meta)stable and one unstable. The size of the balloon, pressure of gas in the balloon, and partitioning of gas between the adsorbent and the balloon differ among the equilibrium states. Temperature changes and the addition/removal of gas into/from the adsorbent-balloon system can induce catastrophe bifurcations and show hysteresis. Furthermore, the adsorbent-balloon system exhibits a critical temperature where, when approached from below, the discrepancy of balloon size between the two (meta)stable states decreases and, beyond, bistability is impossible.</div><div><br></div><div>Practically, our findings preclude multiple partitions of adsorbed gas in rigid mixed-linker metal-organic frameworks and may inspire new soft actuator and sensor designs.</div>

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Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02175-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yahya Dadjo ◽

Maryam Moshkani Farahani ◽

Reza Nowshad ◽

Mohsen Sadeghi Ghahrodi ◽

Alireza Moaref ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Protective Factor ◽

Cardiac Events ◽

Mitral Valve Area ◽

Adverse Cardiac Events ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Valve Area

Abstract Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

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B-PO05-108 SAFETY, EFFICACY, AND REPRODUCIBILITY OF FAST CAVOTRICUSPID ISTHMUS ABLATION: ACUTE RESULTS OF THE FACTI STUDY

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.1027 ◽

2021 ◽

Vol 18 (8) ◽

pp. S415-S416

Author(s):

Vincenzo Schillaci ◽

Giuseppe Stabile ◽

Alberto Arestia ◽

Alessia Agresta ◽

Gergana Shopova ◽

...

Keyword(s):

Cavotricuspid Isthmus ◽

Acute Results

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THE EFFECT OF INTRAPERICARDIAL AND INTRACARDIAC PROCAINE UPON THE CIRCULATION IN MAN DURING MITRAL COMMISSUROTOMY AND PULMONARY VALVULOTOMY

Journal of Thoracic Surgery ◽

10.1016/s0096-5588(20)30981-8 ◽

1954 ◽

Vol 28 (3) ◽

pp. 259-265

Author(s):

Hugh F. Fitzpatrick ◽

E.M. Papper ◽

Enzo Krahl ◽

F.F. McAllister ◽

George H. Humphreys

Keyword(s):

Mitral Commissurotomy

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