Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations—Part I

Figures

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  Figure 1. The author’s recommendations specify the type of therapy depending upon the patient’s age and type of coarctation. Reproduced from Reference [94].

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  Figure 2. Selected frames from right ventricular (RV) cine-angiograms in a sitting-up (15° left anterior oblique and 35° cranial) view before (A) and immediately after (B) balloon pulmonary valvuloplasty. Note the thin jet (arrows in (A)) prior to valvuloplasty which increased in width (arrows in (B)) after valvuloplasty. C, Catheter; MPA, main pulmonary artery. Reproduced from Reference [62].

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  Figure 3. Selected frames from right ventricular (RV) cine-angiograms in lateral views before (A) and immediately after (B) balloon pulmonary valvuloplasty. Note the thin jet (barely seen) (arrow in (A)) prior to valvuloplasty which increased in width (arrow in (B)) after valvuloplasty. C, Catheter; MPA, main pulmonary artery. Reproduced from Reference [32].

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  Figure 4. Balloon dilatation catheter placed across the pulmonary valve showing “waisting” of the balloon (A) in the early phases of inflation (thick arrows) which is almost completely abolished with further balloon inflation (B) (thin arrows). Modified from Reference [62].

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  Figure 5. (A) A selected cine frame in 15° left anterior oblique with a 35° cranial angulated view demonstrates the position of a balloon angioplasty catheter across the stenotic pulmonary valve. Note the waisting of the balloon (arrow) during the early phase of balloon inflation. (B) The waist has been completely abolished on further inflation of the balloon. Note that the guide wire is passing through the ductus into the descending aorta (DAo). ET, endotracheal tube; NG, nasogastric tube. Reproduced from Reference [100].

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  Figure 6. Selected cine-radiographic frames in lateral view, demonstrating two balloon catheters placed across the pulmonary valve, showing “waisting” of the balloons (arrows) during the initial phases of balloon inflation (A), which was completely abolished after the complete inflation of the balloons (B). Reproduced from Reference [62].

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  Figure 7. Selected cine frames from left ventricular (LV) cine-angiograms in posterior-anterior view in two neonates with severe aortic stenosis. (A) A pigtail (PG) catheter was introduced into the LV retrogradely; (B) A Berman angiographic (BA) catheter was advanced from the right atrium (RA), across a patent foramen ovale (not marked) into the left atrium (not marked) and from there into the LV. These angiograms demonstrate the aortic valve annulus (arrows in (A,B)). Note the domed and thickened aortic valve leaflets. Reproduced from Reference [127].

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  Figure 8. Selected cine frames in posterior–anterior projections illustrating a balloon dilatation catheter across the stenosed aortic valve. Waisting of the balloon (arrow) was seen during the early phases of inflation of the balloon (A) which was completely abolished on further inflation of the balloon (B). Ao, aorta; DAo, descending aorta; GW, guide wire; LV, left ventricle; MC, marker catheter. Reproduced from Reference [84].

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  Figure 9. Selected cine frames from ascending aortic (AAo) cine-angiogram in 20° left anterior oblique projection demonstrating (A) narrowed coarcted aortic segment (arrow) prior to balloon angioplasty (B) which increased following balloon angioplasty. Note mild hypoplasia of the distal transverse aortic arch and isthmus. DAo, descending aorta; LCC, left common carotid artery; LSA, left subclavian artery; NG, nasogastric tube; PG, pigtail catheter; RInn, right innominate artery. Reproduced from Reference [94].

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  Figure 10. Selected aortic cine-angiographic frames in 20° left anterior oblique projection demonstrating (A) narrowed coarcted aortic segment (arrow) prior to balloon angioplasty (B) which increased following balloon angioplasty. DAo, descending aorta; LCC, left common carotid artery; LSA, left subclavian artery; PG, pigtail catheter; RCC, right common carotid artery; RInn, right innominate artery. Reproduced from Reference [94].

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  Figure 11. Selected cine-fluorographic frames in posteroanterior projection in a child demonstrating (A) an angioplasty balloon across the aortic coarctation with waisting (arrow) of the balloon (B) during the initial phases of balloon inflation; the waist has completely disappeared with further balloon inflation. The guidewire (GW) is positioned in the ascending aorta (AAo). Modified from Reference [64].

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  Figure 12. Line graph showing the immediate results of balloon pulmonary valvuloplasty. Note a significant (p < 0.001) decrease in the right ventricular peak systolic pressure (left panel) and the peak-to-peak systolic pressure gradient across the pulmonary valve (middle panel). Additionally shown is a slight but significant (p < 0.001) increase in the peak systolic pressure in the pulmonary artery (right panel). The mean ± standard deviation (SD) is shown. Reproduced from Reference [75].