The Effect of Guidance of Transesophageal Echocardiography During Percutaneous Balloon Mitral Valvuloplasty on Procedural Success and Complications
Abstract
Patients with mitral stenosis (MS) can be treated with percutaneous
methods. In this patient population, MS and symptoms can be relieved by
percutaneous mitral balloon valvuloplasty (PMBV). In our study we aimed to investigate the
effect of guidance of transesophageal echocardiography (TEE) during PMBV on
procedural success and complications in patients with MS. Fourty-five patients
who were planning to undergo PMBV because of severe MS were included to the
study. Procedure of PBMV performed in 23 patients with TEE guidance (TEE(+))
and in 22 patients without TEE guidance (TEE(-)). Transseptal puncture (TSP)
duration, transseptal transition success and transmitral transition success
evaluated for each group. All patients treated with PMBV were evaluated with
transthorasic echocardiography after 24. h and 12 weeks. The mean age in the TEE(+)
group of the study was 47,9±11,4 and
48,5±15 (p=0,88) in TEE(-) group. The mean height was 163,1±7,5 cm in
TEE(-) group and 161,7±5,4 cm (p=0,47) in TEE(+) group. It was demonstrated
that Wilkins score was 8.5 (7.0-10.0) in the TEE (-) group and 9.0 (7.0-11.0)
in TEE (+) group (p = 0.111). TSP duration in the TEE (-) group and TEE (+)
group were 25,24 ± 5,1 min. and 21.86 ± 3.8 min (p = 0.02), respectively. In
the TEE (-) group, transmitral transition success was 100%, while in the TEE
(+) group it was 85.8%. In TEE (+) group, transmitral transition was more
unsuccessful but there was no statistically significant difference (p = 0.072).
Complications were similar in both groups. It was demonstrated that TEE
guidance during PMBV shortened the TSP duration despite there was no effect on
complications due to TSP, TSP success, transmitral transition success,
operation success, and operation complications. In PMBV procedure, TEE guidance
can be added to the conventional methods to shorten the procedure time and
minimize radiation exposure.
Keywords
Severe mitral stenosis percutaneous balloon mitral valvulplasty transseptal puncture echocardiography
References
- KAYNAKLAR
- 1. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010;85:483500.
- 2. Onat A, Keleş İ, Çetinkaya A, Başar Ö, Yıldırım B, Erer B, et al. Prevalence of coronary mortality and morbidity in the Turkish adult risk factor study: 10-year follow-up suggests coronary “Epidemic”. Türk Kardiyol Dern Arş 2001;29:8-19.
- 3. Inoue K, Owaki T, Nakamura T, et al. Clinicalapplication of transvenous mitral commissurotomy by a new balloon catheter. J ThoracCardiovascSurg 1984; 87:394.
- 4. Kronzon I, Tunick PA, Schwinger ME, et al. Transesophageal echocardiography duringpercutaneous mitral valvuloplasty. J AmSocEchocardiogr 1989; 2:380.
- 5. Quinones MA, Otto CM, Stoddard M, et al. Recom- mendations for quanti cation of Doppler echocardiog- raphy: a report from the Doppler Quanti cation Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15:167-184.
- 6. Şenol Y, Özdemir İ. Kalp kapağı hastalıklarında cerrahi endikasyonlar.PTT Tıp Dergisi 1999;21; 108-115.
- 7. Guidelines on the management of valvular heart disease (version 2012)
- 8. Inoue K, Feldman T. Percutaneoustransvenous mitral commissurotomy using the Inoue balloon catheter. CathetCardiovascDiagn 1993; 28:119.
- 9. Kultursay H. Suggestions on how to do / InterventionalCardiology / Practical tips for transseptal cardiac catheterization. ArchTurkSocCardiol 2012; 40:102-105
- 10. Iung B, Vahanian A: Rheumatic mitral valve disease. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2013 Saunders Philadelphia 255-277
- 11. Shavelle DM: Evaluation of valvular heart disease by cardiac catheterization and angiography. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2009 Saunders Philadelphia 85-100
- 12. Tuzcu EM, Kapadia SR: Long-term efficacy of percutaneous mitral commissurotomy for recurrent mitral stenosis. Heart. 99:1307 2013
- 13. Lau KW, Hung JS. A simple balloon-sizing method in Inoue-balloon percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn 1994; 33(2): 120–129; discussion 130–131.
- 14. Tastan A, Ozturk A, Senarslan Ö, Ozel E, Uyar S, Ozcan E, Kozan Ö. Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty:which is preferable? Cardiovasc J Afr 2016; 27:DOI: 10. 5830/CVJA
- 15. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC.Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
- 16. Karaçağlar E, Atar i, Özin B . Transseptal puncture. Journal of Turkish Arrythmia, Pacemaker and Electrophysiology. Volüme 9, issue 2, June 2011.
- 17. Cheng-Wen Chiang, MD, FCCP; Lung-An Hsu, MD; Po-Hsien Chu, MD, FCCP;Wan-Jing Ho, MD; Hung-Shun Lo, MD; and Chao-Chien Chang. Feasibility of Simplifying Balloon Mitral Valvuloplasty by Obviating Left-Sided Cardiac Catheterization Using On-line Guidance With Transesophageal Echocardiography* MD CHEST 2003; 123:1957–1963
- 18. Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy. Neth Heart J (2017) DOI 10.1007/s12471-016-0937-0
- 19. Kultursay H . Practical tips for transseptal cardiac catheterization. Arch Turk Soc Cardiol 2012;40(1):102-105 doi: 10.5543/tkda.2012.01931
- 20. Radinovic A, Mazzone P, Landoni G,Agricola E, Regazzoli D, Bella PD. Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography. Ann Card Anaesth 2016;19:589-93.
- 21. Yıldız A , Kaya H, Ertaş F, Polat N, Aydın M,Yüksel M, Soydinç S, Çaylı M , Ülgen M.S., Toprak N. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience. 41 (4): 695-699 Dicle Medical Journal doi: 10.5798/diclemedj.0921.2014.04.0502
- 22. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
- 23. Seyfollah Abdi1 Negar salehi, Babak Ghodsi, Hossein Ali Basiri, Mahmoud Momtahen, Ata Firouzi, Hamid Reza Sanati, Farshad Shakerian, Mohsen Maadani, Homan Bakhshandeh, Soheila Chamanian, Mitra Chitsazan,Anoushiravan Vakili-Zarch. Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. Clinical Medicine Insights: Cardiology 2012:6 35–39.
Perkütan Balon Mitral Valvuloplasti Sırasında Transözofajiyal Ekokardiyografi Kılavuzluğunun İşlem Başarısı ve Komplikasyonlar Üzerine Etkisi
Abstract
Semptomatik mitral
darlığı (MD) hastaları perkütan yolla tedavi edilebilmektedir. Bu hastalarda
perkütan mitral balon valvulaplasti (PMBV) ile MD ve semptomları
giderilebilmektedir. Bu çalışmamızda ciddi MD hastalarında PMBV işlemi
sırasında transözofajiyal ekokardiyografi (TEE) kılavuzluğunun işlem başarısı
ve komplikasyonlar üzerine etkisini araştırmak istedik. Çalışmaya ciddi MD ile
başvuran ve PMBV yapılması planlanan 45 hasta alındı. PMBV işlemi 23 hastaya
TEE kılavuzluğunda (TEE(+)), 22 hastaya ise TEE kılavuzluğu olmadan (TEE(-))
gerçekleştirildi. Çalışmada her iki grubun transseptal ponksiyon (TSP) süresi,
septum geçiş başarısı, kapak geçiş başarısı değerlendirildi. PMBV ile tedavi
edilen tüm hastalara 24. saat ve 12. haftada transtorasik ekokardiyografi ile
değerlendirildi. Çalışmaya alınan hastaların TEE(+) grubunda yaş ortalaması
47,9±11,4, TEE(-) grubunda ise 48,5±15 (p=0,88) idi. TEE(-) grubundaki
olguların ortalama boyu 163,1±7,5 cm, TEE(+) grubunda ise 161,7±5,4 cm (p=0,47)
olarak gözlendi. TEE(-) grubunda Wilkins skoru 8,5(7,0-10,0), TEE(+) grubunda
ise 9,0(7,0-11,0) (p=0,111) olarak gözlendi. TSP süresi TEE(-) grubunda ve
TEE(+) grubunda sırasıyla 25,24±5,1 dk. ve 21,86±3,8 dk (p=0,02) olarak tespit
edildi. TEE(-) grubunda kapak geçiş başarısı %100 iken, TEE(+) grubunda %85,8
olarak bulundu. TEE(+) grubunda mitral kapak geçişi daha başarısızdı ancak
istatistiksel anlamlı fark yoktu (p=0,072). Komplikasyonlar her iki grupta
benzerdi. PBMV esnasında kullanılan TEE’nin TSP’den doğan komplikasyonlar, TSP
başarısı, kapak geçiş başarısı, işlem başarısı, işlem komplikasyonları üzerine
ise herhangi bir etkisinin olmamasına rağmen TSP süresini kısalttığı
gösterildi. Hastalarda işlem süresini kısaltmak, radyasyon maruziyetini en aza
indirmek için PBMV işlemi sırasında TEE kılavuzluğu konvansiyonel yönteme
eklenebilir.
References
- KAYNAKLAR
- 1. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010;85:483500.
- 2. Onat A, Keleş İ, Çetinkaya A, Başar Ö, Yıldırım B, Erer B, et al. Prevalence of coronary mortality and morbidity in the Turkish adult risk factor study: 10-year follow-up suggests coronary “Epidemic”. Türk Kardiyol Dern Arş 2001;29:8-19.
- 3. Inoue K, Owaki T, Nakamura T, et al. Clinicalapplication of transvenous mitral commissurotomy by a new balloon catheter. J ThoracCardiovascSurg 1984; 87:394.
- 4. Kronzon I, Tunick PA, Schwinger ME, et al. Transesophageal echocardiography duringpercutaneous mitral valvuloplasty. J AmSocEchocardiogr 1989; 2:380.
- 5. Quinones MA, Otto CM, Stoddard M, et al. Recom- mendations for quanti cation of Doppler echocardiog- raphy: a report from the Doppler Quanti cation Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15:167-184.
- 6. Şenol Y, Özdemir İ. Kalp kapağı hastalıklarında cerrahi endikasyonlar.PTT Tıp Dergisi 1999;21; 108-115.
- 7. Guidelines on the management of valvular heart disease (version 2012)
- 8. Inoue K, Feldman T. Percutaneoustransvenous mitral commissurotomy using the Inoue balloon catheter. CathetCardiovascDiagn 1993; 28:119.
- 9. Kultursay H. Suggestions on how to do / InterventionalCardiology / Practical tips for transseptal cardiac catheterization. ArchTurkSocCardiol 2012; 40:102-105
- 10. Iung B, Vahanian A: Rheumatic mitral valve disease. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2013 Saunders Philadelphia 255-277
- 11. Shavelle DM: Evaluation of valvular heart disease by cardiac catheterization and angiography. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2009 Saunders Philadelphia 85-100
- 12. Tuzcu EM, Kapadia SR: Long-term efficacy of percutaneous mitral commissurotomy for recurrent mitral stenosis. Heart. 99:1307 2013
- 13. Lau KW, Hung JS. A simple balloon-sizing method in Inoue-balloon percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn 1994; 33(2): 120–129; discussion 130–131.
- 14. Tastan A, Ozturk A, Senarslan Ö, Ozel E, Uyar S, Ozcan E, Kozan Ö. Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty:which is preferable? Cardiovasc J Afr 2016; 27:DOI: 10. 5830/CVJA
- 15. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC.Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
- 16. Karaçağlar E, Atar i, Özin B . Transseptal puncture. Journal of Turkish Arrythmia, Pacemaker and Electrophysiology. Volüme 9, issue 2, June 2011.
- 17. Cheng-Wen Chiang, MD, FCCP; Lung-An Hsu, MD; Po-Hsien Chu, MD, FCCP;Wan-Jing Ho, MD; Hung-Shun Lo, MD; and Chao-Chien Chang. Feasibility of Simplifying Balloon Mitral Valvuloplasty by Obviating Left-Sided Cardiac Catheterization Using On-line Guidance With Transesophageal Echocardiography* MD CHEST 2003; 123:1957–1963
- 18. Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy. Neth Heart J (2017) DOI 10.1007/s12471-016-0937-0
- 19. Kultursay H . Practical tips for transseptal cardiac catheterization. Arch Turk Soc Cardiol 2012;40(1):102-105 doi: 10.5543/tkda.2012.01931
- 20. Radinovic A, Mazzone P, Landoni G,Agricola E, Regazzoli D, Bella PD. Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography. Ann Card Anaesth 2016;19:589-93.
- 21. Yıldız A , Kaya H, Ertaş F, Polat N, Aydın M,Yüksel M, Soydinç S, Çaylı M , Ülgen M.S., Toprak N. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience. 41 (4): 695-699 Dicle Medical Journal doi: 10.5798/diclemedj.0921.2014.04.0502
- 22. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
- 23. Seyfollah Abdi1 Negar salehi, Babak Ghodsi, Hossein Ali Basiri, Mahmoud Momtahen, Ata Firouzi, Hamid Reza Sanati, Farshad Shakerian, Mohsen Maadani, Homan Bakhshandeh, Soheila Chamanian, Mitra Chitsazan,Anoushiravan Vakili-Zarch. Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. Clinical Medicine Insights: Cardiology 2012:6 35–39.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | ORİJİNAL MAKALE |
| Authors | |
| Publication Date | September 1, 2018 |
| Published in Issue | Year 2018 Volume: 40 Issue: 3 |