Author + information
- Received September 29, 1986
- Revision received December 17, 1986
- Accepted January 9, 1987
- Published online July 1, 1987.
- Charles E. Mullins, MD, FACC*,1,
- Michael R. Nihill, MD, FACC1,
- G. Wesley Vick III, MD, PhD1,
- Achi Ludomirsky, MD1,
- Martin P. O’Laughlin, MD1,
- J. Timothy Bricker, MD, FACC1 and
- Victoria E. Judd, MD1
- ↵*Address for reprints: Charles E. Mullins, MD, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Street, Houston, Texas 77030.
Despite the generally excellent success with balloon dilation for the stenotic lesions of congenital and acquired heart disease, technical difficulties sometimes prevent satisfactory results. Such technical difficulties include: 1) a large diameter of the anulus of the stenotic lesion relative to available balloon diameter, 2) difficulty in the insertion or removal of the larger balloon catheters, and 3) permanent damage to or obstruction of the femoral vessels by the redundant deflated balloon material of the large balloons. A double balloon technique was initiated to resolve these difficulties. With this method, percutaneous balloon angioplasty catheters were inserted in right and left femoral vessels, placed side by side across the stenotic lesion and inflated simultaneously.
Dilation procedures using the two balloon technique were performed in 41 patients: 18 with pulmonary valve stenosis, 14 with aortic valve stenosis, 5 with mitral valve stenosis, 3 with vena caval obstruction following the Mustard or Senning procedure and 1 with tricuspid valve stenosis. Patient ages ranged from 1 to 75 years (mean 17.8) and patient weights ranged from 8.9 to 89 kg (mean 42.3). Balloon catheter sizes ranged from 10 to 20 mm in diameter. Average maximal pressure gradient in mm Hg before dilation was 61 in pulmonary stenosis, 68 in aortic stenosis, 21 in mitral stenosis, 12 in tricuspid stenosis and 25 in vena caval stenosis. Average maximal valvular pressure gradient after dilation was 13 in pulmonary stenosis, 24 in aortic stenosis, 4 in mitral stenosis, 0 in tricuspid stenosis, and 1 in vena caval stenosis. No major complications were encountered with the procedures.
It is concluded that the two balloon technique of percutaneous balloon dilation is effective and has substantial advantages, in selected cases, over techniques employing a single large angioplasty balloon.
- Received September 29, 1986.
- Revision received December 17, 1986.
- Accepted January 9, 1987.
- American College of Cardiology Foundation