Background: The purpose of our study was to prove the hypothesis that balloon pulmonary valvuloplasty could effectively reduce valvular gradient ranged 30 to 50 mmHg to less than 30 mmHg in long-term follow-up.Methods: This cross-sectional study was performed on 271 consecutive patients aged 12 to 67 years who suffered from severe pulmonary stenosis who were scheduled for balloon pulmonary valvuloplasty at Shahid Rajaie Heart Center in Tehran between 2003 and 2013. Two years after the procedure, the patients were examined by transthoracic echocardiography and parameters related to pulmonary valve and right ventricular condition were reassessed. Among all 271 patients who were initially included into the survey, 37 patients (13.7%) had pulmonary valve gradient 30 to 50mmHgthat included our final targeted population for assessment.Results: Valvular gradient significantly dropped down from 93.19±39.77mmHgto 38.78±26.26 (P<0.001). Among all 271 patients initially assessed, in two patients with valvular gradient less than 30 mmHg, the gradient remained unchanged long-term after procedure. In 37 patients with gradient ranged 30 to 50 mmHg before procedure, the gradient reduced to less than 30 mmHg in 32 patients with an overall rate of 86.5%, but remained in the same range in 4 patients and even increased to higher than 50 mmHg in 2 patients. There was a strong positive relationship between the change in valvular gradient and initial right ventricular systolic pressure (beta=0.519, P<0.001).Conclusions: Majority of patients with moderate pulmonic stenosis with gradient of 30 to 50 mmHg benefit from this procedure to achieve gradient less than 30 mmHg in long-term follow-up.

Background: Little is known about the natural history of aortic regurgitation (AR) in patients undergoing mitral valve procedures for mitral stenosis. Objectives: The aim of this study was to evaluate the short- and long-term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR.Materials and Methods: A total of 327 patients with rheumatic mitral stenosis (282 females and 45 males; mean age at the time of intervention = 47 ± 11 years) were followed up for between 48 hours and 13 years after PMV. At the time of PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR, and 61 (18.7%) had moderate AR. After PMV, the follow-up showed that 120 (36.6%) patients had no AR, 103 (31.5%) had mild AR, and 104 (31.8%) had moderate AR.Results: AR progression after PMV and during the follow-up was significant (P <0.00), but there was no significant increase in aortic valve replacement (AVR) procedures. The rate of AVR was higher in the moderate AR group (3.8%). There were no significant changes in the left atrial size (LA) (P = 0.6), ejection fraction (EF) (P = 0.4), and rhythm (P = 0.4) before and after PMV, respectively.Conclusions: Our findings indicate that among patients with rheumatic mitral stenosis, a considerable number have concurrent AR. Concomitant AR at the time of PMV does not influence procedural success and is not associated with inferior outcomes. Rheumatic aortic insufficiency progresses slowly by nature, and patients with AR and mitral stenosis can safely tolerate PMV without the possibility of undergoing AVR in the near future. Patients with moderate degrees of AR remain good candidates for PMV.

Objectives: The aim of this study was to evaluate the short- term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR.Methods: Clinical, echocardiographic and catheterization data from hospital records of a total of 327 patients with rheumatic mitral stenosis who underwent PMV at a tertiary centre were retrospectively reviewed and aortic regurgitation changes 48 hours post PMV was recorded.Results: The study population consisted of 282 females and 45 males. Mean age at the time of intervention was 47.13±11 years. Before PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR and 61 (18.7%) had moderate AR. There was no change in AR severity in post- PMV follow-up. AR progression after PMV and during the follow-up was not significant and there was no increase in the need for aortic valve replacement (AVR) procedures.Conclusions: Our findings indicated that a considerable number of patients with rheumatic mitral stenosis had concurrent AR. At the time of PMV concomitant AR does affect procedural success and is not associated with inferior outcomes. Patients with moderate degrees of AR remain good candidates for PMV.

Balloon aortic valvuloplasty (BAV) is a therapeutic option as palliative or bridging therapy in severe aortic stenosis, even though it is a risky procedure, especially in patients with concomitant left ventricular dysfunction. The use of percutaneous ventricular assist devices, such as the Impella CP, in this scenario provides optimal circulatory support and considerably reduces the risk of the procedure. Two patients with severe aortic stenosis and left ventricular dysfunction underwent BAV with the support of the Impella-CP. The Impella CP provided adequate support in both high-risk patients and safely allowed BAV.

Aims: The purpose of this study was to determine whether there is any association between the optimal increase in mitral valve area and mitral transvalvular gradient decrement and pulmonary arterial pressure decrement after balloon mitral valvuloplasty (BMV) in patients with mitral stenosis.Methods: The study population consisted of 49 patients (47 women, 2 men; mean age=43.7±13.35 years) with symptomatic rheumatic mitral stenosis who underwent balloon mitral valvuloplasty. Optimal immediate outcome of BMV is defined as a valve area increment of 50% or more or a final mitral valve area of ³1.5 cm 2 and mitral regurgitation Sellers' grade £ 2.Mitral valve area, mitral transvalvular peak pressure gradient, mitral transvalvular mean pressure gradient, and pulmonary arterial pressure were measured before and 24-48 hours after balloon mitral valvuloplasty, and differences were compared between patients with successful and unsuccessful optimal outcomes.Results: There was a direct relationship between mitral valve area enhancement and amount of reduction in mitral transvalvular peak and mean pressure gradient and pulmonary arterial pressure.Conclusion: After BMV, mitral transvalvular peak pressure gradient, mitral transvalvular mean pressure gradient, and pulmonary arterial pressure reduction were significantly higher in patients with optimal outcome compared with those with suboptimal outcome.

Background: Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis (PS) in children. Transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer VSD occluder is an alternative to surgical repair.Case Presentation: A 12 year old boy presented with history of exertional dyspnea and atypical chest pain.Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty.Conclusion: We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session.