Right to left interatrial shunting following balloon mitral valvuloplasty

A complication of balloon mitral valvuloplasty is development of left-to-right interatrial shunt. This report describes right-to-left interatrial shunting following balloon mitral valvuloplasty in a patient with mitral stenosis, tricuspid regurgitation and pulmonary hypertension.

Clinical trial of the disposable transducer catheter

We compared the intracardiac and intravascular pressures obtained by a conventional strain gauge transducer (CT) with a recently developed disposable high-fidelity transducer catheter (DT) during cardiac catheterization. CT was positioned at the patient's midchest level. The pressure measurements obtained by DT compared favorably with those of CT. Femoral arterial pressures by the two methods showed no statistical difference. Right heart pressures were similar using both transducers. However, right ventricular pressures by DT in five of eight patients were lower than that from CT. Higher pulmonary arterial pressures were noted in two of seven patients and higher pulmonary capillary wedge pressures were seen in four patients using DT compared to CT. None of these differences were of statistical significance. These pressure differences may be due to transducer position. Because the midchest position of CT does not precisely define the anatomic location of the cardiac chamber being studied, pressure measurements can be overestimated or underestimated. DT eliminates this problem, as well as overshooting and concern with air bubbles in the catheter system commonly associated with CT. Therefore DT may provide accurate hemodynamic measurements. It would appear to be useful regardless of patient position and may be useful in ambulatory hemodynamic determinations.

Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease--a case report

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is associated with arteriovenous fistulas throughout the body that can cause hemodynamic abnormalities. Owing to their size and extent, surgical repair is often not feasible. A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arteriovenous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.