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Biomedical subjects

J S Hung

Publications and source records attributed to J S Hung.

At least 55 records · Page 3Linked to original sources
PubMed1994

Urgent/emergent percutaneous transvenous mitral commissurotomy.

Urgent/emergent percutaneous transvenous mitral commissurotomy (PTMC) was performed in 10 patients (two men and eight women, aged 21 to 60 yr). All patients had arterial hypoxemia and four required mechanical respirators. PTMC was performed in the semi-recumbent position in four patients. The seven patients with pliable valves (group 1) achieved good hemodynamic and echocardiographic results after PTMC, but one died 2 wk later because of sepsis complicating preexisting pneumonitis. The two pregnant patients uneventfully delivered normal babies at term. There was continued clinical improvement in the six surviving patients at last follow-up at 11 to 39 mon (median 26). Of the three patients with calcified valves and severe subvalvular lesions (group 2), the premoribund patient in whom last-resort PTMC created severe mitral regurgitation died 3 days later of multiple organ failure. The other two patients underwent mitral valve replacement 1-6 days later because of lack of clinical improvement due to creation of severe mitral regurgitation and ineffective mitral valve dilation, respectively. In conclusion, urgent/emergent PTMC is feasible and safe. However, its outcomes are dictated by the status of diseased mitral valve and coexisting illness.

Adult↗
PubMed1994

Estimation of pulmonary artery pressure from pulmonary vein wedge pressure.

Correlations between pulmonary artery and pulmonary vein wedge pressures were investigated in 13 patients with atrial septal defect and 1 patient with Tetralogy of Fallot. Pulmonary vein wedge pressure wave form resembled that of pulmonary artery pressure, and the former lagged behind the latter by 70 to 110 msec (mean 88 +/- 14) as observed by the fluid-filled catheter system. Diastolic pulmonary artery and diastolic pulmonary vein wedge pressures were nearly identical. Although systolic and mean pulmonary artery pressures correlated well with respective pulmonary vein wedge pressures, there were discrepancies when systolic and mean pulmonary artery pressure exceeded 35 and 20 mm Hg, respectively. However, systolic and mean pulmonary artery pressures could be estimated by adding the difference between the diastolic pulmonary vein wedge pressure and the mean left atrial pressure to corresponding systolic or mean pulmonary artery pressure. In conclusion, pulmonary artery pressures can be estimated by measuring pulmonary vein wedge pressures and the mean left atrial pressure.

Adult↗
PubMed1994

A simple balloon-sizing method in Inoue-balloon percutaneous transvenous mitral commissurotomy.

This study was carried out to examine whether the previously determined balloon sizing method based on patient height was valid for percutaneous transvenous mitral commissurotomy using the current second-generation Inoue balloon catheter. The study consisted of 70 patients with pliable noncalcified mitral valves (group 1) and 85 patients with calcified mitral valves and/or severe subvalvular lesions (group 2). The mitral valve area was increased more in group 1 than in group 2 (1.0 +/- 0.3 to 1.9 +/- 0.5 cm2 versus 1.0 +/- 0.3 to 1.6 +/- 0.5 cm2, P = 0.002). Using the stepwise dilatation technique, none of the group 1 patients developed severe mitral regurgitation. Severe mitral regurgitation occurred in 4 patients (4.7%) in group 2. In conclusion, a simple balloon sizing method based on body height for selection of an appropriate-sized balloon catheter, as well as an initial inflated balloon diameter for the stepwise dilatation technique is useful for optimal acute outcomes in mitral commissurotomy.

Adult↗
PubMed1993

Pulmonary valvuloplasty in adults using the Inoue balloon catheter.

This report describes a new balloon pulmonary valvuloplasty technique using the Inoue balloon catheter performed in 14 consecutive adult patients, aged 17-47 years (mean 27). The mean right ventricular systolic pressure and the pulmonary valvular peak-to-peak systolic gradient decreased from 102 +/- 41 to 52 +/- 19 mm Hg (p = 0.001) and 81 +/- 40 to 7 +/- 7 mm Hg (p = 0.0002), respectively. An infundibular peak-to-peak systolic gradient either developed (n = 13) or increased (n = 1). None of the patients were treated with beta-adrenergic blockers before or after the valvuloplasty. Eight patients underwent repeat hemodynamic study 12-30 months (mean 17) after treatment, and had no evidence of valvular restenosis. The mean right ventricular systolic pressure and the mean infundibular peak-to-peak systolic gradient decreased, compared to the values immediately after valvuloplasty (54 to 40 mm Hg, p = 0.03, and 28 to 10 mm Hg, p = 0.03, respectively). The study suggests that pulmonary valvuloplasty in adults using the Inoue balloon catheter technique is feasible, safe, and effective.

Adolescent↗
PubMed1993

Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis.

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.

Adult↗
PubMed1993

Prognosis after a first Q-wave myocardial infarction in ethnic Chinese people: a prospective study.

The prognosis after a first Q-wave myocardial infarction was investigated in 206 Chinese patients of 65 years or younger who had a predischarge cardiac catheterization and coronary angiography. Three patients studied were lost to follow-up. In the remaining 203 patients with ages of between 28 and 65 years, 101 (49.8%) had 0- or 1-vessel disease, 56 (27.6%) had 2-, and 38 (18.7%) had 3-vessel disease. Significant left main coronary artery stenosis was noted in 8 (3.9%). During a mean follow-up of 33 months, 33 (16.3%) patients had 36 episodes of cardiac events, and 16 (7.9%) died of cardiac causes. Stepwise logistic regression analysis revealed that the left ventricular ejection fraction and left main coronary artery disease were predictors of cardiac mortality, while age and the extent of coronary artery disease were predictors of total cardiac events. There was no variable that could predict recurrence of myocardial infarction.

Aged↗
PubMed1993

Balloon mitral valvotomy with a single catheter: a comparison between bifoil/trefoil and the Inoue balloon.

Results of percutaneous mitral valvotomy were compared in two groups undergoing the procedure at our institution. Group I: 100 patients having had percutaneous valvotomy with the Schneider-Medintag bifoil (2 x 19 mm) or trefoil (3 x 15 mm or 3 x 12 mm) catheters, and group II; 150 patients in whom the procedure was performed with the Inoue balloon (24-30 mm). Baseline clinical (age, gender, NYHA class and echo score) and haemodynamic variables were similar in both groups. Haemodynamic improvement occurred in both groups. Although the reduction in left atrial pressure did not differ significantly between the two groups, the increase in mitral valve area was significantly (P < 0.001) higher for group I (0.8 +/- 0.2 to 1.9 +/- 0.7 and 0.8 +/- 0.3 to 1.6 +/- 0.3 cm2 respectively for mitral area, and 22 +/- 6 to 13 +/- 5 and 21 +/- 6 to 13 +/- 5 mmHg respectively for mean left atrial pressure). The increase in cardiac output was statistically significant in group I (3.2 +/- 0.7 to 4.0 +/- 0.9 l.min-1, P < 0.05) but not in group II (3.5 +/- 2.0 to 3.7 +/- 0.9 l.min-1, ns). Inter-atrial shunting immediately after valvotomy was recorded in 19% of group I patients compared with 6% in group II (P < 0.001). The overall incidence of significant mitral regurgitation (3+ or 4+) was similar in both groups (5% and 4% respectively). However, when the stepwise dilatation technique was employed in group II, the incidence had dropped to 2.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Complete membranous obstruction of the inferior vena cava: clinical characteristics of Chinese patients.

OBJECTIVES: To analyse the clinical presentations of membranous-type Budd-Chiari syndrome and the long-term outcome of balloon angioplasty. DESIGN: A case-control study. Patients who received abdominal sonography and were suspected of having hepatic venous outflow obstruction were advised to receive cardiac catheterization and angiography. SETTING: Patients were collected from Chung Hisao Hospital and Chang Gung Medical Centre. Angioplasty was done at Chang Gung Medical Centre. SUBJECTS: Seventeen patients who had the symptoms and signs of portal hypertension were suspected of having hepatic venous outflow obstruction after abdominal sonography and a radionuclide liver scan and eight of them were confirmed as having membranous-type obstruction. INTERVENTIONS: Simultaneous catheterization and contrast angiography was performed via the right brachial and femoral veins. Angioplasty was performed afterwards. MAIN OUTCOME MEASURES: The remission of clinical symptoms and signs and a decrease of the pressure gradient between the right atrium and inferior vena cava were used as indicators of successful intervention. RESULTS: All patients had remarkable remission of symptoms and signs. The average pressure gradient between right atrium and inferior vena cava dropped from 16.5 +/- 1.6 to 6.5 +/- 1 mmHg (mean +/- SD). CONCLUSION: The clinical presentations of membranous-type Budd-Chiari syndrome are somewhat different from hepatic vein occlusion. Balloon angioplasty may be a modality for curing this disease. A larger patient population is necessary to confirm this study.

Adult↗
PubMed1993

Controversies in percutaneous balloon pulmonary valvuloplasty: timing, patient selection and technique.

Balloon valvuloplasty is currently the preferred therapeutic alternative to surgical valvotomy in selected patients with isolated congenital pulmonary stenosis. Not only does pulmonary valvuloplasty consistently afford safe and dramatic reduction of the valvular obstruction, it also produces less trauma and an equivalent sustained gradient relief when compared to surgical intervention. However, despite its established role, controversies persist in certain aspects of balloon pulmonary valvuloplasty (BPV). They include the timing of intervention, the suitability of certain valve morphologies and the choice of balloon techniques. Based on clinical experience, the following recommendations can be made: 1. BPV is currently recommended for moderate to severe pulmonary stenosis. Patients with mild stenosis are better served by conservative management and serial echocardiographic assessments. 2. Classic pulmonary stenosis is most suitable for BPV. However, patients with milder forms of dysplastic valves are still potential candidates for BPV. 3. Adequate dilatation with optimal relief of obstruction can be achieved with either the single or double balloon technique. Whether the Inoue or fixed-balloon system is used is a personal preference. Equally good results can potentially be obtained by either balloon design.

Catheterization↗
PubMed1992

Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: mitral valvuloplasty using the Inoue balloon catheter technique.

Transseptal catheterization is a vital component of percutaneous transvenous mitral commissurotomy. Therefore, a well-executed transseptal catheterization is the key to a safe and successful percutaneous transvenous mitral commissurotomy. Two major problems inherent in atrial septal puncture for percutaneous transvenous mitral commissurotomy are cardiac perforation and puncture of an inappropriate atrial septal site. The former may lead to serious complication of cardiac tamponade and the latter to possible difficulty in maneuvering the Inoue balloon catheter across the mitral orifice. This article details atrial septal puncture technique, including landmark selection for optimal septal puncture sites, avoidance of inappropriate puncture sites, and step-by-step description of atrial septal puncture.

Balloon Occlusion↗
PubMed1992

Cardiovocal (Ortner's) syndrome left recurrent laryngeal nerve palsy associated with cardiovascular disease.

Five patients with cardiovascular disease presented with hoarseness due to left recurrent laryngeal nerve palsy. One had secundum atrial septal defect, one had ventricular septal defect, two had mitral stenosis and the other had aortic aneurysm. All except the patient with aortic aneurysm had pulmonary artery dilatation and moderate to severe pulmonary hypertension. Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery. We postulate that the dilated pulmonary artery or aortic arch was responsible for the compression of the left recurrent laryngeal nerve.

Adult↗
PubMed1991

Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy.

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 +/- 5.6 to 15.1 +/- 5.1 mm Hg), mean pulmonary artery pressure (39.7 +/- 13.0 to 30.6 +/- 10.9 mm Hg) and mitral valve gradient (13.0 +/- 5.1 to 5.7 +/- 2.6 mm Hg). Mitral valve area increased from 1.0 +/- 0.3 to 2.0 +/- 0.7 cm2 (p = 0.0001) and cardiac output from 4.4 +/- 1.4 to 4.7 +/- 1.2 liters/min (p less than 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score greater than 8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗