Hand-made sizing balloon in surgical ventricular restoration
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《血管的通路杂志》
a Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
b Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, 7 Chung-Shan S. Rd., Taipei, Taiwan
Abstract
Left ventricular size and shape are considered as a key issue in surgical ventricular restoration procedure. A commercially preshaped balloon could provide a guide to perform the procedure. We developed a new, reliable and simple method with simple material and without additional sterilization to achieve the similar goal.
Key Words: Heart failure; Surgical restoration; Sizing balloon
1. Introduction
Postinfarction left ventricular remodeling is characterized by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction, and then heart failure syndrome. Surgical ventricular restoration (SVR) is designed to diminish the dilated ventricular volume and restore the shape. If the residual ventricular volume is too small, the pathophysiology of restrictive cardiomyopathy will result in a catastrophic event; if the residual ventricular volume is too large, the result will be the same condition as the preoperative status of heart failure or even worse.
To diminish the risk, Dor introduced the use of an intraventricular balloon to guide the volume reduction [1,2]. The volume 60 ml/m2 is chosen for the balloon size after study. More recently, a preshaped elliptical balloon (Chase Medical, Dallas, TX) is used to size and configure the ventricle, achieving a more normal short axis/long axis ratio and it gives us the correct position of the new apex.
We designed a new method with a hand-made sizing balloon to achieve this goal.
2. Technique
We cut off the basal part of the middle finger and its tip of a 7 size plastic surgical glove (Fig. 1). Then we make a silk tie in the base and its tip is tied to a connector with another silk. The connector is connected to a three-way lock (Fig. 2). During the operation, we insert the balloon into the ventricle and inflate it with the desired volume of normal saline using a 20-ml syringe to size the ventricle. Also, the glove's finger tip may be used to point the direction for the new apex; while the glove's base may be used to guide the basal part of the left ventricle. When the patch closure is nearly completed, we deflate the balloon and remove it. The following procedure is continued.
3. Comment
Whether a sizing balloon is mandatory for the SVR still requires further investigation, it is not cost effective to prepare every size of the designed balloon commercially available. The hand-made sizing balloon using a surgical plastic glove is cheap and easily available in the operating room. The procedure is also easy to perform and reproducible. After inflation by normal saline, it has a nearly elliptical shape and its finger tip can be used as a guide for the new apex. Its obtuse part can be used as a guide of the left ventricular base. The features are almost the same as the commercialized preshaped sizing balloon. One advantage of this hand-made balloon is that we don't have to remove it until the last stitches are placed because it can be completely deflated. And this is not possible for the rigid commercially available preshaped balloon. But, on the contrary, the hand-made balloon may be compressed and the dimensions changed despite the same quantity of saline present because it is not as rigid as the commercialized preshaped sizing balloon.
We have performed SVR in 10 patients in the past 2 years and two of them were applied with this modified method. The shape of the ventricle could be maintained with this method and the hand-made balloon is much easier to extract after deflation.
In conclusion, the hand-made sizing balloon may be a cheap and practical alternative choice in surgical ventricular restoration.
References
Dor V, Saab M, Coste P, Komaszewska M, Montiglio F. Left ventricular aneurysm: new surgical approach. Thorac Cardiovasc Surg 1989; 37:11–19.
Dor V. Surgery for left ventricular aneurysm. Curr Opin Cardiol 1990; 5:773–780.(Kun-Kuang Lee, Chih-Hsien)
b Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, 7 Chung-Shan S. Rd., Taipei, Taiwan
Abstract
Left ventricular size and shape are considered as a key issue in surgical ventricular restoration procedure. A commercially preshaped balloon could provide a guide to perform the procedure. We developed a new, reliable and simple method with simple material and without additional sterilization to achieve the similar goal.
Key Words: Heart failure; Surgical restoration; Sizing balloon
1. Introduction
Postinfarction left ventricular remodeling is characterized by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction, and then heart failure syndrome. Surgical ventricular restoration (SVR) is designed to diminish the dilated ventricular volume and restore the shape. If the residual ventricular volume is too small, the pathophysiology of restrictive cardiomyopathy will result in a catastrophic event; if the residual ventricular volume is too large, the result will be the same condition as the preoperative status of heart failure or even worse.
To diminish the risk, Dor introduced the use of an intraventricular balloon to guide the volume reduction [1,2]. The volume 60 ml/m2 is chosen for the balloon size after study. More recently, a preshaped elliptical balloon (Chase Medical, Dallas, TX) is used to size and configure the ventricle, achieving a more normal short axis/long axis ratio and it gives us the correct position of the new apex.
We designed a new method with a hand-made sizing balloon to achieve this goal.
2. Technique
We cut off the basal part of the middle finger and its tip of a 7 size plastic surgical glove (Fig. 1). Then we make a silk tie in the base and its tip is tied to a connector with another silk. The connector is connected to a three-way lock (Fig. 2). During the operation, we insert the balloon into the ventricle and inflate it with the desired volume of normal saline using a 20-ml syringe to size the ventricle. Also, the glove's finger tip may be used to point the direction for the new apex; while the glove's base may be used to guide the basal part of the left ventricle. When the patch closure is nearly completed, we deflate the balloon and remove it. The following procedure is continued.
3. Comment
Whether a sizing balloon is mandatory for the SVR still requires further investigation, it is not cost effective to prepare every size of the designed balloon commercially available. The hand-made sizing balloon using a surgical plastic glove is cheap and easily available in the operating room. The procedure is also easy to perform and reproducible. After inflation by normal saline, it has a nearly elliptical shape and its finger tip can be used as a guide for the new apex. Its obtuse part can be used as a guide of the left ventricular base. The features are almost the same as the commercialized preshaped sizing balloon. One advantage of this hand-made balloon is that we don't have to remove it until the last stitches are placed because it can be completely deflated. And this is not possible for the rigid commercially available preshaped balloon. But, on the contrary, the hand-made balloon may be compressed and the dimensions changed despite the same quantity of saline present because it is not as rigid as the commercialized preshaped sizing balloon.
We have performed SVR in 10 patients in the past 2 years and two of them were applied with this modified method. The shape of the ventricle could be maintained with this method and the hand-made balloon is much easier to extract after deflation.
In conclusion, the hand-made sizing balloon may be a cheap and practical alternative choice in surgical ventricular restoration.
References
Dor V, Saab M, Coste P, Komaszewska M, Montiglio F. Left ventricular aneurysm: new surgical approach. Thorac Cardiovasc Surg 1989; 37:11–19.
Dor V. Surgery for left ventricular aneurysm. Curr Opin Cardiol 1990; 5:773–780.(Kun-Kuang Lee, Chih-Hsien)