The entry of balloons has heralded a new era in the world of medicine with profound effects in its various important fields. The strongest ripples were however felt in cardiology and specialties dealing with gastroenterology, anaesthesia and urinary system. In cardiology it has revolutionized the approach to many commonly encountered problems. Many more fields await the application of this exciting ‘balloon technology’!
What can balloon do for us? It has been used to track into blood carrying tube – vessels, as air is lighter than blood, so this travels along the course of the vessels. It has been used for retention of a tube in a cavity, with balloon inflated on an end of tube after the entry has been secured prevents its slippage. Similarly it has been used to retain the urinary catheter in the bladder by inflating the balloon at the end. Tubes used in anaesthesia used to have leaking of air around it, that problem is solved by inflating balloon around it. Balloons have been used to arrest bleeding in patients with bleeding varices in dire emergency by exerting direct pressure on bleeding varices.
The biggest breakthrough came with the realization that these balloon could be employed to ‘blow up’ blockages in various parts of body. Balloons of different sizes and quality mounted on different structures have been successfully used for this purpose. They have been used to open up obstructions in gastrointestinal tract without surgery. Blockages in urinary system have been dilated by balloons with minimal patient discomfort and without surgery.
The epic of balloon technology can be witnessed in cardiology where the whole scenario has changed in cardiac catheterization laboratory. Initially cardiac catheterization laboratory was used truly as a laboratory where different diseases were diagnosed based on the information gleaned from catheterization. Now the emphasis is shifting from diagnosis to therapeutics. With the advent of echocardiography, most diseases can be accurately diagnosed without cardiac catheterization. In cardiac cath lab, catheter based therapeutics is predominantly dependent on “poor old balloon”, small balloons blowing up obstruction in coronary and other vessels with excellent results and large balloons opening up narrowed valves with enviable results obviating the need for surgery.
Valvuloplasty:
Large balloons ranging from 10 to 30 mm in diameter are used to open up different valves. Obviously, size of balloon depends on the target and size of patient. These valves are either congenitally narrow or narrow down in later life due to various disease process. Previously surgery was required to open up the stenosed valves and remove the impediments in blood flow. Not any more! The procedure is performed without anaesthesia. As an initial step baseline data is recorded, then access beyond the narrowed valve is secured by manipulating a flexible catheter across it. A long wire is left across the valve and a narrow balloon mounted catheter is manipulated on the wire across the narrowed valve. Once satisfied with the position, the balloon is inflated, first a waist appears confirming the impinging valve on balloon and then it slowly gives way. The The valve is open! No ugly scar on chest, no confinement to bed for days, no need for prolonged antibiotics, no loss of work and the beauty is that the patient can actually walk home the next day.
Obviously these balloon mounted catheters are made of very sophisticated material and a lot of research has been done to perfect the technique and hardware. The catheter system to open Mitral valve is named after Inoue. The only way to cut down the costs are to reuse the balloon after proper sterilization. The chances of success are more than ninety five percent and complication rate is quite low. The balloon used for Pulmonic and Aortic valves are different in size and shape.
Angioplasty (PCI)
Balloon have only recently been tamed, to be used in small vessels supplying heart. It started with Andrea Grundzick in 1979, when a blockage in a vessel was opened in a patient. Since then there has been an explosion in the cath lab of angioplasties. In USA, it is called ‘occulo dilating reflex’ which implies that as soon as a cardiologist sees an obstruction in a vessel, he has an irrepressible urge to dilate it. Or, according to our not very good friends, cardiologists on seeing a blockage develop severe stomach ache which can only be relived on opening up that lesion. No doubt there has been a mad race in opening of the lesions and technology is witnessing tremendous progress in this field.
Most research taking place in cardiology is focused on small balloons used in vessels supplying heart. The aim is to produce tough balloons which can endure high pressure without deforming, mounted on catheter which should have very small profile so that it can negotiate the bends and cross the blockage, the catheters should have enough strength to be pushed around and cross the lesion. Similar research is taking place in paraphernalia like catheter and guide wire.
How is it done? After identifying the blockage a strategy is devised regarding the approach and hardware to be employed. The procedure is similar to angiography where no anaesthesia is administered. After doing angiography, the lesion is crossed with the help of a very find guide wire. Care is taken to float this wire across the lesion preventing it from going to small branches. It is like going through a large tree to a specific branch which might take a minute or a couple of hours. Once the lesion is crossed balloon mounted catheter is introduced and parked at the lesion. The size of balloon chosen depends on the size of the vessel. Satisfied with the position of catheter, the balloon is inflated under X-ray control. Patient experiences pain when balloon is inflated as blood supply to a part of heart is totally prevented. The balloon is kept inflated for as long as a patient can tolerate, varying from a few seconds to a minute. The appearance of waist and later giving way is apparent on X-ray. The lesion gives way with increase in lumen size.
Balloon are also being used to dilate obstructions in vessels supplying brain, kidneys and extremities. New territories are being ventured into and with the development of proper hardware the need for surgery will be obviated in most cases.
Introduction of balloon technology is a fine example of application of common sense to common problems. Balloons have been used for retention, and opening up blockages. This has proven to be a major advance in medicine and surgery and almost all specialties are benefiting from this simple but very exciting technology.
___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
What can balloon do for us? It has been used to track into blood carrying tube – vessels, as air is lighter than blood, so this travels along the course of the vessels. It has been used for retention of a tube in a cavity, with balloon inflated on an end of tube after the entry has been secured prevents its slippage. Similarly it has been used to retain the urinary catheter in the bladder by inflating the balloon at the end. Tubes used in anaesthesia used to have leaking of air around it, that problem is solved by inflating balloon around it. Balloons have been used to arrest bleeding in patients with bleeding varices in dire emergency by exerting direct pressure on bleeding varices.
The biggest breakthrough came with the realization that these balloon could be employed to ‘blow up’ blockages in various parts of body. Balloons of different sizes and quality mounted on different structures have been successfully used for this purpose. They have been used to open up obstructions in gastrointestinal tract without surgery. Blockages in urinary system have been dilated by balloons with minimal patient discomfort and without surgery.
The epic of balloon technology can be witnessed in cardiology where the whole scenario has changed in cardiac catheterization laboratory. Initially cardiac catheterization laboratory was used truly as a laboratory where different diseases were diagnosed based on the information gleaned from catheterization. Now the emphasis is shifting from diagnosis to therapeutics. With the advent of echocardiography, most diseases can be accurately diagnosed without cardiac catheterization. In cardiac cath lab, catheter based therapeutics is predominantly dependent on “poor old balloon”, small balloons blowing up obstruction in coronary and other vessels with excellent results and large balloons opening up narrowed valves with enviable results obviating the need for surgery.
Valvuloplasty:
Large balloons ranging from 10 to 30 mm in diameter are used to open up different valves. Obviously, size of balloon depends on the target and size of patient. These valves are either congenitally narrow or narrow down in later life due to various disease process. Previously surgery was required to open up the stenosed valves and remove the impediments in blood flow. Not any more! The procedure is performed without anaesthesia. As an initial step baseline data is recorded, then access beyond the narrowed valve is secured by manipulating a flexible catheter across it. A long wire is left across the valve and a narrow balloon mounted catheter is manipulated on the wire across the narrowed valve. Once satisfied with the position, the balloon is inflated, first a waist appears confirming the impinging valve on balloon and then it slowly gives way. The The valve is open! No ugly scar on chest, no confinement to bed for days, no need for prolonged antibiotics, no loss of work and the beauty is that the patient can actually walk home the next day.
Obviously these balloon mounted catheters are made of very sophisticated material and a lot of research has been done to perfect the technique and hardware. The catheter system to open Mitral valve is named after Inoue. The only way to cut down the costs are to reuse the balloon after proper sterilization. The chances of success are more than ninety five percent and complication rate is quite low. The balloon used for Pulmonic and Aortic valves are different in size and shape.
Angioplasty (PCI)
Balloon have only recently been tamed, to be used in small vessels supplying heart. It started with Andrea Grundzick in 1979, when a blockage in a vessel was opened in a patient. Since then there has been an explosion in the cath lab of angioplasties. In USA, it is called ‘occulo dilating reflex’ which implies that as soon as a cardiologist sees an obstruction in a vessel, he has an irrepressible urge to dilate it. Or, according to our not very good friends, cardiologists on seeing a blockage develop severe stomach ache which can only be relived on opening up that lesion. No doubt there has been a mad race in opening of the lesions and technology is witnessing tremendous progress in this field.
Most research taking place in cardiology is focused on small balloons used in vessels supplying heart. The aim is to produce tough balloons which can endure high pressure without deforming, mounted on catheter which should have very small profile so that it can negotiate the bends and cross the blockage, the catheters should have enough strength to be pushed around and cross the lesion. Similar research is taking place in paraphernalia like catheter and guide wire.
How is it done? After identifying the blockage a strategy is devised regarding the approach and hardware to be employed. The procedure is similar to angiography where no anaesthesia is administered. After doing angiography, the lesion is crossed with the help of a very find guide wire. Care is taken to float this wire across the lesion preventing it from going to small branches. It is like going through a large tree to a specific branch which might take a minute or a couple of hours. Once the lesion is crossed balloon mounted catheter is introduced and parked at the lesion. The size of balloon chosen depends on the size of the vessel. Satisfied with the position of catheter, the balloon is inflated under X-ray control. Patient experiences pain when balloon is inflated as blood supply to a part of heart is totally prevented. The balloon is kept inflated for as long as a patient can tolerate, varying from a few seconds to a minute. The appearance of waist and later giving way is apparent on X-ray. The lesion gives way with increase in lumen size.
Balloon are also being used to dilate obstructions in vessels supplying brain, kidneys and extremities. New territories are being ventured into and with the development of proper hardware the need for surgery will be obviated in most cases.
Introduction of balloon technology is a fine example of application of common sense to common problems. Balloons have been used for retention, and opening up blockages. This has proven to be a major advance in medicine and surgery and almost all specialties are benefiting from this simple but very exciting technology.
___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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