Double balloon dilation involves catheters inserted in the left and right femoral vessels placed parallel to stenotic lesions and inflated simultaneously. The two balloon technique creates a substantial decrease in pressure gradients by achieving greater dilation from the use of two smaller balloons as opposed to a single large balloon. Balloons are inflated and deflated repeatedly to reduce the resistance of the vessels to inflation. Once the balloons are removed an end-hole catheter is passed over the wires to ensure a moderate systemic pressure drop occurs and then a stent is placed. Substantial pressure drops are common following single balloon dilation procedures. Hydrophilic catheter treatments can also be used through placement of the catheter through the femoral veins to access the stenosis in the vena cava to measure haemodynamic and angiography. Angiography allows for visualisation of the stenosis in the vena cava and measurements of the pressures and length of narrowing can be obtained from the technique, including the narrowest diameter of the stenosis. Balloon angioplasties can also be performed in the narrowed vena cava using Sterling balloons. Dilations are also performed with higher pressure Dorado balloons, using the same wire as the Sterling balloon. Sustained results of increased flow and significant reduction in obstructions following stent implantation occurs from balloon angioplasty treatments. Epidemiology
Congenital stenosis of the vena cava is a rare congenital heart disease affecting 0.7 - 8.7% of the population. Vena cava anomalies are very rare and arise from incorrect development in the foetal heart.
For acute cases the treatment is
antibiotics:
if anaerobic: metronidazole or clindamycin
if aerobic: beta-lactams, cephalosporins
if MRSA or Staphylococcus infection: vancomycin or linezolid
postural drainage and chest physiotherapy
bronchoscopy is used for the following cases:
aspiration or instillation of antibiotics
patients with atypical presentation suspected of having underlying foreign body or malignancy

Prognosis
Most cases respond to antibiotics and prognosis is usually excellent unless there is a debilitating underlying condition. Mortality from lung abscess alone is around 5% and is improving. See also
Empyema
Bronchiectasis
Abscess
Pleural effusion

References


== External links ==