• Hi Dr. Sclafani,
hi searchy, pleasure to meet you.
I would like to know your opinion about the following questions, what makes me a little bit confused after reading about the technique, what is used by Dr. Sinan, and Dr Arata. ( Larger balloons, and destroying the valves)
I am using the same technique.
Dr Sinan was first to describe using larger balloons at my symposium last June. I was surprised but pleased to see that he stated that patients tolerated distension of the vein to such diameters. I was fearful that excessive distension would be problematic and lead to thrombosis.
In my knowledge the jugular vein valve is the only valve between the heart and the brain, which has a significant role in the prevention of venous reflux and plays an important role in preventing retrograde blood flow to the brain.
I wonder how important these valves are. 15% of humans do not have them.
Are they really “destroying” the valves or restoring the original normal function?
it depends upon how far the distension of the balloon. The valve is composed of two major parts, the ANNULUS which is the scaffolding for the attachment of the mobile VALVE LEAFLETS.
The annulus is very resistant to stretch, makes sense: it holds the valve leaflets at the proper distance from each other. resistance so great that it takes up to 25 atmospheres of pressure to stretch them. In the process of that stretch of inelastic tissue, a disruption of the tissue occurs.
If these velves are permanently destroyed then it does not affect the intracranial pressure?
Excellent questions you ask!
Increased central venous pressure could be transmitted along the axis of the jugular veins in situations where there are incompetent valves or absence of valves. As i said 15% of humans do not have valves. without obvious sequellae. I wonder how important these valves are in upright mammals. i can see their value in quadripeds and those animals that spend time upside down like bats.
That is not to say that reflux cannot occur. generally this pressure would be dissipated along the dural sinus and cervical collaterals. Occasionally is it reported to be associated with transient global amnesia.
However one must put that potential in perspective. If your normal jugular vein can distend to 16-18 millimeters but your annulus is fixed at 6 millimeters. You might just as well have a complete diminutive jugular vein. The vein swells to accomodate the flow just as the banks of a river swell to accomodate the spring rain. A beaver's dam restricts flow and leads to flooding upstream.
If they are destroyed what is the long-time effect of that? Does it increase the chances of transient global amnesia?
it is possible that this might occur, but that is often associated with high central venous pressure.
What happens with the remaining pieces of the valve?
i believe it remains attached to the wall. I have seen this with ivus but i am waiting more experience with ivus before really studying this.
Could transient blood reflux up into the brain cause MS lesions and damage, if valves are not there any more?
as long as there is unrestricted flow in the jugular veins, there shoujld not
but remember, we are early in this process.