Case report
Intracardiac echocardiography-guided percutaneous mitral balloon valvuloplasty
Ecocardiografia intracardíaca – Valvuloplastia mitral percutânea conduzida por balão
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"estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112003356?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000597?idApp=UINPBA00004E" "url" => "/21742049/0000003200000004/v1_201308021404/S2174204913000597/v1_201308021404/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Intracardiac echocardiography-guided percutaneous mitral balloon valvuloplasty" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "339" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Konstantinos Marmagkiolis, Mehmet Cilingiroglu" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Konstantinos" "apellidos" => "Marmagkiolis" "email" => array:1 [ 0 => "c.marmagiolis@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mehmet" "apellidos" => "Cilingiroglu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Citizens Memorial Hospital, Bolivar, MO, United States" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA, United States" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ecocardiografia intracardíaca – Valvuloplastia mitral percutânea conduzida por balão" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2792 "Ancho" => 1667 "Tamanyo" => 301621 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Left: ICE image showing tenting of the interatrial septum (large white arrow) with the Mullins catheter and Brockenbrough needle (small white arrow). LA: left atrium; RA: right atrium. Right: ICE 2-chamber view after insertion of the ICE probe into the right ventricle (RV). Visualization of the mitral valve (white arrow) prior to percutaneous mitral balloon valvuloplasty. Left atrial enlargement and left ventricular function and dimensions can be assessed. (B) Percutaneous mitral balloon valvuloplasty. Angiographic and ICE visualization of the inflated Inoue balloon (white arrow). ICE catheter probe (large black arrow) is located in the RV and the pig-tail catheter (small black arrow) in the left ventricle. (C) Post-PMBV ICE assessment. Left: two-dimension assessment. Right: Doppler evaluation of the mitral valve showing 1+ mitral regurgitation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Percutaneous mitral balloon valvuloplasty (PMBV) was initially described by Inoue in 1984 as a novel percutaneous technique for the management of mitral stenosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> PMBV provides excellent immediate and mid-term results comparable to surgical mitral commissurotomy<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and is currently the standard of care for selected patients with moderate or severe mitral stenosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although PMBV can be performed by a retrograde non-transeptal technique with comparable clinical results, most North American centers use the transeptal Inoue technique due to ease of use and greater experience.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Transeptal puncture is a critical and challenging step because of the distorted septal anatomy in most mitral stenosis patients. It commonly constitutes the longest part of the procedure and a failure or complication may terminate the case or place the patient at significant risk or subject to unnecessary long hospitalizations. Traditionally, transeptal puncture was performed using angiographic landmarks. The use of transesophageal echocardiography (TEE) has improved the safety and efficiency of the procedure and it is currently the preferred method in most North American institutions.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Intracardiac echocardiography was initially used in the 1980s but was not universally accepted due to its high-frequency transducers and problems with steerability and manipulation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the 1990s technical improvements led to more generalized use in various structural interventional procedures. The first successful balloon valvuloplasty using ICE was described in 2002 by Salem.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 31-year-old woman with known rheumatic mitral valve disease was referred for PMVB. She had been diagnosed with rheumatic heart disease four years previously after a routine transthoracic echocardiogram (TTE) and she had been asymptomatic during her recent annual clinic visits.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over the previous three months she had noticed progressive dyspnea on exertion limiting her daily activities. The ECG showed normal sinus rhythm with left atrial enlargement. Repeat TTE revealed progressive moderate mitral stenosis with a mean valve area of 1.2 cm<span class="elsevierStyleSup">2</span> and mild mitral regurgitation, preserved left ventricular ejection fraction (LVEF), moderate left atrial enlargement and normal pulmonary artery pressure. A treadmill stress echocardiogram with a standard Bruce protocol was ordered, during which she performed 6 METS, which was less than normal for her age. She experienced significant dyspnea towards the end of the test with no associated left ventricular wall motion abnormalities but with a mean transmitral gradient increased from 8 mmHg to 17 mmHg, consistent with severe obstruction.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Elective PMBV was scheduled. Standard right heart catheterization was initially performed to invasively assess right heart pressures. Through a second right transfemoral venous access, the ICE catheter probe was advanced to the mid segment of the right atrium in order to visualize the atrial septum and guide the transeptal puncture. All septal borders were assessed before and during the tenting of the septum with the Mullin catheter (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). After identification of the optimal interatrial septal position for puncture, the Brockenbrough needle and the sheath were advanced to the left atrium. With angiographic and ICE guidance the mitral valve balloon was advanced and inflated (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). Immediate assessment of the post-procedural mitral valve morphology, transmitral valve gradient and mitral regurgitation were performed by fluoroscopy and ICE (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Transeptal puncture is an important skill for interventional cardiologists. The significant decrease in the incidence of mitral stenosis in the USA and the universal acceptance of echocardiography, cardiac computed tomography (CT) and cardiac MRI as alternative accurate and safe non-invasive imaging modalities have significantly decreased the number of transeptal punctures in most cardiac catheterization labs. Today fewer centers which are involved in structural heart interventions perform routine transeptal punctures and maintain their operators’ expertise.</p><p id="par0040" class="elsevierStylePara elsevierViewall">ICE-guided structural heart disease procedures have gained increasing attention due to the ease of ICE use, the improved imaging resolution, use of Doppler and the feasibility of three-dimensional imaging applications.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Compared to plain angiography, it achieves accurate assessment of the atrial septum and the adjacent anatomic structures, improving the safety of the puncture and the operator's level of comfort with a lower radiation exposure. Compared to TEE it eliminates the need for deeper procedural sedation, patient intubation and the involvement of an additional operator, with a probable decrease of the overall procedural cost.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres251741" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec239337" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres251742" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec239336" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-07-26" "fechaAceptado" => "2012-08-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec239337" "palabras" => array:2 [ 0 => "Intracardiac echocardiography" 1 => "Mitral balloon valvuloplasty" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec239336" "palabras" => array:2 [ 0 => "Ecocardiografia intracardíaca" 1 => "Valvuloplastia mitral percutânea por balão" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percutaneous mitral balloon valvuloplasty (PMBV) was initially described by Inoue in 1984 as a novel percutaneous technique for the management of mitral stenosis. Intracardiac echocardiography was initially used in the 1980s but was not universally accepted due to its high-frequency transducers and problems with steerability and manipulation. In the 1990s technical improvements led to more generalized use in various structural interventional procedures. We present the case of a successful PMBV guided exclusively by ICE.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A valvuloplastia mitral percutânea por balão foi inicialmente descrita por Inoue em 1984 como uma nova técnica percutânea para o tratamento da estenose mitral. A ecocardiografia intracardíaca foi inicialmente utilizada na década de 80 sem aceitação universal devido à alta frequência dos transdutores e à sua capacidade de manobra e manuseamento problemáticos. Na década de 90 melhorias técnicas conduziram à sua utilização mais generalizada em diversos procedimentos de intervenção estrutural. Os autores apresentam um caso de uma valvuloplastia mitral percutânea conduzida por ecocardiografia intracardíaca.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2792 "Ancho" => 1667 "Tamanyo" => 301621 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Left: ICE image showing tenting of the interatrial septum (large white arrow) with the Mullins catheter and Brockenbrough needle (small white arrow). LA: left atrium; RA: right atrium. Right: ICE 2-chamber view after insertion of the ICE probe into the right ventricle (RV). Visualization of the mitral valve (white arrow) prior to percutaneous mitral balloon valvuloplasty. Left atrial enlargement and left ventricular function and dimensions can be assessed. (B) Percutaneous mitral balloon valvuloplasty. Angiographic and ICE visualization of the inflated Inoue balloon (white arrow). ICE catheter probe (large black arrow) is located in the RV and the pig-tail catheter (small black arrow) in the left ventricle. (C) Post-PMBV ICE assessment. Left: two-dimension assessment. Right: Doppler evaluation of the mitral valve showing 1+ mitral regurgitation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical application of transvenous mitral commissurotomy by a new balloon catheter" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Inoue" 1 => "T. Owaki" 2 => "T. Nakamura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1984" "volumen" => "87" "paginaInicial" => "394" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6700245" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NHLBI Balloon Valvuloplasty Registry Report on immediate and 30-day follow-up results. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry Participants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Multicenter experience with balloon mitral commissurotomy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1992" "volumen" => "85" "paginaInicial" => "448" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1735143" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.O. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 36 | 25 | 61 |
| 2024 September | 46 | 20 | 66 |
| 2024 August | 40 | 30 | 70 |
| 2024 July | 37 | 32 | 69 |
| 2024 June | 31 | 21 | 52 |
| 2024 May | 36 | 19 | 55 |
| 2024 April | 31 | 36 | 67 |
| 2024 March | 27 | 18 | 45 |
| 2024 February | 34 | 20 | 54 |
| 2024 January | 36 | 24 | 60 |
| 2023 December | 33 | 28 | 61 |
| 2023 November | 41 | 34 | 75 |
| 2023 October | 27 | 21 | 48 |
| 2023 September | 17 | 21 | 38 |
| 2023 August | 28 | 23 | 51 |
| 2023 July | 33 | 14 | 47 |
| 2023 June | 22 | 17 | 39 |
| 2023 May | 34 | 32 | 66 |
| 2023 April | 23 | 9 | 32 |
| 2023 March | 37 | 25 | 62 |
| 2023 February | 35 | 19 | 54 |
| 2023 January | 20 | 16 | 36 |
| 2022 December | 32 | 18 | 50 |
| 2022 November | 47 | 28 | 75 |
| 2022 October | 27 | 10 | 37 |
| 2022 September | 33 | 35 | 68 |
| 2022 August | 35 | 28 | 63 |
| 2022 July | 40 | 38 | 78 |
| 2022 June | 21 | 28 | 49 |
| 2022 May | 26 | 34 | 60 |
| 2022 April | 32 | 28 | 60 |
| 2022 March | 24 | 34 | 58 |
| 2022 February | 31 | 29 | 60 |
| 2022 January | 23 | 18 | 41 |
| 2021 December | 14 | 27 | 41 |
| 2021 November | 36 | 38 | 74 |
| 2021 October | 53 | 38 | 91 |
| 2021 September | 16 | 18 | 34 |
| 2021 August | 28 | 29 | 57 |
| 2021 July | 27 | 26 | 53 |
| 2021 June | 31 | 24 | 55 |
| 2021 May | 40 | 48 | 88 |
| 2021 April | 40 | 51 | 91 |
| 2021 March | 61 | 18 | 79 |
| 2021 February | 41 | 13 | 54 |
| 2021 January | 27 | 11 | 38 |
| 2020 December | 19 | 10 | 29 |
| 2020 November | 32 | 13 | 45 |
| 2020 October | 15 | 13 | 28 |
| 2020 September | 32 | 7 | 39 |
| 2020 August | 27 | 7 | 34 |
| 2020 July | 38 | 5 | 43 |
| 2020 June | 30 | 2 | 32 |
| 2020 May | 28 | 5 | 33 |
| 2020 April | 35 | 7 | 42 |
| 2020 March | 42 | 7 | 49 |
| 2020 February | 92 | 18 | 110 |
| 2020 January | 22 | 5 | 27 |
| 2019 December | 34 | 5 | 39 |
| 2019 November | 26 | 6 | 32 |
| 2019 October | 22 | 5 | 27 |
| 2019 September | 27 | 8 | 35 |
| 2019 August | 30 | 7 | 37 |
| 2019 July | 52 | 11 | 63 |
| 2019 June | 39 | 8 | 47 |
| 2019 May | 52 | 2 | 54 |
| 2019 April | 41 | 17 | 58 |
| 2019 March | 62 | 11 | 73 |
| 2019 February | 60 | 10 | 70 |
| 2019 January | 62 | 7 | 69 |
| 2018 December | 84 | 10 | 94 |
| 2018 November | 76 | 5 | 81 |
| 2018 October | 84 | 19 | 103 |
| 2018 September | 50 | 9 | 59 |
| 2018 August | 50 | 6 | 56 |
| 2018 July | 33 | 1 | 34 |
| 2018 June | 50 | 10 | 60 |
| 2018 May | 63 | 2 | 65 |
| 2018 April | 62 | 6 | 68 |
| 2018 March | 62 | 7 | 69 |
| 2018 February | 31 | 4 | 35 |
| 2018 January | 34 | 5 | 39 |
| 2017 December | 51 | 9 | 60 |
| 2017 November | 39 | 8 | 47 |
| 2017 October | 41 | 7 | 48 |
| 2017 September | 25 | 7 | 32 |
| 2017 August | 33 | 10 | 43 |
| 2017 July | 22 | 9 | 31 |
| 2017 June | 21 | 10 | 31 |
| 2017 May | 34 | 6 | 40 |
| 2017 April | 15 | 1 | 16 |
| 2017 March | 38 | 4 | 42 |
| 2017 February | 35 | 4 | 39 |
| 2017 January | 22 | 4 | 26 |
| 2016 December | 30 | 8 | 38 |
| 2016 November | 13 | 2 | 15 |
| 2016 October | 28 | 6 | 34 |
| 2016 September | 18 | 3 | 21 |
| 2016 August | 7 | 3 | 10 |
| 2016 July | 7 | 3 | 10 |
| 2016 June | 4 | 3 | 7 |
| 2016 May | 12 | 3 | 15 |
| 2016 April | 16 | 2 | 18 |
| 2016 March | 28 | 2 | 30 |
| 2016 February | 31 | 14 | 45 |
| 2016 January | 25 | 6 | 31 |
| 2015 December | 24 | 5 | 29 |
| 2015 November | 24 | 6 | 30 |
| 2015 October | 31 | 7 | 38 |
| 2015 September | 31 | 8 | 39 |
| 2015 August | 31 | 9 | 40 |
| 2015 July | 20 | 7 | 27 |
| 2015 June | 16 | 3 | 19 |
| 2015 May | 20 | 2 | 22 |
| 2015 April | 24 | 8 | 32 |
| 2015 March | 17 | 7 | 24 |
| 2015 February | 18 | 6 | 24 |
| 2015 January | 22 | 10 | 32 |
| 2014 December | 28 | 6 | 34 |
| 2014 November | 25 | 5 | 30 |
| 2014 October | 16 | 4 | 20 |
| 2014 September | 19 | 4 | 23 |
| 2014 August | 39 | 7 | 46 |
| 2014 July | 40 | 7 | 47 |
| 2014 June | 24 | 8 | 32 |
| 2014 May | 32 | 9 | 41 |
| 2014 April | 17 | 3 | 20 |
| 2014 March | 44 | 13 | 57 |
| 2014 February | 41 | 7 | 48 |
| 2014 January | 43 | 9 | 52 |
| 2013 December | 41 | 6 | 47 |
| 2013 November | 52 | 10 | 62 |
| 2013 October | 36 | 7 | 43 |
| 2013 September | 36 | 13 | 49 |
| 2013 August | 52 | 11 | 63 |
| 2013 July | 38 | 13 | 51 |
| 2013 June | 11 | 3 | 14 |
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