Percutaneous Balloon Aortic Valvuloplasty: The State of the Art. A Review of Two Years Experience in Rouen
ABSTRACT Since the first case performed by us in September 1985, percutaneous transluminal aortic valvuloplasty (PTAV) has been applied in Rouen in a broad clinical spectrum of patients with aortic stenosis. After our encouraging initial experience, there have been changes in our objectives and technique which have allowed us to proceed more quickly, with less discomfort to the patient, lower risk, and improved results. The development of a new device, a triple lumen-double size balloon catheter has been a major advance as well as the use of extra-stiff guidewires and arterial sheaths.Our series has grown to more than 300 patients, mostly elderly (mean age 73 ± 11, 25% at or above 80) and very ill (71% in NYHA functional class HI or IV). Indication for PTA V was either absolute contraindication to valve replacement (30%), increased surgical risk (31%), refusal of surgery (10%), or attempt to postpone surgery (29%).The largest balloon size used has been 20 mm or above (23 mm or even 25 mm) in 70% of the cases. The double-balloon technique has been used in only 5% of the cases. In our series, PTAV resulted in a decrease in transvalvular peak gradient from 71 ± 26 mm Hg to 28 ± 13 mm Hg and an increase in aortic valve area from 0.54 ± 0.18 cm2 to 0.96 ± 0.33 cm2. With gained experience and the use of larger balloon sizes, the results have clearly improved: in the last 100 patients a valve area to or above 1 an2 has been obtained in 55% compared to 30% of the cases in our early experience. Patients less than 70 years old had the best results but the aortic stenosis was less severe before PTAV.The total procedural and post-PTA V mortality was 4% and involved primarily very old patients. The nonfatal complication rate remained low. Clinical information for 204 patients followed for 12 ± 5 months has been obtained and repeat catheterization has been done in 56 patients at an average of 4.5 months after PTA V.The data confirms that PTA V is feasible and can be accomplished with a relatively low risk in an elderly and ill population and in patients with contraindication to valve replacement or very high surgical risk. The procedure alters the natural history of the disease in these patients, improving both symptoms and survival. Indications in other categories of patients deserve further studies.
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ABSTRACT: Recent reports have established the feasibility of using balloon valvuloplasty to reduce left ventricular outflow tract obstruction due to a calcified aortic valve. The present study summarizes experiences with this technique in 9 patients (7 women, 2 men, mean age 78 years) in whom balloon valvuloplasty was used to treat calcific aortic stenosis. Peak aortic valve gradient (mm Hg) decreased from 68 +/- 8 (mean +/- standard error of the mean) before valvuloplasty to 35 +/- 5 after valvuloplasty (p = 0.003). Mean aortic valve gradient decreased from 57 +/- 7 before valvuloplasty to 30 +/- 5 after valvuloplasty (p = 0.006). Calculated aortic valve area increased from 0.42 +/- 0.04 to 0.81 +/- 0.06 cm2 (p = 0.005). Balloon valvuloplasty failed to diminish aortic valve obstruction in only 1 patient who, at subsequent surgery, had a congenitally bicuspid aortic valve. Significant aortic regurgitation was not observed in any of the 9 patients after valvuloplasty. One patient did have a highly focal, presumably embolic, brain stem infarct during the procedure. Femoral arterial blood loss, related to wire-guided exchange of balloon catheters too large for a 12Fr introducer sheath, was minimized by direct arterial exposure in 8 of the 9 patients. Thus, these findings confirm the efficacy of balloon valvuloplasty for the treatment of calcific aortic stenosis. The procedure, however, is not without hazard.The American Journal of Cardiology 03/1987; 59(4):313-7. DOI:10.1016/0002-9149(87)90805-8 · 3.43 Impact Factor
- The American Journal of Cardiology 10/1987; 60(8):733-6. DOI:10.1016/0002-9149(87)90397-3 · 3.43 Impact Factor
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ABSTRACT: 1.1. Standard hydrokinetic orifice formulas have been applied to stenotic mitral, pulmonic, tricuspid, and aortic valves, patent ductus arteriosus, and atrial and ventricular septal defects. These formulas were considered applicatble because of the high kinetic energy losses through small orifices or in the presence of high volume flow.2.2. In its general form, the formula is as follows: where A = cross-sectional area in cm.2 of the orifice F = flow rate in c.c. per second C = empirical constant g = gravity acceleration h = pressure gradient across the orifice in mm. Hg.3.3. Cross-sectional valve areas have been calculated in twenty-one patients with mitral stenosis. Calculated and measured areas have checked within 0.2 cm.2 in six post-mortem examinations and in five patients at the time of operation. Repeated calculations from different sets of data in the same patient have checked well in all instances. Valve area showed a good correlation with severity of pulmonary symptoms. Changes in valve area following finger fracture valvuloplasty were observed in two patients. The exponential relation of pressure to flow and valve area is briefly discussed.4.4. The stenotic cross-sectional area has been calculated in ten patients with pulmonic stenosis with one post-mortem observation and in two patients with patent ductus arteriosus with operative correlations.5.5. Calculations have likewise been made but without post-mortem confirmation in tricuspid stenosis, atrial septal defect, and ventricular septal defect. Formulas are presented for calculation of the size of the aortic orifice in aortic stenosis. In these groups, the empirical constant, C, has not as yet been determined and must await the collection of post-mortem data.6.6. In each case an attempt has been made to assess the sources of error as well as the degree of accuracy involved in the particular formula.7.7. The chief value of these formulas is that they present an objective evaluation of surgical procedures designed to widen stenotic orifices or to abolish abnormal shunts. Furthermore, a theoretical prediction of the benefit to be derived from surgical widening of stenotic valves may be made.American Heart Journal 02/1951; 41(1):1-29. DOI:10.1016/0002-8703(51)90002-6 · 4.56 Impact Factor