Circulation, Vol 74, 119-125, Copyright © 1986 by American Heart Association
RG McKay, RD Safian, JE Lock, VS Mandell, RL Thurer, SJ Schnitt and W Grossman
To assess the safety and efficacy of percutaneous balloon valvuloplasty in
calcific aortic stenosis, balloon dilatation of critically stenosed,
calcified aortic valves was performed in five postmortem hearts, in five
patients intraoperatively before aortic valve replacement, and in two
elderly patients percutaneously at the time of diagnostic catheterization.
The etiology of aortic stenosis in the 12 cases was rheumatic in two,
congenital bicuspid calcific stenosis in one, and senile calcific
degenerative stenosis in the remaining nine. Prevalvuloplasty examination
in the 10 postmortem and intraoperative cases revealed rigid valve leaflets
with commissural fusion in three valves and extensive nodular calcification
in seven. Subsequent balloon dilatation with 15 to 18 mm valvuloplasty
balloons resulted in decreased cusp rigidity and increased mobility of
valve leaflets in all cases, without evidence of tearing of valve leaflets,
disruption of the valvular ring, or liberation of calcific or valvular
debris. In the three valve specimens with commissural fusion, balloon
dilatation resulted in partial or complete separation of leaflets along
fused commissures. In two cases with extensive nodular calcification,
balloon dilatation resulted in a fracture of a calcified leaflet that was
evident on both gross and radiologic examination. After postmortem and
intraoperative studies, percutaneous catheter valvuloplasty was performed
at the time of diagnostic catheterization in two elderly patients (93- and
85-year-old women) with long-standing calcific aortic stenosis. Balloon
dilatation with 12 to 18 mm balloons resulted in significant decreases in
aortic gradients and significant increases in cardiac index and aortic
valve area in both patients. Percutaneous valvuloplasty in both patients
resulted in a mild increase in aortic insufficiency and no evidence of
embolic phenomena.
ARTICLES
Balloon dilatation of calcific aortic stenosis in elderly patients: postmortem, intraoperative, and percutaneous valvuloplasty studies
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