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(Circulation. 1999;99:2598-2599.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Effect of Balloon Dilatation on Aortic Stenosis Assessed by 3-Dimensional Echocardiographic Reconstruction

Philippe Acar, MD; Yacine Aggoun, MD; Zakhia Saliba, MD; Daniel Sidi, MD; Jean Kachaner, MD

From Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-malades, Paris, France.

Correspondence to Dr Philippe Acar, Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-malades, 149, rue de Sèvres, 75743 Paris Cedex 15, France.

A10-year-old boy with aortic valve stenosis treated by surgical valvotomy when he was 6 months old underwent balloon dilatation of recurrent aortic stenosis. The procedure was performed through the right femoral artery under general anesthesia with mechanical ventilation. The aortic valve was dilated with a balloon 20 mm in diameter. The peak systolic gradient dropped from 120 to 30 mm Hg after the procedure. Postprocedural aortography showed mild aortic regurgitation.

Multiplane transesophageal echocardiographic images of the aortic valve were acquired with a rotational scan before and after balloon dilatation. Three-dimensional (3D) views from the aorta were reconstructed (TomTec). The anatomy of the aortic valve and effects of the balloon dilatation are shown on the 3D views (Figures 1 through 3).

View larger version (150K): [in this window] [in a new window]   Figure 1. 3D view from aorta in diastole before balloon dilatation. Aortic valve is bicuspid. Two leaflets have equal areas. Edges of leaflets appear thickened, and waves on their surfaces express flexibility of valve.

View larger version (144K): [in this window] [in a new window]   Figure 2. 3D view from aorta in systole before balloon dilatation. Fusion of anterior commissure associated with thickness of leaflet edges makes valve stenotic. Posterior commissure is free. Opening surface of valve is 0.7 cm2.

View larger version (143K): [in this window] [in a new window]   Figure 3. 3D view from aorta in systole after balloon dilatation. Anterior commissure is clearly opened after balloon inflation. Mild aortic regurgitation assessed by 2D color Doppler emanates from this commissure. Opening surface of valve is now 1.2 cm2.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's . . . [Full Text of this Article]

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