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European Heart Journal 1989 10(5):417-422;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Double balloon aortic valvotomy for rheumatic aortic stenosis; in vitro studies

P. A. RIBEIRO, M. AL ZAIBAG and V. RAJENDRAN

Cardiac Department Riyadh Armed Forces Hospital Kingdom of Saudi Arabia

Received 21 March 1988; revised 19 September 1988; .

Address for correspondence: Dr Paulo A. Ribeiro Instituto Coragèo R. Prof. Reynaldo Dos Santos, 27 Carnaxide-Linda-a-Velha 2795 Portugal.

Abstract

The manner in which aortic valve area increases after in vitro double balloon aortic valvotomy for severe rheumatic aortic stenosis has not been defined. We selected ten intact aortic valves excised at cardiac surgery from patients (mean age 45 ± 10 years) with severe rheumatic aortic stenosis, with a valve area ≤ cm2. In vitro double ballon aortic valvotomy was attempted on each valve using two Meditech 15 mm diameter balloon catheters. The balloon catheters were simultaneously inflated to 4 atm pressure for 10 s. Before and after balloon valvotomy the valve area was calculated with a conical sizer, and radiological studies were also performed to study the effect of balloon valvotomy on calcified aortic commissures. The mean valve area increased from 0.7 ± 0.2 (mean ± SD) to 1.1 ± 0.2 cm2 (P≤0.001) after balloon valvotomy, with a mean total commissural split ting for each aortic valve of 9.3 ±6 mm. Overall, 63% of the aortic commissures were split, splitting occurring in 81% of non-calcified commissures and 43% of calcified commissures. There was no leaflet tear or calcium fracture either macroscopically or radiologically. Commissural splitting of rheumatic aortic stenosis is the manner in which valve area is increased after double balloon aortic valvotomy. The inflated balloon catheters split not only non-calcified, but also calcified arotic commissures. The adequate commissural splitting achieved and consequent 57% increase in valve area indicate that the double balloon aortic valvotomy technique may become a palliative therapeutic procedure for patients with severe rheumatic aortic stenosis.

Key Words: Aortic stenosis • balloon valvotomy


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