Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Aortie valve area evolution after percutaneous aortic valvuloplasty
A prospective trial using a combined Doppler echocariographic and haemodynamic method
Department of Cardiology, University Hospital Besancon, France
Received 5 January 1989; revised 8 May 1989; .
Address for reprints Yuette Bernard, M.D., Department of Cardiology, University Hospital, 2 Palce Saint-Jacques, 25030 Besascom Cedex, France
Abstract
The aortic valve area was serially evaluated in 45 patients, mean age 78 years, suffering from severe aortic stenosis who underwent percutaneous aortic valvuloplasty. The aortic valve area was calculated from haemodynamic data prior to and immediately after the procedure using the mean gradient. Serial determinations of the aortic valve area were also obtained 1 day before, 1 day after and 2 months after valvuloplasty from the thermodilution cardiac output and Doppler echocardiography mean left ventricle-to-aorta gradient. The mean gradient significantly decreased from 75±24 to 42±16mmHg (P>0.01) when measured from haemodynamic data and from 63±20 to 41±13 mmHg (P>001) when estimated from Doppler-derived data. It rose to 48±15 mmHg at 2 months (NS). The aortic valve area increased significantly from 0–48±0–13 to 0–67±0–29 cm2 (P>0.01) when calculated from haemodynamic data, and from 0–53±0–18 to 0–74±0–23 cm2 (P<001) when estimatedfrom Doppler-derived data. It declined to 0–69±0.27 cm2 at 2 months (NS). Aortic valve area values determined from haemodynamic data and from Doppler-derived data correlated well before valvuloplasty (r=0.80, P>0.01) but poorly afterwards (r=0.57, P>0.01). The aortic valve area was not influenced by valvuloplasty in eight patients. At 2 months, restenosis was apparent in eight patients out of 32 that were re-evaluated. Three patients died within 5 days of the procedure. After an average 12 months 'follow-up, eight more patients died. Symptoms were not influenced or recurred in 17 patients, while 17 others remained improved by at least one NYHA functional class. Seven patients were operated on, and there was one operative death. The calculated aortic valve area was significantly greater at the end of the procedure in the patients with persistent improvement compared with those with a poor result (0–83±0–29 cm2 vs 065±0–14 cm2, P < 0–05). In conclusion, in this study one third of the patients submitted to percutaneous aortic valvuloplasty had no objective improvement in calculated valve area or early restenosis after 2 months. Functional improvement was observed in one third of the patients. Immediate re-estimation of the aortic valve area from haemodynamic data at the end of the procedure may not reflect the actual effect of valvuloplasty on the aortic orifice
Key Words: Aortic stenosis • percutaneous aortic valvuloplasty • Doppler echocardiography • aortic valve area