Abstract
Percutaneous balloon aortic valvuloplasty (PBAV), which is used to treat symptomatic aortic stenosis, requires ionizing radiation and contrast agent for imaging guidance. The aim of the study is to evaluate the feasibility and effectiveness of ultrasound-guided PBAV in patients with aortic stenosis. This case series included 30 patients (14 males; mean age, 61.5 ± 4.5 years) with moderate/severe aortic stenosis treated with ultrasound-guided PBAV at the Ultrasound Department, Fuwai Hospital, Beijing, China, between January 2016 and July 2019. Cardiac function (New York Heart Association grade) was assessed before PBAV and 1 month after the procedure. Aortic peak jet velocity, aortic valve orifice area (AVA), mean transvalvular pressure gradient (MTPG), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were determined before and immediately after PBAV using Doppler echocardiography. Preprocedural cardiac function was grade I in 3 cases, grade II in 9 cases, grade III in 10 cases, and grade IV in 8 cases. Postprocedural cardiac function was grade I in 22 cases, grade II in 4 cases, and grade III in 4 cases, suggesting that cardiac function was improved by PBAV. Ultrasound-guided PBAV resulted in significant improvements (P < 0.05) in aortic peak jet velocity (3.68 ± 0.811 m/s vs. 4.79 ± 0.63 m/s), MTPG (33.77 ± 13.85 mmHg vs. 54.54 ± 13.81 mmHg), AVA (1.96 ± 0.25 cm2 vs. 0.98 ± 0.12 cm2), LVEDD (51.90 ± 3.21 mm vs. 65.60 ± 6.81 mm), LVEF (63.46 ± 11.29% vs. 56.31 ± 11.04%), and LVESD (35.50 2.62 mm vs. 45.20 ± 2.42 mm). Ultrasound-guided PBAV is feasible and achieves good short-term effects in patients with aortic stenosis.
Highlights
Aortic stenosis is the most common valvular disease worldwide, and the vast majority of cases are acquired rather than congenital [1]
Aortic valve replacement is generally suitable for patients who are tolerant of thoracotomy and extracorporeal circulation, and the two approaches available are surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) [7,8,9]
E inclusion criteria were as follows [11]: (1) a diagnosis of moderate or severe aortic stenosis [29] was made based on the clinical manifestations and echocardiography; (2) color Doppler flow imaging showed that the aortic valve was still functioning; and (3) aortic valve replacement could not be performed due to severe hemodynamic instability or refusal by the patient, so the patient underwent percutaneous balloon aortic valvuloplasty (PBAV); and (4) severe aortic stenosis with a peak Doppler gradient ≥70 mmHg or severe aortic stenosis with a peak Doppler gradient ≥50 mmHg accompanied by clinical symptoms and/or electrocardiogram (ECG) strain or heart failure
Summary
Aortic stenosis is the most common valvular disease worldwide, and the vast majority of cases are acquired rather than congenital [1]. Journal of Interventional Cardiology using techniques such as percutaneous balloon aortic valvuloplasty (PBAV). PBAV can be used to improve cardiac function in high surgical risk patients because it avoids extracorporeal circulation, and the technique has been applied successfully in the bridging of patients for definitive treatment with SAVR/TAVR or as a palliative therapy [11,12,13,14,15,16,17,18,19]. E aim of this case series was to evaluate whether ultrasound-guided PBAV might be a feasible and effective procedure in patients with aortic stenosis We hypothesized that echocardiography could be used to guide PBAV. e aim of this case series was to evaluate whether ultrasound-guided PBAV might be a feasible and effective procedure in patients with aortic stenosis
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