Circulation, Vol 79, 1189-1196, Copyright © 1989 by American Heart Association
J Berland, A Cribier, T Savin, E Lefebvre, R Koning and B Letac
The efficacy, morbidity, and 1-year follow-up of balloon aortic
valvuloplasty in patients with low ejection fraction (less than 40%) were
studied on a consecutive series of 55 patients (mean age, 77 years) treated
from September 1985 to February 1987. Because of their age (20 patients
greater than 80 years old), poor left ventricular function, and associated
diseases, 45 patients were definitely not surgical candidates. Balloon
dilatation with 15-23-mm diameter balloon catheters decreased the
transvalvular gradient from 66 +/- 24 to 28 +/- 14 mm Hg (p less than
0.001) and increased the valve area from 0.47 +/- 0.15 to 0.83 +/- 0.27 cm2
(p less than 0.001). Immediately after dilatation, ejection fraction mildly
increased from 29 +/- 7% to 34 +/- 9% (p less than 0.001) in 38 patients
who had undergone a second left ventricular angiogram after dilatation. No
significant change in the degree of aortic regurgitation was found after
the procedure. Three patients died in hospital (femoral arterial
complications in two, septicemia in one). Immediate clinical improvement
was noted in 80% of the patients. During the follow-up (mean, 11 months),
22 patients died (heart failure in 15 patients, sudden death in five
patients, myocardial infarction in one patient, cancer in one patient).
Thirty patients survived, 21 with persistent clinical improvement. Repeat
cardiac catheterization was performed at 6 months in 20 patients, of whom
eight had recurrence of symptoms. Nine patients had restenosis: their
hemodynamic indexes had returned to prevalvuloplasty values.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Percutaneous balloon valvuloplasty in patients with severe aortic stenosis and low ejection fraction. Immediate results and 1-year follow- up
Service de Cardiologie, Centre Hospitalo-Universitaire, Hospital Charles Nicolle, Rouen, France.
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