title: Serial left ventricular performance evaluated by cardiac catheterization before, immediately after and at 6 months after balloon aortic valvuloplasty.
abstract: Although impaired ventricular function has been shown to improve after aortic valve replacement, there are few data on hemodynamic changes after balloon aortic valvuloplasty based on follow-up catheterization. Of 71 patients surviving 6 months after balloon aortic valvuloplasty, 41 agreed to late recatheterization. All patients had pre- and postvalvuloplasty and 6 month catheterization data measured with high fidelity micromanometer pressure recordings and simultaneous digital subtraction left ventriculography. The hemodynamic result immediately after valvuloplasty included a reduction in the aortic valve gradient and a moderate increase in aortic valve area (0.51 +/- 0.14 to 0.81 +/- 0.19 cm2, p less than 0.0001). Ejection fraction increased slightly (52 +/- 18 to 55 +/- 17%, p less than 0.0001) despite a decrease in peak positive rate of rise of left ventricular pressure (dP/dt 1,650 +/- 460 to 1,500 +/- 490 mm Hg/s, p less than 0.05). There was also a decrease in left ventricular afterload and a small decrease in preload. At 6 month recatheterization, the mean aortic valve gradient and area were similar to baseline values, with 31 (76%) of 41 patients demonstrating valvular restenosis. At 6 months many left ventricular hemodynamic variables, including peak positive dP/dt and stroke work, also resembled prevalvuloplasty values. However, left ventricular end-diastolic volume was reduced (111 +/- 40 ml at 6 months versus 136 +/- 52 ml before valvuloplasty, p less than 0.01). The mean left ventricular ejection fraction was unchanged from prevalvuloplasty values in the study group of 41 patients, but was significantly improved in 9 of 15 patients with a baseline ejection fraction less than 50%.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: J K
authors.initials: JK
authors.lastname: Harrison
authors.forename: C J
authors.initials: CJ
authors.lastname: Davidson
authors.forename: M E
authors.initials: ME
authors.lastname: Leithe
authors.forename: K B
authors.initials: KB
authors.lastname: Kisslo
authors.forename: T N
authors.initials: TN
authors.lastname: Skelton
authors.forename: T M
authors.initials: TM
authors.lastname: Bashore
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006328:Cardiac Catheterization; D002404:Catheterization; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012008:Recurrence; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*