[Percutaneous transfemoral valvuloplasty in patients with calcified aortic stenosis and significantly increased surgical risk: clinical course and value of Doppler sonography in assessment of therapeutic success].
Percutaneous transluminal valvuloplasty (PTV) was performed in 24 patients (aged 67-86 years, mean: 76 +/- 5.7 years) with calcific aortic stenosis and high operative risk. The gradient between maximal left ventricular and aortic pressures (peak-to-peak gradient, PPPG) could be reduced by 52% from 73 +/- 21 to 34 +/- 12 mmHg (p less than 0.001). Peak pressure gradient (PPG), as assessed by continuous wave Doppler, could be reduced from 80 +/- 28 to 58 +/- 21 mmHg (p less than 0.001). Aortic valve area (AVA) as determined by Doppler and two dimensional echocardiography increased significantly from 0.39 +/- 0.14 to 0.61 +/- 0.3 cm2 (p less than 0.05). Clinical symptoms were found to be improved in 5 of 8 patients with impaired ejection fraction and in 11 of 16 patients with normal ejection fraction during the first week after PTV. Complications due to the procedure were surgical revision of femoral artery puncture site in one patient and hemodynamic relevant pericardial effusion in another patient. Transmitral early (E) and late (L) diastolic filling integrals were measured by pulsed Doppler: the ratio E/L decreased significantly after PTV from 0.9 +/- 0.5 to 0.63 +/- 0.31 (p less than 0.03) indicating further reduction of left ventricular early diastolic filling. Ejection fraction, stroke volume and cardiac output did not significantly change immediately after PTV.(ABSTRACT TRUNCATED AT 250 WORDS)
Kücherer
H
H
Abteilung Innere Medizin III, Universität Heidelberg.
Katus
H
H
Dietz
R
R
Rauch
B
B
Kübler
W
W
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D002114:Calcinosis / Q000628:therapy*; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002404:Catheterization / Q000295:instrumentation*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012307:Risk Factors
Perkutane transfemorale Valvuloplastie bei Patienten mit kalzifizierter Aortenstenose und deutlich erhöhtem Operationsrisiko: Klinischer Verlauf und Wertigkeit der Dopplersonographie zur Beurteilung des Therapieerfolges.