Feasibility of a pressure wire and single arterial puncture for assessing aortic valve area in patients with aortic stenosis.
BACKGROUND
Determination of a transvalvular pressure gradient for measurement of aortic valve area (AVA) by hemodynamic cardiac catheterization usually requires 2 catheters and 2 arterial access sites. We assessed the feasibility of using a single arterial puncture and a 0.014 inch pressure wire for evaluation of aortic stenosis.


METHODS
Eighteen patients (mean age, 76 years; 10 men) underwent hemodynamic catheterization for assessment of AVA. Cardiac output was determined by thermodilution (using a pulmonary artery catheter), and the transvalvular pressure gradient was obtained from simultaneous pressure recordings (using a pressure wire to measure left ventricular pressure and a 5 Fr catheter to measure ascending aortic pressure).


RESULTS
This novel technique was technically feasible in all patients. Calibration of the pressure wire with the pressure of the fluid-filled catheter was possible and accurate in the left ventricle and aorta. The method required 36.4 +/- 9.6 minutes from injection of a local anesthetic to completion of AVA measurement; 53.3 +/- 18.6 minutes were required to finish all catheterization procedures, including coronary angiography. Measurements of AVA (mean, 1.01 +/- 0.43 cm2) and pressure gradients (mean, 27.5 +/- 10.5 mmHg) taken by a pressure wire were similar to measurements taken by Doppler echocardiography (1.07 +/- 0.58 cm2 and 32.9 +/- 12.1 mmHg, respectively); the correlation was significant (r = 0.856; p < 0.001, and r = 0.741; p < 0.001, respectively).


CONCLUSIONS
Our findings suggest that a single arterial approach using a pressure wire is feasible, safe, accurate and rapid for the invasive assessment of aortic stenosis.
Bae
Jang-Ho
JH
Konyang University, Daejon City, South Korea.
Lerman
Amir
A
Yang
Eric
E
Rihal
Charanjit
C
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology*; D002138:Calibration; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D011312:Pressure; D011677:Punctures