[Balloon stabilization by means of cardiac stimulation during aortic valvuloplasty]

To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability.

From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated.

The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases.

Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.