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Serial left ventricular performance evaluated by cardiac catheterization before, immediately after and at 6 months
J K Harrison1, C J Davidson, M E Leithe
1Duke University Medical Center, Durham, North Carolina 27710.
Insights
Balloon aortic valvuloplasty offers short-term hemodynamic improvement but often leads to restenosis. Ventricular function may improve in select patients, but long-term benefits are limited by restenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Hemodynamics
Background:
- Impaired ventricular function can improve after aortic valve replacement.
- Limited data exist on hemodynamic changes following balloon aortic valvuloplasty (BAV) with late follow-up catheterization.
Purpose of the Study:
- To evaluate the late hemodynamic changes after BAV using follow-up catheterization.
- To assess the incidence of restenosis and its impact on ventricular function post-BAV.
Main Methods:
- Prospective study of 71 patients surviving 6 months post-BAV, with 41 undergoing late recatheterization.
- High-fidelity micromanometer pressure recordings and digital subtraction left ventriculography were used for pre- and post-BAV and 6-month catheterization data acquisition.
Main Results:
- Immediately post-BAV, aortic valve gradient decreased, and aortic valve area increased significantly.
- Ejection fraction slightly increased, but peak positive rate of rise of left ventricular pressure (dP/dt) decreased.
- At 6 months, 76% of patients showed restenosis, with hemodynamic variables returning to baseline; however, left ventricular end-diastolic volume decreased, and ejection fraction improved in those with baseline EF < 50%.
Conclusions:
- BAV provides immediate hemodynamic benefits but is often followed by significant restenosis within 6 months.
- While overall ventricular function may not improve long-term, BAV can benefit patients with severely impaired baseline ejection fraction.
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)