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[Course of aortic valve insufficiency in percutaneous aortic valvuloplasty]
V Voudris1, G Drobinski, I Sotirov
1Service de cardiologie, CHU Pitié-Salpêtrière, Paris.
Insights
Percutaneous aortic valvuloplasty carries a low risk of worsening aortic regurgitation. Mild or moderate leakage should not prevent patients with aortic valve stenosis from undergoing this procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Context:
- Percutaneous aortic valvuloplasty (PAV) is a treatment for severe aortic valve stenosis.
- Assessing the impact of PAV on aortic regurgitation (AR) is crucial for patient selection and procedural success.
Purpose:
- To evaluate the risk of new or aggravated aortic regurgitation following percutaneous aortic valvuloplasty using angiography.
- To determine if pre-existing mild or moderate aortic regurgitation influences the decision to perform PAV.
Summary:
- Angiography in 50 patients undergoing PAV showed that 41 had no change in aortic regurgitation.
- Minute leakage developed in one patient; regurgitation decreased or resolved in eight patients.
- The study suggests PAV has a low risk of causing significant aortic regurgitation, with observed improvements in some cases.
Impact:
- Findings indicate that mild to moderate aortic regurgitation should not be a contraindication for PAV in patients with aortic valve stenosis.
- This supports the expanded use of PAV as a viable treatment option for selected patients.
- The study contributes to understanding the safety profile of PAV regarding valvular competence.
Abstract:
The risk of occurrence or aggravation of aortic valve regurgitation after percutaneous aortic valvuloplasty was evaluated by angiography in 50 consecutive patients: 17 men, 33 women, mean age 77.6 years. In all cases angiography was performed with a pigtail catheter, trying to get the catheter in the same position for injections before and after dilatation. Forty-one patients showed no changes from the predilatation situation: aortic regurgitation was absent in 10 cases, minimal in 30 cases and moderate in 1 case. Minute leakage developed in a patient who had no aortic valve regurgitation prior to dilatation. Regurgitation decreased or subsided in 8 patients, i.e.: moderate leakage became minimal in 6 cases and minimal leakage completely disappeared in 2 cases. In the last 8 patients (3 men, 5 women, mean age 76 years) heart rate and transaortic diastolic pressure gradient were identical before and after dilatation, which means that the angiographic reduction of leakage was due to better closure of the valve. Aortic valve dilatation seems to carry a low risk of major aortic regurgitation. In patients who require percutaneous valvuloplasty for tight aortic valve stenosis, the presence of a small or moderate aortic leakage should not preclude the procedure from being performed.