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Complete heart block developing during aortic valvuloplasty
R H Plack1, J K Porterfield, J A Brinker
1Department of Medicine, Johns Hopkins Medical Institution, Baltimore.
Insights
Balloon aortic valvuloplasty (BAV) can lead to complete heart block (CHB). This case study highlights CHB occurrence following BAV in a patient with calcific aortic stenosis, necessitating pacemaker implantation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Calcific aortic stenosis is a common valvular heart disease.
- Balloon aortic valvuloplasty (BAV) is a less invasive treatment option.
- Aortic stenosis can be associated with conduction abnormalities.
Observation:
- An 80-year-old female with calcific aortic stenosis underwent BAV.
- Initial BAV with a 20 mm balloon resulted in modest valve area increase and gradient decrease.
- The procedure was complicated by transient complete heart block (CHB), requiring temporary pacing.
Findings:
- A second BAV with a 23 mm balloon was performed four weeks later.
- This subsequent procedure resulted in persistent CHB.
- Persistent CHB necessitated the implantation of a dual-chamber pacemaker.
Implications:
- BAV, while effective for aortic stenosis, carries a risk of CHB.
- The risk of CHB may be related to balloon size and repeated procedures.
- Careful monitoring and consideration of permanent pacing are crucial after BAV in susceptible patients.
Abstract:
We report the occurrence of CHB consequent to ABV in an 80-year-old white woman with calcific aortic stenosis. The patient underwent ABV with a balloon 20 mm in diameter, resulting in only a modest increase in aortic valve area and a decrease in aortic valve gradient. The procedure was complicated by transient intermittent CHB which required temporary transvenous pacemaking and resolved within 72 hours. A second ABV was performed four weeks later with a balloon 23 mm in diameter. This was complicated by persistent CHB which required placement of a dual-chamber pacemaker.