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[Percutaneous mitral and aortic valve dilatation in the same session]
A Ramondo1, A Barchitta, L Budano
1Servizio di Emodinamica Cardiologia Interventistica, Università degli Studi, Padova.
Insights
Percutaneous balloon valvuloplasty offers good long-term results for rheumatic mitral and aortic stenosis. However, it shows limited success in elderly degenerative aortic stenosis, necessitating careful patient selection.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous balloon valvuloplasty (PBV) is a recognized treatment for rheumatic mitral and aortic stenosis.
- Its efficacy in elderly degenerative aortic stenosis is limited due to suboptimal long-term outcomes.
- PBV is typically reserved for high-risk surgical patients.
Observation:
- Three cases of simultaneous mitral and aortic PBV were analyzed.
- Etiologies included rheumatic (two cases) and mixed rheumatic-degenerative (one case).
- No immediate major complications were reported.
Findings:
- PBV successfully reduced mitral and aortic gradients, increasing valve areas and cardiac index post-procedure.
- Rheumatic valvulopathy cases demonstrated sustained positive results at seven-year follow-up.
- The degenerative component in the third case led to restenosis within a few years.
Implications:
- Simultaneous mitral and aortic PBV can be effective for rheumatic valvular stenosis.
- Long-term success is dependent on the underlying etiology, with degenerative disease posing a challenge.
- This procedure may be a viable option for select high-risk patients with mixed valvular disease.
Abstract:
Percutaneous balloon valvuloplasty is used successfully for mitral and aortic rheumatic stenosis. Its application is limited in elderly degenerative aortic stenosis because of its poor long-term results. It is thus indicated only in selected groups of patients at high surgical risk. We describe three cases affected with mitral and aortic stenosis who underwent simultaneous mitral and aortic percutaneous balloon valvuloplasty. Etiology was rheumatic in the first two cases, while it was rheumatic and degenerative in the third case. Immediately after the procedure, mitral and aortic gradients decreased, with a simultaneous increment in aortic and mitral areas and cardiac index. There were no major complications. The follow-up after seven years revealed the persistence of relatively good results in the first two cases affected with rheumatic valvulopathies. In the last case, restenosis recurred a few years after the procedure.