Percutaneous aortic balloon valvuloplasty (PABV) is useful in palliating symptoms
of severe aortic stenosis in patients who are not candidates for aortic valve replacement.
In 15 patients who had severe aortic stenosis and a contraindication to aortic valve
replacement, PABV was performed before a noncardiac procedure, in an attempt to improve
their hemodynamics and reduce the risks associated with the operation or preoperative
diagnostic test. The mean aortic gradient was reduced from 58.1 ± 6.0 mm Hg to 32.2
± 4.0 mm Hg (P<0.0002), and the aortic valve area was increased from 0.49 ± 0.04 cm2 to 0.85 ± 0.10 cm2 (P<0.0002). Complications associated with PABV included left ventricular perforation
in three patients (which resulted in death in one of them), transient congestive heart
failure in one, and development of femoral pseudoaneurysms in one. After PABV, nine
patients underwent the planned surgical procedure under general anesthesia without
complications. Five patients underwent surgical diagnostic procedures after PABV that
resulted in a change in treatment strategy. Three of these patients required no further
treatment, and two required resection of the colon for bleeding, which was preceded
by aortic valve replacement. This study demonstrates that PABV may be useful in reducing
the risks of noncardiac procedures in selected patients with severe aortic stenosis
who are otherwise not candidates for aortic valve replacement.
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© 1989 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
