Catheter balloon valvuloplasty of stenotic aortic valves Part I: Anatomic basis and mechanisms of balloon dilation

Abstract

Summary:Catheter balloon valvuloplasty of stenotic aortic valves has met with generally poor short-and longtemi clinical results. Part of this problem resides with the lack of recognition of various etiologies of aortic stenosis. Part I of this review discusses the various etiologies of aortic stenosis and provides an anatomic basis for successful valve dilation. Results of an in vitro study indicate stenotic aortic valves are dilated by various mechanisms (cracking, stretching) based in part upon the etiology of the aortic valve stenosis.Key words: aortic stenosis, aortic balloon valvuloplasty, bicuspid aortic valve, rheumatic disease, degenerative aortic stenosis percutaneous balloon aortic valvuloplasty may improve some symptoms, the high incidence of recurrence of clinical symptoms within several weeks and the high mortality within 8 months of the dilation limits the procedure to selected patients.The results of aortic balloon valvuloplasty described above represent no clinical or morphologic attempt to separate patients (aortic valves) into subgroups of specific aortic valve etiology. Specific morphologic selection of stenotic aortic valves for balloon dilation may greatly improve these initial dismal clinical results of dilation. Part 1 of this review provides an anatomic basis for aortic balloon valvuloplasty and indicates mechanisms of successful balloon dilation for various causes of aortic valve stenosis.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

“…This merely reflects the modified natural history of the disease. Considering that both the balloon and the scalpel cause variable degrees of fractures in the sites of commissural fusion [50][51][52] , which is the major mechanism of stenosis, the progression of the regurgitation is not a surprising finding. In our and other case series 25,27,28 , the progression of aortic regurgitation to moderate or severe degrees was associated with the need for surgery in a shorter period of time.…”

Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty

“…Real-time TEE can provide useful information regarding whether each of the leaflets is adequately compressed during the procedure. Previous histopathological studies have reported that the major mechanisms of successful BAV for degenerative AS are cracking the calcified nodules on the leaflets and creation of cleavage planes in the stroma (2,4,(12)(13)(14). In our cases, real-time TEE demonstrated that leaflets with less calcification were primarily stretched and compressed, probably because the radial balloon force was exerted more strongly on the more pliable leaflets.…”

“…Previous histopathological studies have also reported that another mechanism of successful BAV is stretching the aortic annulus at the commissure sites (wrinkling and folding cuspal margins) (2,4,(12)(13)(14). Nevertheless, it is possible that oversized or off-center dilation may result in annulus disruption or leaflet avulsion with abrupt aortic regurgitation (12,14,15). In our cases, using real-time TEE guidance, we A B…”

Balloon valvuloplasty in adults with severe aortic stenosis

“…Рестеноз и, как след-ствие, рост градиента на АК очевидны в течение не-скольких дней после баллонной пластики у всей иссле-дуемой группы пациентов. Рубцовые ткани быстро за-полняют разрывы между спайками, микроповреждения самого клапана, а также трещины кальцификатов [3,31]. Все это позволяет сегодня рассматривать БВ ПАК как вспомогательный этап перед хирургической коррекцией АК.…”

“…Restenosis and following increased pressure gradient are evident during several days after balloon valvuloplasty in all patients. Scar tissues rapidly fill ruptures between adhesions, valve's microscopic injuries, as well as chaps of calcificates [3,31]. This allows to consider aortic balloon valvuloplasty as a supplementary method before valve surgery.…”