Mechanism of Aortic Balloon Valvuloplasty: Fracture of Valvular Calcific Deposits

Abstract

Balloon valvuloplasty has been shown to acutely reduce the hemodynamic and symptomatic severity of calcific aortic stenosis. The mechanism by which this improvement is accomplished is not known. At necropsy, three patients who died after hemodynamically successful aortic balloon valvuloplasty were found to have aortic valve calcific deposits fractured at one or more sites. These findings suggest that fracture of leaflet calcium represents the basis for successful aortic balloon valvuloplasty.

Impact of rapid ventricular pacing during percutaneous balloon aortic valvuloplasty in patients with critical aortic stenosis: Should we be using it?

“…Precise and stable balloon positioning during BAV is a critical part of the procedure as it is expected to enhance fracturing of calcified nodules within the valve cusps, and maximize stretch of the aortic annulus. Both of these effects are presumed to be the mechanism by which valvular dilatation occurs during BAV [15–17].…”

Diretriz Brasileira de Valvopatias - SBC 2011/ I Diretriz Interamericana de Valvopatias - SIAC 2011

“…A VACB é um procedimento no qual um ou mais balões são colocados através da valva aórtica e inflados com a finalidade de reduzir a gravidade da estenose aórtica 180 . Ocasiona a fratura do cálcio depositado nos folhetos valvares, com alargamento do ânulo aórtico e separação das comissuras 181 .…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…The mechanism underlying relief of the stenotic lesion in older adults is fracture of calcific deposits within the valve leaflets and, to a minor degree, stretching of the annulus and separation of the calcified or fused commissures. [191][192][193] Immediate hemodynamic results include a moderate reduction in the transvalvular pressure gradient, but the postvalvotomy valve area rarely exceeds 1.0 cm 2 . Despite the modest change in valve area, an early symptomatic improvement is usually seen.…”