Balloon Valvuloplasty for Aortic Stenosis
The treatment of patients with symptomatic aortic stenosis is based on the history of the disease and on the success of surgical correction of the diseased valve. Although balloon dilatation of the aortic valve has been available since 1983, surgery is still recommended in all but very high-risk patients. Most commonly, aortic stenosis results in degeneration of a bicuspid valve or of a previously normal trileaflet valve, as sometimes occurs in the elderly patient. Sherman and colleagues studied the clinical outcomes of 36 patients who underwent balloon aortic valvuloplasty at a large urban hospital.
Patients were considered candidates for balloon valvuloplasty if they had severe aortic stenosis, as documented by echocardiography and cardiac catheterization; grade 3 or 4 symptoms according to the New York Heart Association Functional Classification system, and high surgical risk, as determined by clinical evaluation by a cardiologist and cardiovascular surgeon. High surgical risk included patients who had one or more of the following conditions: severe left ventricular dysfunction (ejection fraction less than 30 percent); a debilitating disease that could significantly increase operative morbidity; age over 80 years, and multivalvular disease that would require a prolonged surgical procedure. Patients with diseases associated with limited life expectancy or who had a strong desire to avoid a more extensive surgical procedure were also eligible to participate in the study.
Dilatation was performed following intravenous administration of 5,000 units of herapin. After the procedure, each patient was monitored for one or more days in the coronary care unit. Medical therapy following the procedure included aspirin, 75 mg daily, and other cardiac medications considered necessary by the attending physician.
Balloon dilatation was successful in 33 of the 36 patients. At two weeks' follow-up, 89 percent of the patients had improved, but only 56 percent remained improved at 26 weeks. Mortality rates were high at eight weeks (9 percent) and 26 weeks (28 percent). Predictors of adverse events included a low ventricular ejection fraction, a high pulmonary artery systolic pressure and elevated pulmonary end-diastolic pressure.
The authors conclude that valve surgery remains the treatment of choice for aortic stenosis in adults. Balloon aortic valvuloplasty remains a good, although palliative, treatment when there are no other alternatives. (Annals of Internal Medicine, March 15, 1989, vol. 110, p. 421.)
COPYRIGHT 1989 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group