Our patient did well post aortic balloon valvuloplasty. His peak-to-peak aortic valve gradient was markedly reduced on pressure tracings immediately following the procedure and his residual aortic regurgitation was mild.
He gradually resumed a normal lifestyle and was entirely asymptomatic.
Balloon diagram
This diagram demonstrates the basic anatomy and principles of aortic balloon valvuloplasty. The catheter is well seen in the aorta with its tip in the left ventricle, the constriction, or waist, of the balloon is caused by the stenotic aortic valve.
Balloon valvuloplasty
This is a still-frame of the aortic balloon valvuloplasty procedure in the anterior posterior view in our patient. It clearly shows the “j” wire guide curled in the left ventricle with its “j” tip just below the aortic valve. The constriction, or waist, in the center of the balloon identifies the stenotic aortic valve.
In the real-time study that follows, note that repetitive inflations of the balloon caused the waist to disappear, indicating that the valve orifice has been enlarged.
Post balloon pressure tracings
These are the left ventricular and aortic root pressure tracings obtained post balloon valvuloplasty. The delayed onset of the aortic root pressure curve is due to a difference in the two catheter systems. The tracings clearly show a marked reduction in the systolic peak-to-peak pressure gradient to less than 10 mm of hg. This is typical of a successful result.
Ao root post balloon - AP view
This is a systolic still-frame of a post balloon valvuloplasty aortic root angiogram in the anterior posterior view in our patient. The tip of the pigtail catheter is in the ascending aorta, where contrast material has been injected. The arrows clearly identify the widened stream of unopacified blood entering the aorta from the left ventricle across the more open aortic valve.
In the real-time study that follows, note the motion of the bicuspid aortic valve leaflets is less restricted. Note also that the degree of aortic valve regurgitation is only mildly increased.
Ao root post balloon - lat. view
This is a systolic still-frame of a post balloon valvuloplasty aortic root angiogram in the lateral view from our patient. The tip of the pigtail catheter is in the ascending aorta, where contrast material has been injected. The arrows clearly identify the enlarged aortic valve orifice, as a widened area of unopacified blood streaming from the left ventricle into the aorta.
In the real-time study that follows, note that the degree of aortic regurgitation is only mildly increased.
Surgery
The following aortic valve surgery is presented through the courtesy of drs. Robert hall and denton cooley and it was carried out at the texas heart institute. The patient’s valve is heavily calcified and required aortic valve replacement.
You can really see that it is really basically a bicuspid configuration valve. One could not get the tip of his little finger through that orifice. That accounts for the almost 100 mm pressure gradient across that valve. In removing a calcified valve one must be careful not to remove too much, at the first excision, because it is very easy to get outside of the annula. Here is one piece, put that on a pad, will you? Maybe on a towel so that it shows. And now i’m taking out the right coronary and left coronary cusps as a unit, and here you see the deformed, heavily calcified leaflets. The left coronary leaflet, the right coronary leaflet, and the non-coronary leaflet.