Early and late changes in left ventricular systolic performance after percutaneous aortic balloon valvuloplasty.
To evaluate early and late hemodynamics after aortic valvuloplasty, 17 patients underwent first-pass radionuclide angiocardiography with simultaneous high-fidelity micromanometer pressure before, 10 minutes after and 6 months after aortic valvuloplasty. Pressure-volume and stress data were assessed. Immediately after the procedure, no significant change was observed in heart rate, systemic blood pressure, cardiac output or aortic insufficiency (as measured by visual or quantitative aortography). The mean and peak transvalvular gradient decreased from 64 to 36 mm Hg (p less than 0.001) and 76 to 38 mm Hg (p less than 0.001), respectively. The mean aortic valve area increased from 0.5 to 0.8 cm2 (p less than 0.001). Using echocardiography, meridional end-systolic wall stress decreased from 81 to 63 x 10(3) dynes/cm2 (p less than 0.001). Left ventricular ejection fraction increased from 0.48 to 0.54 (p less than 0.01), end-diastolic volume decreased from 161 to 143 ml (p less than 0.001) and end-diastolic pressure decreased from 18 to 13 mm Hg (p less than 0.01). Left ventricular stroke work (the area of the pressure-volume loop) also decreased from 17.5 to 14.7 x 10(6) ergs (p less than 0.001). The loop shifted to the left and downward. At the 6-month study, the mean and peak aortic valve gradient increased from 36 to 56 mm Hg (p less than 0.001) and 38 to 61 mm Hg (p less than 0.001), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Harpole, DH; Davidson, CJ; Skelton, TN; Kisslo, KB; Jones, RH; Bashore, TM
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