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Perkutane transfemorale Valvuloplastie bei Patienten mit kalzifizierter Aortenstenose und deutlich erhöhtem Operationsrisiko: Klinischer Verlauf und Wertigkeit der Dopplersonographie zur Beurteilung des Therapieerfolges

Percutaneous transfemoral valvuloplasty in patients with calcific aortic stenosis and high operative risk: Clinical results and applicability of Doppler echocardiography

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Summary

Percutaneous transluminal valvuloplasty (PTV) was performed in 24 patients (aged 67–86 years, mean: 76±5.7 years) with calcific aortic stenosis and high operative risk. The gradient between maximal left ventricular and aortic pressures (peak-to-peak gradient, PPPG) could be reduced by 52% from 73±21 to 34±12 mmHg (p<0.001). Peak pressure gradient (PPG), as assessed by continuous wave Doppler, could be reduced from 80±28 to 58±21 mmHg (p<0.001). Aortic valve area (AVA) as determined by Doppler and two dimensional echocardiography increased significantly from 0.39±0.14 to 0.61±0.3 cm2 (p<0.05). Clinical symptoms were found to be improved in 5 of 8 patients with impaired ejection fraction and in 11 of 16 patients with normal ejection fraction during the first week after PTV. Complications due to the procedure were surgical revision of femoral artery puncture site in one patient and hemodynamic relevant pericardial effusion in another patient. Transmitral early (E) and late (L) diastolic filling integrals were measured by pulsed Doppler: the ratio E/L decreased significantly after PTV from 0.9±0.5 to 0.63±0.31 (p<0.03) indicating further reduction of left ventricular early diastolic filling. Ejection fraction, stroke volume and cardiac output did not significantly change immediately after PTV.

The results indicate, that PTV can successfully reduce aortic pressure gradients and improve symptoms in patients with calcific aortic stenosis and high operative risk. Doppler echocardiography provides an adequate method to noninvasively evaluate the initial outcome of PTV and seems valuable for the assessment of long term results.

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Abbreviations

AKE:

prothetischer Aortenklappenersatz

AoP:

maximaler systolischer Aortendruck

AVA:

Aortenklappenöffnungsfläche

E:

Integral frühdiastolischer Füllungsgeschwindigkeiten

EF:

Ejektionsfraktion

HR:

Herzfrequenz

HZV:

Herzzeitvolumen

L:

Integral spätdiastolischer Füllungsgeschwindigkeiten

LVP:

maximaler systolischer linksventrikulärer Druck

NYHA:

New York Heart Association

PPG:

peak pressure gradient

PPPG:

peak-to-peak pressure gradient

PTV:

Perkutane transmfemorale Valvuloplastie

SEP:

Systolische Ejektionsperiode

SV:

Schlagvolumen

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Authors and Affiliations

  1. Abteilung Innere Medizin III, Universität Heidelberg, Germany

    H. Kücherer, H. Katus, R. Dietz, B. Rauch & W. Kübler

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  1. H. Kücherer
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  2. H. Katus
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  3. R. Dietz
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  4. B. Rauch
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  5. W. Kübler
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Kücherer, H., Katus, H., Dietz, R. et al. Perkutane transfemorale Valvuloplastie bei Patienten mit kalzifizierter Aortenstenose und deutlich erhöhtem Operationsrisiko: Klinischer Verlauf und Wertigkeit der Dopplersonographie zur Beurteilung des Therapieerfolges. Klin Wochenschr 66, 571–578 (1988). https://doi.org/10.1007/BF01720831

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