Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty

Charles J. Davidson; David A. Harpole; Katherine Kisslo; Thomas N. Skelton; Joseph Kisslo; Robert H. Jones; Thomas M. Bashore

doi:10.1016/0002-8703(89)90788-6

Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty

Charles J. Davidson, David A. Harpole, Katherine Kisslo, Thomas N. Skelton, Joseph Kisslo, Robert H. Jones, Thomas M. Bashore^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p < 0.001) reduction in peak-to-peak (72 ± 24 mm Hg to 36 ± 11 mmHg) and mean (60 ± 20 mm Hg to 34 ± 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 ± 0.2 cm² to 0.8 ± 0.2 cm²) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p < 0.001) immediate decrease in peak instantaneous (81 ± 22 mm Hg to 53 ± 15 mm Hg) and mean (48 ± 14 mm Hg to 31 ± 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p < 0.001) return of peak (56 ± 15 mm Hg to 65 ± 20 mm Hg) and mean (31 ± 9 mm Hg to 39 ± 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 ± 0.2 cm² to 0.6 ± 0.2 cm² immediately after the procedure (p < 0.001), then partially returned to baseline (0.5 ± 0.2 cm²; p < 0.005) at 2 to 4 days. Results of serial first-pass radionuclide angiography performed at the same time as the Doppler evaluations showed a continued decrement in left ventricular end-diastolic volume (184 ± 42 ml to 158 ± 35 ml to 151 ± 35 ml) and a trend toward an increase in stroke volume. Additionally the mean ejection fraction continued to improve during this period (42 ± 18% to 49 ± 19% to 52 ± 19%). These data indicate that the early rise in aortic valve gradient seen after percutaneous aortic valvuloplasty is likely due to both remodeling of the aortic valve architecture and a small increase in stroke volume.

Original language	English (US)
Pages (from-to)	411-417
Number of pages	7
Journal	American heart journal
Volume	117
Issue number	2
DOIs	https://doi.org/10.1016/0002-8703(89)90788-6
State	Published - Feb 1989

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/0002-8703(89)90788-6

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@article{a7e7a99d40d941369599f510f996292c,

title = "Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty",

abstract = "The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p < 0.001) reduction in peak-to-peak (72 ± 24 mm Hg to 36 ± 11 mmHg) and mean (60 ± 20 mm Hg to 34 ± 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 ± 0.2 cm2 to 0.8 ± 0.2 cm2) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p < 0.001) immediate decrease in peak instantaneous (81 ± 22 mm Hg to 53 ± 15 mm Hg) and mean (48 ± 14 mm Hg to 31 ± 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p < 0.001) return of peak (56 ± 15 mm Hg to 65 ± 20 mm Hg) and mean (31 ± 9 mm Hg to 39 ± 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 ± 0.2 cm2 to 0.6 ± 0.2 cm2 immediately after the procedure (p < 0.001), then partially returned to baseline (0.5 ± 0.2 cm2; p < 0.005) at 2 to 4 days. Results of serial first-pass radionuclide angiography performed at the same time as the Doppler evaluations showed a continued decrement in left ventricular end-diastolic volume (184 ± 42 ml to 158 ± 35 ml to 151 ± 35 ml) and a trend toward an increase in stroke volume. Additionally the mean ejection fraction continued to improve during this period (42 ± 18% to 49 ± 19% to 52 ± 19%). These data indicate that the early rise in aortic valve gradient seen after percutaneous aortic valvuloplasty is likely due to both remodeling of the aortic valve architecture and a small increase in stroke volume.",

author = "Davidson, {Charles J.} and Harpole, {David A.} and Katherine Kisslo and Skelton, {Thomas N.} and Joseph Kisslo and Jones, {Robert H.} and Bashore, {Thomas M.}",

note = "Funding Information: From the Divisions of Cardiology and Cardiovascular Thoracic Surgery, Departments of Internal Medicine and Surgery, Duke University Medical Center. Supported in part by the National Institutes of Health and National Research Service Award HL07101 from the National Heart, Lung, and Blood Institute. Received for publication May 16, 1988, accepted Sept. 12, 1988. Reprint requests: Thomas M. Flashore, MD, Cardiovascular Laboratory, Duke University Medical Center, Box 3012, Durham, NC 27710.",

year = "1989",

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doi = "10.1016/0002-8703(89)90788-6",

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pages = "411--417",

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T1 - Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty

AU - Davidson, Charles J.

AU - Harpole, David A.

AU - Kisslo, Katherine

AU - Skelton, Thomas N.

AU - Kisslo, Joseph

AU - Jones, Robert H.

AU - Bashore, Thomas M.

N1 - Funding Information: From the Divisions of Cardiology and Cardiovascular Thoracic Surgery, Departments of Internal Medicine and Surgery, Duke University Medical Center. Supported in part by the National Institutes of Health and National Research Service Award HL07101 from the National Heart, Lung, and Blood Institute. Received for publication May 16, 1988, accepted Sept. 12, 1988. Reprint requests: Thomas M. Flashore, MD, Cardiovascular Laboratory, Duke University Medical Center, Box 3012, Durham, NC 27710.

PY - 1989/2

Y1 - 1989/2

N2 - The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p < 0.001) reduction in peak-to-peak (72 ± 24 mm Hg to 36 ± 11 mmHg) and mean (60 ± 20 mm Hg to 34 ± 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 ± 0.2 cm2 to 0.8 ± 0.2 cm2) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p < 0.001) immediate decrease in peak instantaneous (81 ± 22 mm Hg to 53 ± 15 mm Hg) and mean (48 ± 14 mm Hg to 31 ± 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p < 0.001) return of peak (56 ± 15 mm Hg to 65 ± 20 mm Hg) and mean (31 ± 9 mm Hg to 39 ± 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 ± 0.2 cm2 to 0.6 ± 0.2 cm2 immediately after the procedure (p < 0.001), then partially returned to baseline (0.5 ± 0.2 cm2; p < 0.005) at 2 to 4 days. Results of serial first-pass radionuclide angiography performed at the same time as the Doppler evaluations showed a continued decrement in left ventricular end-diastolic volume (184 ± 42 ml to 158 ± 35 ml to 151 ± 35 ml) and a trend toward an increase in stroke volume. Additionally the mean ejection fraction continued to improve during this period (42 ± 18% to 49 ± 19% to 52 ± 19%). These data indicate that the early rise in aortic valve gradient seen after percutaneous aortic valvuloplasty is likely due to both remodeling of the aortic valve architecture and a small increase in stroke volume.

AB - The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p < 0.001) reduction in peak-to-peak (72 ± 24 mm Hg to 36 ± 11 mmHg) and mean (60 ± 20 mm Hg to 34 ± 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 ± 0.2 cm2 to 0.8 ± 0.2 cm2) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p < 0.001) immediate decrease in peak instantaneous (81 ± 22 mm Hg to 53 ± 15 mm Hg) and mean (48 ± 14 mm Hg to 31 ± 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p < 0.001) return of peak (56 ± 15 mm Hg to 65 ± 20 mm Hg) and mean (31 ± 9 mm Hg to 39 ± 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 ± 0.2 cm2 to 0.6 ± 0.2 cm2 immediately after the procedure (p < 0.001), then partially returned to baseline (0.5 ± 0.2 cm2; p < 0.005) at 2 to 4 days. Results of serial first-pass radionuclide angiography performed at the same time as the Doppler evaluations showed a continued decrement in left ventricular end-diastolic volume (184 ± 42 ml to 158 ± 35 ml to 151 ± 35 ml) and a trend toward an increase in stroke volume. Additionally the mean ejection fraction continued to improve during this period (42 ± 18% to 49 ± 19% to 52 ± 19%). These data indicate that the early rise in aortic valve gradient seen after percutaneous aortic valvuloplasty is likely due to both remodeling of the aortic valve architecture and a small increase in stroke volume.

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Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty

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