To evaluate the serial changes in right and left ventricular performance after percutaneous aortic balloon valvuloplasty, 15 patients, mean age 75±18 years, and in New York Heart Association (NYHA) class III, were studied with first-pass radionuclide angiocardiography (RNA) immediately before, then 5 minutes, 2 hours, 4 hours, 6 hours, and 3 days after valvuloplasty. No change was observed in heart rate, aortic root systolic pressure, Fick, or RNA cardiac output, amount of aortic insufficiency measured either angiographically or with the regurgitant fraction determination immediately after valvuloplasty. However, significant changes were observed in the peak-to-peak aortic valve gradient (63 to 35 mm Hg; p<0.001), mean aortic valve gradient (54 to 33 mm Hg; p<0.001), aortic valve area (0.60 to 0.90 cm2; p<0.001), and meridional wall stress (79 to 50 103 dynes/cm2; p<0.01) immediately following valvuloplasty. In addition, left ventricular end-diastolic volume decreased from 186 to 153 ml (p<0.001), end-systolic volume decreased from 114 to 86 ml (p<0.001), micromanometric left ventricular end-diastolic pressure decreased from 20 to 14 mm Hg (p<0.02), and left ventricular ejection fraction increased from 0.39 to 0.45 (p<0.001). Peak positive left ventricular dP/dt and end-systolic pressure-volume ratio did not change after valvuloplasty (1700 to 1550 mm Hg/sec, 2.1 to 2.5 mm Hg/ml, respectively. The serial RNA data revealed that left ventricular ejection fraction gradually increased (0.45 to 0.52; p<0.001) and end-systolic volume decreased (86 to 69 ml; p<0.001) during the first 6 hours after valvuloplasty, while heart rate, blood pressure, and end-diastolic volume did not change. The improved systolic performance persisted at 3 days and appeared to be due to a reduced left ventricular outflow obstruction and to recovery from balloon-induced left ventricular dysfunction.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine