The role of echocardiography/Doppler in catheter balloon treatment of adults with aortic and mitral stenosis.

Doppler and two-dimensional echocardiography (2DE) have played a major role in the evaluation of patients undergoing catheter balloon treatment of aortic and mitral stenosis. Doppler/2DE has made possible an understanding of the mechanism of increase in valve area. Before the procedure, Doppler/2DE provides a reasonable estimate of the severity of the valvular stenosis and associated cardiac abnormalities. The evaluation of mitral valve morphology by 2DE before catheter balloon treatment has shown that patients with excellent leaflet motion and minimal increase in valve thickness have the greatest increase in mitral valve area. During the procedure, Doppler/2DE can aid in the transseptal puncture, in positioning the balloons across the stenotic orifice, and in the immediate assessment of changes in valve function and complications. The estimate of the aortic and mitral valve gradients and areas by Doppler/2DE before catheter balloon treatment shows a reasonable correlation with hemodynamic measurements. Immediately after the procedure, the Doppler/2DE estimates of aortic valve gradient and area show a fair correlation with data from cardiac catheterization, provided care is taken to avoid technical problems. Doppler/2DE assessment of mitral valve area immediately after catheter balloon commissurotomy (CBC) shows a poor correlation with catheterization data, which has been attributed to rapid changes in left atrial compliance and gradient. However, the correlation of Doppler estimates of mitral valve area with catheterization data improves at 3 months after CBC. Serial evaluations of patients after aortic or mitral catheter balloon dilatation should permit detection of restenosis and valve regurgitation and assessment of ventricular function and may provide valuable insights into the mechanisms of restenosis and changing clinical status.