Safian R D, Kuntz R E, Berman A D
Harvard Medical School, Boston, Massachusetts.
Cardiol Clin. 1991 May;9(2):289-99.
Balloon aortic valvuloplasty is a palliative treatment for adult patients with aortic stenosis who are not candidates for AVR. BAV can be performed using a single balloon (one balloon, one shaft), multiple balloons (multiple balloons, multiple shafts), or complex balloon configurations (bifoil or trefoil balloons on a single shaft) by the retrograde (femoral or brachial) or antegrade (transseptal) approach. The mechanisms of successful BAV are fracture of calcified nodules, separation of fused commissures, and simple stretching of valve leaflets, leading to increased leaflet mobility and larger orifice dimensions. Clinically, these changes lead to a 50% to 70% decrease in transaortic valve gradient and a 50% to 70% increase in aortic valve area, resulting in immediate improvement in symptoms in most patients. Despite the fact that these beneficial hemodynamic results are achieved with a low incidence of life-threatening complications, the major limitation of BAV is the high incidence of restenosis. About 80% of patients have recurrent symptoms within 2 years of BAV, leading to death of the patient or requiring late AVR or repeat BAV. As a result of the high incidence of restenosis after BAV, elderly patients with aortic stenosis should not be denied the opportunity for AVR solely on the basis of age. BAV may have a role, however, in the following situations: (1) to treat patients in whom AVR is contraindicated for clinical or technical reasons; (2) to treat patients who require urgent noncardiac operations; (3) to clarify the extent of surgery required in patients with aortic stenosis, severe mitral regurgitation, and poor LV function; and (4) to predict the likelihood of successful outcome after AVR in patients with aortic stenosis, low gradients, low cardiac output, and poor LV function.
球囊主动脉瓣成形术是一种针对不适合进行主动脉瓣置换术（AVR）的成年主动脉瓣狭窄患者的姑息治疗方法。球囊主动脉瓣成形术可通过逆行（经股动脉或肱动脉）或顺行（经房间隔）途径，使用单个球囊（一个球囊，一个导管）、多个球囊（多个球囊，多个导管）或复杂球囊配置（单导管上的双叶或三叶球囊）来进行。成功的球囊主动脉瓣成形术的机制包括钙化结节的断裂、融合瓣叶的分离以及瓣膜小叶的简单伸展，从而导致小叶活动度增加和瓣口尺寸增大。临床上，这些变化导致跨主动脉瓣压差降低50%至70%，主动脉瓣面积增加50%至70%，从而使大多数患者的症状立即得到改善。尽管这些有益的血流动力学结果是在危及生命的并发症发生率较低的情况下实现的，但球囊主动脉瓣成形术的主要局限性是再狭窄发生率高。约80%的患者在球囊主动脉瓣成形术后2年内出现复发症状，导致患者死亡或需要晚期进行主动脉瓣置换术或再次进行球囊主动脉瓣成形术。由于球囊主动脉瓣成形术后再狭窄发生率高，老年主动脉瓣狭窄患者不应仅因年龄而被剥夺接受主动脉瓣置换术的机会。然而，球囊主动脉瓣成形术在以下情况中可能发挥作用：（1）治疗因临床或技术原因而禁忌进行主动脉瓣置换术的患者；（2）治疗需要紧急非心脏手术的患者；（3）明确患有主动脉瓣狭窄、严重二尖瓣反流和左心室功能不良的患者所需的手术范围；（4）预测患有主动脉瓣狭窄、低压差、低心输出量和左心室功能不良的患者在接受主动脉瓣置换术后成功的可能性。
