[Percutaneous aortic valvuloplasty in the elderly. Evaluation in 1990].

Percutaneous aortic valvuloplasty was used to treat aortic stenosis in elderly patients after attempts performed on the pulmonary and aortic valves of children had proved successful. The technique was initially intended for palliative treatment of aortic stenosis in elderly subjects for whom surgery was contraindicated, but its indications were later extended to younger subjects with the purpose of postponing surgical valve replacement. Aortic valvuloplasty is a delicate procedure with fairly frequent complications of its own and a mortality rate ranging from 3 to 8 p. 100. It consists fo separating the fused aortic valve commissures and breaking the plaques on calcified aortic cusps. The increase in aortic valve area obtained is modest (at the end of procedure this area is less than 1 sq cm in most patients), but valvuloplasty reduces the transvalvular gradient, thereby improving left ventricular function and reducing the symptoms... At least for a while, since a rapid loss of the benefits provided by the procedure is observed in a number of patients. Restenosis may occur within hours or days after valvuloplasty, and 9 months later its incidence reaches about 50 p. 100. Recurrence of symptoms that have led to valvuloplasty is frequent and justifies valve replacement in a second stage. Only about 30 p. 100 of the subjects remain with functional improvement and a sufficient aortic valve area at long term. For these reasons, it is now generally agreed that percutaneous aortic valvuloplasty should be envisaged only in those elderly patients for whom surgery is absolutely contraindicated.