The risk for systemic embolization associated with percutaneous balloon valvuloplasty in adults. A prospective comprehensive evaluation.

STUDY OBJECTIVE

To prospectively investigate the evidence for embolic phenomena associated with percutaneous mitral and aortic valvuloplasty.

DESIGN

Prospective, consecutive case series before and after balloon valvuloplasty.

SETTING

Referral center hospital and cardiac catheterization laboratory.

PATIENTS

Consecutive sample of 32 patients having balloon valvuloplasty for critical symptomatic stenosis of the mitral or aortic valve. Twenty-six patients had aortic stenosis; 6 had mitral stenosis.

INTERVENTION

Computed tomography of the head, funduscopy, and electrocardiography were done in all patients before and after valvuloplasty. Cardiac isoenzymes were measured serially in 19 patients.

MEASUREMENTS AND MAIN RESULTS

Previous cerebral infarction was seen in nine patients, with three showing a new abnormality after aortic valvuloplasty. In one of these patients a funduscopic hemorrhage was detected by photography. Total creatinine kinase and MB fraction were elevated in 1 of 19 patients. Serial electrocardiograms were unchanged in all patients.

CONCLUSIONS

The incidence of cerebral neurologic events and myocardial injury are acceptably low after balloon valvuloplasty of calcific aortic and mitral stenosis. Both episodes of symptomatic cerebral infarction occurred in patients with apparent bicuspid aortic valvular stenosis, suggesting that calcific bicuspid aortic stenosis may be associated with more neurologic events after aortic valvuloplasty.