Aortic valvuloplasty for acquired aortic stenosis.

With the advent of reliable prosthetic valves, the number of aortic valvuloplastic procedures performed in adults has decreased significantly. This is in contradistinction to patients with congenital aortic stenosis, in whom aortic valvuloplasty remains the primary approach. Although only a 25% to 50% incidence of long-term clinical improvement has been reported after aortic valvuloplasty for acquired aortic stenosis, long-term success in adults can be predicted only if a valve area of greater than 1.0 cm2 is obtained, and if there is only minimal residual aortic insufficiency. Due to potential prosthetic valve-related complications aortic valvuloplasty was performed in 23 patients (14 women; nine men) with a mean age of 75 years (range 59 to 94). All patients had small aortic roots (20 less than or equal to 19 mm, 3 less than or equal to 21 mm) and a contraindication to anticoagulation. Baseline and postprocedure intraoperative two-dimensional contrast echocardiography was used to image leaflet mobility and the degree of aortic insufficiency. Cardiac outputs and pressure gradients were also recorded to calculate valve area before and after cardiopulmonary bypass. The postrepair gradient (mean 9 +/- 1.4 mm Hg) was significantly less (p = 0) than the prerepair gradient (mean 54 +/- 6.3 mm Hg). The postrepair valve area (mean 1.56 +/- 0.05 cm2) was significantly greater (p = 0) than the prerepair valve area (mean 0.55 +/- 0.05 cm2). Two patients required late reoperation: one for late bacterial endocarditis and one, whose valve area after valvuloplasty increased from 0.71 to only 0.91 cm2, for "restenosis."(ABSTRACT TRUNCATED AT 250 WORDS)