International Society For Minimally Invasive Cardiothoracic Surgery

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The Mechanism Of Annular Dilatation In Antegrade Aortic Valvuloplasty - A Study Using Three Dimensional Transesophageal Echocardiography
Kazato Ito1, Yukio Abe2, Yoshihisa Shimada1, Yuki Yamanaka1, Satoshi Nishiura1, Kentaro Yano1, Daisuke Tonomura1, Takahiko Naruko2, Hitoshi Fukumoto1, Minoru Yoshiyama3.
1Shiroyama Hospital, Habikino City, Japan, 2Osaka City General Hospital, Osaka City, Japan, 3Osaka City University School of Medicine, Osaka City, Japan.

Background: Balloon Aortic Valvuloplasty (BAV) is a therapy to improve aortic stenosis (AS) with separation of fused commissures, cracking the calcified nodules on the leaflets, and so on. However the efficacy of BAV in aortic annulus is uncertain. The purpose of this study was to investigate whether aortic annulus was dilated in BAV using three dimensional transesophageal echocardiograsphy (3DTEE).Methods: We studied 16 consecutive patients with AS underwent antegrade BAV using real-time 3DTEE. The change of aortic valvular area (AVA) and aortic annulus area (AAA) were measured with 3DTEE. AVA was measured in mid systole and AAA was measured in mid systole and end diastole.Results: The AVA after BAV was larger than at baseline (0.950.12cm2 vs. 0.620.14cm2 p<0.0001). AAA in mid systole was significantly larger than at baseline (5.10.94cm2 vs. 4.91.0cm2, p=0.011). AAA in end diastole was also larger than at baseline (4.861.02cm2 vs. 5.751.62cm2). The changes in AAA during systole after BAV were larger than pre BAV (12.414.1% vs. 6.65.7%). There was no complication caused by over dilation of BAV balloons.Conclusions: The benefits of BAV in AS patients may result not only from the valvular changes itself but also from the dilatation of AAA and the increase of the annular flexibility.

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