Optimal balloon size in balloon aortic valvuloplasty : results from a retrospective analysis of multi-slice computed tomography

Balloon aortic valvuloplasty (BAV) is a bridging therapy for surgical aortic valve replacement and transcatheter aortic valve implantation. Multi-slice computed tomography (MSCT) area-derived aortic annulus diameter was measured retrospectively to determine whether its use can improve the acute gain of aortic valve area compared to echo-derived annulus diameter during BAV. Patients with symptomatic severe aortic stenosis who underwent BAV following MSCT were included in the analyses. All patients underwent evaluations by transthoracic echocardiography before and after BAV. To assess aortic stenosis severity, peak transaortic valve velocity, mean pressure gradient, effective orifice area (EOA), and the Doppler velocity index (DVI) were measured. To assess post-BAV improvement, the ratios of the post-procedural parameters to the pre-procedural parameters, the acute gain ratios, were calculated. Twenty-two patients were analyzable for this study. EOA and DVI improved significantly post-BAV. The optimal cut-off value of the ratio of final balloon size to the MSCT area-derived diameter (B/AREAd) for an adequate DVI increase was >0.936. Frequency of patients with adequate DVI improvement was significantly higher in B/AREAd>0.936 group than that in B/AREAd≤0.936 group (88% vs 43%, p=0.04), with few showing worsening aortic regurgitation. Safe and effective BAV appears feasible using the B/AREAd cut-off value.

aortic stenosis

balloon aortic valvuloplasty

echocardiography

multi-slice computed tomography