CHANGES IN ARTERIAL-PRESSURE DURING LEFT HEART PULLBACK IN PATIENTS WITH AORTIC-STENOSIS - SIGN OF SEVERE AORTIC-STENOSIS

Increases in peripheral arterial pressure of 5 mm Hg or more were noted during retrograde withdrawal of a catheter from the left ventricle to the central aorta in 15 of 42 patients with aortic stenosis undergoing cardiac catheterization. These increases were noted in 15 of 20 patients (75 percent) with an aortic valve area of 0.6 cm2 or less but in none of the 22 patients with an aortic valve area of 0.7 cm2 or more (P < 0.001). The Gorlin formula and known catheter dimensions were used to predict the expected increase in systolic mean arterial pressure given a constant left ventricular pressure and cardiac output during catheter withdrawal. An average predicted Increase of 12.3 ± 1.2 mm Hg (mean ± standard error) compared with an observed increase of only 4.5 ± 0.6 mm Hg suggested either that the Gorlin formula consistently underestimates true aortic valve area or that other hemodynamic changes (such as an increase in left ventricular systolic pressure or a decrease in cardiac output, or both) occur in response to the presence of the retrograde catheter. It is concluded that an increase in peak arterial pressure of 5 mm Hg or more during catheter withdrawal from the left ventricle is an ancillary hemodynamic finding of critical aortic stenosis. Although the mechanism of this phenomenon is uncertain, partial obstruction of an already narrowed aortic orifice by the retrograde catheter and relief of this obstruction with catheter withdrawal may be operative. © 1979.