FOLLOW-UP RECATHETERIZATION AFTER BALLOON AORTIC VALVULOPLASTY

The results of recatheterization were assessed in a select group of 95 patients enrolled in Mansfield Scientific Aortic Valvuloplasty Registry to determine whether any procedural or patient-related variables at baseline predicted either initial immediate or follow-up (6.2 +/- 3.3 months) results. At the follow-up catheterization, 39 (41%) of the patients were in improved condition and 56 patients (59%) had recurrence of symptoms, allowing for analysis of the effect of the procedure in two symptomatic patient subsets. In the total group the aortic valve area increased initially from 0.56 +/- 0.16 to 0.87 +/- 0.27 cm2 but partial return to the baseline valve area was evident at follow-up (0.063 +/- 0.25 cm2). Similarly, the mean aortic gradient intially decreased from 72 +/- 30 to 35 +/- 16 mm Hg but then increased to 55 +/- 25 mm Hg at follow-up. Neither the initial nor the late hemodynamic results appeared affected by any definable procedural variable at the time of valvuloplasty, including the maximal diameter of balloons, number of balloons simultaneously used, mean inflation time or total number of inflations. Such technical concerns also did not seem to affect short-or-long-term outcome. Similarly, no baseline hemodynamic variable clearly separated those who become increasingly symptomatic from those whose condition was improved at the 6 month interval. At recatheterization, a reduction in the aortic valve area toward baseline was observed in 24 (62%) of the 39 improved patients and in 45 (80%) of the 56 who were symptomatic. At follow-up the less symptomatic group did have a greater aortic valve area (0.70 +/- 0.32 versus 0.58 +/- 0.18 cm2; p = 0.02) and a slightly higher ejection fraction (59 +/- 19% versus 48 +/- 20%; p = 0.07) than the symptomatic group. Thus, in this select group of patients, differences in procedural techniques at the time of aortic valvuloplasty did not appear to influence the return toward the baseline aortic valve gradient at follow-up. Fewer symptoms at follow-up were observed in those patients achieving the greatest aortic valve area after the procedure and in those with maintenance of left ventricular contractile performance.