Retrograde balloon aortic valvuloplasty with the newly invented Inoue balloon for aortic stenosis accompanied by severe heart failure: A case report

Abstract

Retrograde balloon aortic valvuloplasty using the newly invented Inoue balloon was one of the feasible and safe therapeutic options in a hemodynamically unstable patient having aortic stenosis with reduced left ventricular ejection fraction complicated with bacterial infection.

Keywords: aortic stenosis; balloon aortic valvuloplasty; heart failure.

FIGURE 1

Chest radiographs and the brain natriuretic peptide (BNP) levels before and after retrograde balloon aortic valvuloplasty (BAV). (A) Preprocedural chest radiograph at day 1 showing severe pulmonary congestion with a butterfly shadow. (B) Postprocedural chest radiograph at day 8 showing resolution of pulmonary edema.

FIGURE 2

Multidetector computed tomography (MDCT) images of aortic complex. Three‐dimensional reconstruction of MDCT showing a severely calcified aortic valve with left ventricular outflow tract calcification (A) and aortic running (B). Multiplanar reconstruction of MDCT showing an aortic annular area of 360.3 mm² (C), sinus of Valsalva diameter of 28.5 mm at the left coronary cusp, 28.0 mm at the right coronary cusp, 30.5 mm at the noncoronary cusp (D), and sinotubular junction maximum and minimum diameter of 25.7 mm and 25.0 mm (E).

FIGURE 3

Retrograde balloon aortic valvuloplasty using the Inoue balloon. Fluoroscopic images showing an inflated proximal portion of Inoue balloon (A), stable fixation of the Inoue balloon with its hourglass shape (B), and a fully inflated Inoue balloon (C). (D) Polygraph showing immediate recovery of blood pressure after balloon deflation. (E) Pressure tracing before BAV showing a mean pressure gradient of 51.5 mm Hg. (F) Pressure tracing after BAV showing a mean pressure gradient of 32.2 mm Hg. AO, aorta; LV, left ventricle