Balloon aortic valvuloplasty in young adults by antegrade, transseptal approach using Inoue balloon

Abstract

Transvenous, transseptal, antegrade balloon aortic valvuloplasty (BAV) was successfully performed in 16 consecutive young adults with noncalcific aortic stenosis using Inoue balloon catheter. There were 13 males and three females, with a mean age of 20.4 +/- 5.8 years (range 14-30 years). All the patients had normal left ventricular systolic function. All procedures were performed electively by the antegrade technique, except the initial index case in whom, the stenosed aortic valve could not be crossed retrogradely. Dilatation was performed using stepwise technique keeping the balloon:annulus ratio < or = 100% in all the cases. Transaortic peak systolic gradient decreased from 113.4 +/- 42.6 (range 70-210) mm Hg to 11.2 +/- 9.2 (range 4-32) mm Hg; P = 0.0005. Following BAV, three patients developed grade 2+ aortic regurgitation, who were managed medically. None of the patients developed tamponade, vascular complications, excessive bleeding, or thromboembolism. Significant left to right atrial shunt (Qp/Qs > or = 1.5:1) was observed in one case. The average procedure time was 20 +/- 8 min (range 18-35 min). On follow-up (n = 11 patients) at 4 +/- 1.5 months (range 2-7 months) all the patients were asymptomatic. Doppler transaortic peak systolic gradient was found to be 15 +/- 10.3 mm Hg (range 4-36 mm Hg). Antegrade BAV technique using Inoue balloon for noncalcific aortic stenosis in young adults is safe, effective and may be technically advantageous.