Author + information
- Kiwamu Kamiya1
The use of balloon aortic valvuloplasty (BAV) is increasing in the current transcatheter aortic valve replacement era. The recent development of the real-time phased-array intracardiac echocardiogram (ICE) with 2D and color Doppler imaging could play a critical role in monitoring therapeutic effects of balloon inflations or in diagnosing potential complications in their early stages.
In this study, 10 severe aortic valve stenosis (AS) patients who underwent ICE-guided BAV were retrospectively compared with 12 AS patients in whom the conventional technique was used. ICE-guided BAV was obtained in all cases starting April 2015 (ICE group) while conventional technique without ICE guidance (non-ICE group) was used in cases prior to this date. All BAV procedures were performed by a transvenous transseptal (antegrade) approach to access the aortic valve.
The mean age was not found to be statistically significant between the groups (84.2 ± 5.5 vs. 83.3 ± 1.4, p=0.68). Technical success was achieved in all patients. Mean trans-aortic valve pressure gradient improved from 55.3 ± 19.4 mmHg to 37.7± 14.3 mmHg (P<0.01) and aortic valve area increased from 0.63 ± 0.18 cm2 to 0.86 ± 0.19 cm2(P<0.01). There was no statistically significant difference between ICE group and non-ICE group. One patient died from a cardiovascular cause within 30 days of BAV procedure and 1 patient developed cardiac tamponade in the non-ICE group. The rates of patients with worsening aortic valve regurgitation were higher in the non-ICE group than in the ICE group after the procedure. Average procedure time was found to be significantly shorter in the ICE group than in the non-ICE group (94 ± 14 minutes vs. 101 ± 15 minutes, P=0.018).
ICE is now employed to provide real-time imaging of relevant intracardiac structures for BAV procedures. The use of ICE during BAV procedures facilitates procedural efficacy and identifies and potentially reduces complications.