Deepak R. Talreja, M.D., presents a patient case where he performs an aortic balloon valvuloplasty procedure to correct severe aortic valve stenosis and improve blood flow across the valve.
Hello. My name is Deepak Tell raja. I'm a cardiologist with Sentara cardiology specialist. And today I'd like to review a case with you of a patient with severe aortic valve stenosis for whom we performed aortic balloon valvular plastic to improve the flow across the aortic valve. This delightful patient is a 72 year old Caucasian male with no previous cardiac history who's been noticing increasing progressive fatigue over the last two years. He'd actually given up golf about a year and a half before. He just didn't have the stamina to keep up with colleagues. And in the last few months he's noticed increasing symptoms consistent with congestive heart failure. He's had shortness of breath with walking on a level plane now and even progressing to where he gets short of breath sometimes at rest and he's noticed increasing swelling in his legs that was picked up during a recent hospitalization and during that hospitalization he was started on fluid pills. Diuretics to relieve the swelling in his legs and initially he responded but then became progressively more short of breath. We brought him into the cardiac catheterization laboratory at Sentara Virginia Beach General Hospital where we performed this balloon valvular plastic procedure after confirming his severe aortic valve stenosis. The patient has been brought back and prepared in the cardiac catheterization laboratory and we have access with the femoral arterial and venus sheath in this prepared patient here first we look at the coronary arteries and we see the left coronary artery first and now the right coronary artery and while there's calcification, mild disease there are no high grade lesions. We then crossed the aortic valve and we see the hallmark of severe Aortic valve stenosis. The white tracing shows us pressure from a catheter in the Aorta and the yellow tracing is a simultaneous catheter in the left ventricle and the peak to peak gradient is almost 100 of mercury. That's severe narrowing of the aortic valve. And we can actually take measurements and define the area of the valve and the gradient, which, as I said, approaches 100 of mercury. This is now the equipment we will use to open that valve. This is a balloon that can be inflated. It's two centimeters wide by six centimeters long and it's passed over a wire through the femoral artery and positioned inside the narrowed aortic valve. Here the balloon is inflated. Now the heart's still beating while we're inflating it. So the balloon gets ejected. But you can see just with that balloon inflation we reduce the pressure difference by approximately 50%. Here the gradient was rich reduced from an initial measurement of 90% down to just under 50% which is a wonderful result. And that showed in the patient's long term outcome. The patient went on to have a trans catheter aortic valve placed at Sentara heart hospital and is doing beautifully now and has returned to golf
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