DATE OF PROCEDURE:
MM/DD/YYYY
REFERRING PHYSICIAN:
John Doe, MD
PREOPERATIVE DIAGNOSES:
1. Critical aortic valve stenosis.
2. Angina pectoris.
3. Congestive heart failure.
POSTOPERATIVE DIAGNOSIS:
Successful balloon aortic valvuloplasty with reduction in transvalvular gradient from greater than 50 mm to 24 mm.
PROCEDURE PERFORMED:
Balloon aortic valvuloplasty, temporary transvenous pacemaker, Swan-Ganz catheter insertion
COMPLICATIONS:
None.
DESCRIPTION OF PROCEDURE:
Following 1% Xylocaine local anesthesia in the right femoral region using the Seldinger technique, an 8 French Hemaquet sheath was inserted in the right femoral artery. Following 1% Xylocaine local anesthesia in the left femoral region using the Seldinger technique, a 6 and 7 French Hemaquet sheath was inserted in the left femoral vein. A 5 French balloon-tipped pacemaker catheter was positioned in the right ventricular apex and a 7 French Swan-Ganz catheter was advanced in antegrade fashion through the right heart chambers and positioned in the pulmonary artery.
Pressure measurements were ascertained. A 5 French Amplatz S1 catheter was used to place a guidewire across the aortic valve after which time an 8 French sheath was exchanged and an 8 French dual-lumen pigtail catheter was placed across the aortic valve. With this across the valve, simultaneous transvalvular pressure gradients were measured. This catheter was removed and a 24 mm balloon was inserted through a 12 French sheath in the right femoral artery. This 24 mm diameter Z-MED balloon was then placed across the aortic valve and a total of nine inflations were performed with considerable difficulty, keeping the balloon at the level of the aortic valve despite the fact that the heart was being paced at the rate of 220 beats per minute.
Following nine successive inflations with the balloon in the aortic valve, transvalvular pressures were again measured with an 8 French dual-lumen pigtail catheter, which demonstrated a gradient of 24 mmHg. All catheters were removed. The patient was taken to the holding area of the catheterization laboratory without incident. There were no complications to the procedure.
SUMMARY:
Preballoon transvalvular gradient was 50-55 mmHg and was reduced by balloon valvuloplasty to 24 mmHg.
CONCLUSIONS:
1. Successful balloon valvuloplasty of the aortic valve with reduction in gradient from greater than 50 to less than 25 mmHg.
2. No complications to the procedure.
