Although this study is small, it points to a very important aspect of ultrasound measurements of atherosclerosis: measurements performed in the common carotid artery or the femoral artery may not relate to coronary atherosclerosis in the same way as measurements performed in the carotid bulb. The findings underline the importance of measuring IMT not only in the common carotid artery but also in the carotid bulb and present data separately. These results have to be confirmed in a larger-scale study.
Despite its status as the indisputable standard of reference for the detection of coronary artery disease, conventional coronary angiography remains costly and highly invasive, with associated risks of major complications, including stroke and death. Breath-hold volume targeted acquisitions permit rapid localization and coverage of the entire coronary tree with adequate resolution for evaluating the coronary arteries.
Objective-To investigate whether balloon dilatation of the aortic valve induces long-term macroscopic or histological changes or both to explain the restenosis process.
Twenty-five elderly patients with calcific aortic stenosis, 12 male (48%) and 13 female (52%), mean age 74.8 +/- 7.6 years, underwent percutaneous aortic balloon valvuloplasty between March 1986 and September 1987. Twenty-two patients (88%) were in class III-IV of the New York Heart Association, 13 (52%) had a history of previous angina and 7 (28%) of syncopal attacks. All patients had been considered either unsuitable or high-risk candidates for aortic-valve replacement because of age or associated diseases. Balloons of increasing size (area ranging from 1.3 to 3.8 cm2 during inflation) were successively passed retrogradely from the femoral artery and manually inflated to 3-7 atmospheres. Inflation duration ranged from 15 to 260 s (mean 40 s). Post-dilatation there were significant changes in left ventricular peak-systolic and end-diastolic pressures (P less than 0.00001 and P less than 0.01, respectively), mean systolic aortic transvalvular gradient (from 73 to 43 mmHg, P less than 0.000001), mean systolic aortic flow (from 176 to 208 ml s-1, P less than 0.0001) and aortic valve area (from 0.47 to 0.72 cm2, P less than 0.000001). Major complications included: in-hospital deaths of two patients (8%) admitted in cardiogenic shock; left haemiplegia (4%); transient haemianopia (8%); development of grade III aortic insufficiency (4%); and persistent complete atrioventricular block (4%). Complications at the puncture-site occurred in 7 patients (28%)--including two femoral pseudoaneurysms and the need for surgical removal of a balloon remnant after rupture in one patient. No local haemorrhagic complications were observed in the latter eight procedures, performed using a 16.5 French 100-cm long arterial introducer. At a mean follow-up of 13.0 +/- 5.0 months, an important functional improvement persisted in 14 patients (56%), no major changes in pre-valvuloplasty symptoms were observed in 3 patients (12%), while five patients (20%) required surgical treatment after a successful valvuloplasty because of recurrence of symptoms (late valve restenosis). Percutaneous aortic balloon valvuloplasty is a possible palliative therapy in elderly patients with calcific aortic stenosis. However, its inherent immediate risk, limited haemodynamic result and the possible development of valve restenosis at medium-term follow-up, suggest that the application of this technique should be limited to poor surgical candidates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.