Hemodynamic rounds: Transvalvular pressure gradient measurement

Fusman, Benjamin; Faxon, David P.; Feldman, Ted

doi:10.1002/ccd.1222

Cited by 25 publications

(11 citation statements)

References 29 publications

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“…Preclosure of the puncture site was performed using a 10 Fr Perclose device as described previously and replaced by 12.5 or 14 Fr sheath for the valvuloplasty procedure [14]. The valve was crossed from the aortic root and the valve area measured [19, 20]. A 0.038″ extrastiff guidewire with a large‐radius distal curve was exchanged into the left ventricle.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous balloon aortic valvuloplasty: Antegrade transseptal vs. conventional retrograde transarterial approach

Sakata

Syed

Salinger

et al. 2005

Cathet Cardio Intervent

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Percutaneous balloon aortic valvuloplasty (BAV) has been limited predominantly to a palliative treatment for poor surgical candidates with critical aortic stenosis and multiple high-risk or comorbid conditions. The most commonly used technique for BAV is the retrograde approach, in which the balloon is passed via the femoral artery using 12-14 Fr sheaths. We compared an antegrade transseptal approach using the Inoue balloon vs. the retrograde transarterial approach using conventional balloons. The antegrade group had an improved acute hemodynamic outcome, including 20% additional increase of aortic valve area and 20% greater reduction of transaortic valve gradient compared to the retrograde approach. Preclosure with the Perclose device was used for the 14 Fr venous access sites, resulting in immediate hemostasis, minimizing the need for transfusion, and diminishing the period of bed rest. The improved acute efficacy and relative ease of venous access for the antegrade approach facilitate BAV by eliminating the need for large-caliber arterial access sheaths. The antegrade approach also incorporates technical elements necessary for percutaneous aortic valve replacement and may have expanded applications as an adjunct to this developing therapy. The impact of improved acute results on the long-term clinical outcome for this patient group will require further study.

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Section: Methodsmentioning

confidence: 99%

Percutaneous balloon aortic valvuloplasty: Antegrade transseptal vs. conventional retrograde transarterial approach

Sakata

Syed

Salinger

et al. 2005

Cathet Cardio Intervent

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“…The use of coronary pressure wire was described by Fusman et al and Bae et al for native valves Five previously described cases showed use of this coronary pressure wire in patients with bileaflet St. Jude (4 cases) and single tilting disc Bjork‐Shiley (1 case) mechanical AoV for assessment of trans‐valvular gradient (Table ). Compared to large plastic‐coated standard angiography catheters, the coronary pressure wire is very low profile with a 0.014" diameter, which makes it easy to maneuver through double disc mechanical valves without apparent risk of entrapment in the space between the closed discs.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde crossing of a mechanical AoV with standard diagnostic catheters has been shown to be associated with risk of catheter entrapment and related fatal complications . Fusman et al have demonstrated the application of a 0.014″ diameter coronary pressure wire, commonly used for coronary fractional flow reserve (FFR) assessment, for hemodynamic evaluation of native aortic valve stenosis . This tool and technic was further tested and proved safe, feasible and accurate in a series of eighteen patients by Bae et al in native aortic stenosis .…”

Section: Introductionmentioning

confidence: 99%

Assessment of trans‐aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses

Kherada

Brenes

Kini

et al. 2017

Cathet Cardio Intervent

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Accurate evaluation of trans-aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non-invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans-valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans-septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans-valvular gradients using a 0.014˝ diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76-year-old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high-fidelity 0.014˝ diameter coronary pressure guidewire resulted in the detection of a normal trans-valvular pressure gradient across the mechanical aortic valve. This avoided a high-risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc.

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“…As a limitation, one could argue that left heart catheterisation was not mandatory in the first place. Indeed, alternative methods such as dual arterial puncture or dual-lumen catheter can be used to assess dynamic outflow obstruction 7. Two arterial punctures can be performed, placing one catheter in the left ventricle and one in the ascending aorta just above the aortic valve.…”

Section: Discussionmentioning

confidence: 99%

Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture

et al. 2016

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Hemodynamic rounds: Transvalvular pressure gradient measurement

Cited by 25 publications

References 29 publications

Percutaneous balloon aortic valvuloplasty: Antegrade transseptal vs. conventional retrograde transarterial approach

Percutaneous balloon aortic valvuloplasty: Antegrade transseptal vs. conventional retrograde transarterial approach

Assessment of trans‐aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses

Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture

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