Can Balloon Aortic Valvuloplasty Help Determine Appropriate Transcatheter Aortic Valve Size?
Vasilis C. Babaliaros, MD*,*,
David Liff, MD*,
Edward P. Chen, MD*,
Jason H. Rogers, MD ,
Ryan A. Brown, MD,
Vinod H. Thourani, MD*,
Robert A. Guyton, MD*,
Stamatios Lerakis, MD, FACC*,
Arthur E. Stillman, MD, PhD*,
Paolo Raggi, MD, FACC*,
Jennifer E. Cheesborough, BS*,
Emir Veladar, PhD*,
Jacob T. Green, MD*,
Peter C. Block, MD, FACC*
* Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, Georgia
University of California, Davis Medical Center, Sacramento, California
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Figure 1 Intraoperative Balloon Aortic Valvuloplasty: Schema of Set-Up and Forces Exerted
(A) Balloon catheter is attached to inflation syringe (Sy) and indeflator (In) in parallel via a 4-way stop cock to measure pressure in the balloon during inflation. (B) At maximal inflation, radial force (quantified by AIBP) is exerted by the native valve on the balloon (arrows) and by the balloon on the valve. AIBP = intra-balloon pressure in addition to the nominal inflation pressure of 2 atms.
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Figure 2 Bland-Altman Plot of Annulus Measurement at Surgery and by Echocardiography
(A) Bland-Altman plot comparing annulus measurement at surgery with TTE. (B) Bland-Altman plot comparing annulus measurement at surgery with TEE. TEE = transesophageal echocardiogram; TTE = transthoracic echocardiogram. Filled diamonds = difference; black lines = mean difference; blue lines = mean difference ± SD.
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Figure 3 Effect of Balloon Oversizing the Annulus in Tricuspid Aortic Valves
(A) Comparison of difference between balloon diameter and surgically measured annulus versus additional intraballoon pressure (AIBP) in mild (blue diamonds), moderate (red squares), and severely (yellow triangles) calcified tricuspid aortic valves (B) Comparison of difference between balloon diameter and transesophageal echocardiogram (TEE)-measured annulus versus AIBP in mild, moderate, and severely calcified tricuspid aortic valves.
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Figure 4 Effect of Balloon Oversizing the Annulus in Bicuspid Aortic Valves
(A) Comparison of difference between balloon diameter and surgically measured annulus versus additional intraballoon pressure (AIBP) in mild (blue diamonds), moderate (red squares), and severely (yellow triangles) calcified bicuspid aortic valves. (B) Comparison of difference between balloon diameter and transesophageal echocardiogram (TEE)-measured annulus versus AIBP in mild, moderate, and severely calcified bicuspid aortic valves. *Leaflet avulsion.
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