Bilateral Slender Transradial Aortic Balloon Valvuloplasty

J INVASIVE CARDIOL 2018;30(6):E48-E49.

Key words: aortic valvuloplasty, aortic stenosis, double radial balloon

An 89-year-old woman with multiple comorbidities and cachexia was admitted to the hospital for refractory heart failure treatment. Echocardiogram revealed a hypertrophied left ventricle with a severe calcific aortic stenosis (pressure gradient, 60 mm Hg; mean gradient, 23 mm Hg; aortic valve area, 0.6 cm²; annulus, 20 mm) and a moderate mitral regurgitation. A percutaneous aortic balloon valvuloplasty as a bridge-to-decision strategy was proposed. Femoral pulses were absent, so we opted for a variant technique using both right and left radial access. Two Glidesheath Slender 6/7 Fr sheaths (Terumo) were placed in the radial arteries and a left venous subclavian access was used for temporary pacemaker (Figures 1A-1C). Coronary angiography and aortography were performed (Figures 1D-1F), and the baseline left ventricle to aorta peak-to-peak gradient was 55 mm Hg.

Two semicompliant CBP balloons (12-40 mm; Balt) were advanced respectively over extra-stiff guidewires at the level of the annulus and inflated at 6 atm using a kissing-balloon technique during rapid pacing without any balloons sliding, with a predicted effective balloon diameter of 20 mm (Figures 1G-1I). Two dilations were performed without complications with a final peak to peak gradient of 10 mm Hg. Electrocardiogram was unchanged from baseline, and no vascular complications occurred. The patient did well; after 1 week, she was discharged home and referred as a possible candidate of transcatheter aortic valve implantation.

View the accompanying video here.

From the Interventional Cath Lab, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors reports no conflicts of interest regarding the content herein.

Manuscript accepted February 22, 2018. 

Address for correspondence: Alberto Francesco Cereda, MD, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo – Italy. Email: alberto.cereda@email.it