Predictors of event-free survival after balloon aortic valvuloplasty

Article Abstract:

The aortic valve is a structure in the heart that directs the flow of blood from the left ventricle to the aorta, the major blood vessel that supplies freshly oxygenated blood to the entire body. Stenosis, or narrowing of the aortic valve, may result in regurgitation, or backflow, of blood into the left ventricle. Aortic stenosis can be treated by replacing the aortic valve or by balloon aortic valvuloplasty. In balloon aortic valvuloplasty, a balloon is inserted into the aortic valve and inflated, thereby widening the narrowed area. Although balloon valvuloplasty was shown to be safe and effective in improving circulation, it is associated with a high rate of restenosis, or recurrence of narrowing. In addition, recent studies suggest that aortic valve replacement in some elderly patients with aortic stenosis is associated with a low death rate of less than 10 percent. The factors that predict survival without restenosis following balloon aortic valvuloplasty were assessed in 205 patients. The rate of survival without restenosis was 18 percent over a follow-up period of two years. Factors associated with increased survival included: the left ventricular ejection fraction (percentage of blood emptied from the left ventricle at the end of a contraction) before valvuloplasty; pressures in the left ventricle and aorta during the contraction phase of the heart cycle before valvuloplasty; a decrease in blood pressure within the aortic valve after valvuloplasty; and pulmonary-capillary wedge pressure (a measure of the blood pressure in the left ventricle at the end of the relaxation phase of the heart cycle). The rate of survival without restenosis was estimated to be between 23 and 65 percent at the end of one year, based on three predictive factors: aortic pressure during heart contraction, pulmonary-capillary wedge pressure, and decreased aortic pressure after valvuloplasty. These findings suggest that survival without restenosis after balloon aortic valvuloplasty is associated with factors related to the function of the left heart ventricle. Patients likely to experience long-term survival after balloon aortic valvuloplasty would also be likely to do well after aortic valve replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Abnormalities, Physiological aspects, Heart ventricle, Left, Left heart ventricle, Aortic valve stenosis, Heart valves

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Predictors of long-term outcome after percutaneous balloon mitral valvuloplasty

Article Abstract:

Balloon mitral valvuloplasty may be an effective treatment for mitral stenosis, a narrowing of the opening of the mitral valve in the heart. Balloon mitral valvuloplasty is a procedure that uses a balloon-tipped catheter to open the mitral valve. Among 146 patients with mitral stenosis on whom balloon mitral valvuloplasty was attempted, 136 (93%) were successfully treated. Twenty-four patients (18%) who underwent the procedure suffered a recurrence of symptoms. Ninety-two patients (63%) were alive an average of 38 months after balloon mitral valvuloplasty was attempted. The estimated disease-free survival rate for patients undergoing balloon mitral valvuloplasty was 74% at the end of two years and 51% at the end of five years. Patients with severe heart valve disease or heart disease were less likely to survive to five years.

Surgery, Mitral valve stenosis, Mitral valve

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A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting

Article Abstract:

Aspirin and ticlopidine may be the most effective drug combination for preventing blood clotting around a coronary artery stent. Stents are small metal cylinders used to keep clogged arteries open. Researchers randomly assigned 1,653 patients who received a stent to treat coronary artery disease to take aspirin alone, aspirin and warfarin, or aspirin and ticlopidine. All of these drugs are anticoagulants. Those taking aspirin and ticlopidine were least likely to experience blood clotting around the stent but they were about three times more likely to experience bleeding than those who took aspirin alone.

Prevention, Complications and side effects, Aspirin, Thrombosis, Warfarin, Stent (Surgery), Stents, Ticlopidine

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