Q. Explain procedure of Aortic Valvuloplasty?

BAV is usually performed by the retrograde transarterial approach. Often another catheter is placed in the LV through transseptal approach to provide continuous LV pressure monitoring throughout the procedure. The AS gradient is measured before angiography from simultaneous ventricular and aortic pressure recordings. After transseptal puncture, heparin is administered to keep the Activated Clotting Time 250-300sec. The aortic valve is crossed in a retrograde manner and a pigtail catheter is positioned in LV apex. If it cannot be crossed retrogradely, it can be crossed antegradely using a transseptal catheter. An exchange length guidewire is passed from the femoral arterial sheath and is used to guide the balloon dilatation catheter across the aortic valve in a retrograde direction.

Biplane LV angiogram is performed in 70 LAO, 20 cranial angulation and frontal or RAO projections. The aortic annulus is best measured in LAO view or in echo. Valvuloplasty is performed by single or double balloon technique. Exchange length wire is passed across the aortic valve and anchored in LV apex. A balloon whose diameter is same or 1mm less than the aortic annulus is chosen. For double balloons, the sum of diameter of the balloons should not exceed 1.2 to 1.3 times the aortic annulus. The balloon/balloons are inflated across the aortic valve until the waist disappears. Aortic root angiogram is performed post procedure to assess aortic regurgitation.