Results of repeat balloon valvuloplasty for treatment of aortic stenosis in patients aged 59 to 104 years.

Balloon aortic valvuloplasty (BAV) may be considered a palliative procedure that is performed in patients who have severely symptomatic aortic stenosis and a prohibitive surgical risk. However, due to poor early survival rates, most previous studies have involved a single BAV procedure. We analyzed long-term outcomes in patients who had severe aortic stenosis and BAV that incorporated repeat procedures to maintain symptom relief and increase survival rate. We retrospectively analyzed 212 consecutive nonsurgical patients (59 to 104 years old) who had severe calcific aortic stenosis and underwent 282 cumulative BAV procedures. Demographic, procedural, and follow-up mortality data were collected. BAV was performed with single or incremental balloon dilatation to obtain a postprocedural transaortic gradient close to 1/3 of the baseline gradient. Peak transaortic gradient after BAV decreased from 55 +/- 22 to 20 +/- 11 mm Hg and aortic valve area increased from 0.6 +/- 0.2 to 1.2 +/- 0.3 cm(2). Mean follow-up duration was 32 +/- 18 months. During follow-up, 24% of patients underwent a second BAV and 9% of patients underwent a third BAV. Duration of symptom alleviation after the first, second, and third BAV procedures were 18 +/- 3, 15 +/- 4, and 10 +/- 3 months, respectively. Median survival rate after BAV was 35 months. Survival rates 1, 3, and 5 years after the procedure were 64%, 28%, and 14% respectively. Patients who underwent repeat BAV had higher 3-year survival rates than did patients who underwent 1 BAV (p = 0.01). Therefore, repeat BAV is a viable treatment strategy in nonsurgical patients who have severe calcific aortic stenosis, because it provides a median survival rate of approximately 3 years and maintains clinical improvement.

Relationship among electrocardiographic potential amplitude, weight, and resistance/reactance/impedance in a patient with peripheral edema treated for congestive heart failure.

We are presenting a 79-year-old woman with congestive heart failure (CHF) and marked peripheral edema, who responded to medical management by losing 19.7% of her weight. The patient was studied with daily weights, 12-lead electrocardiograms (ECGs), and body electrical resistance/reactance/impedance (R/R/I) measurements via electrodes applied on her hand and foot. In the process she showed a gradual increase in the QRS complexes in her daily ECGs pari passu with the weight loss, leading to a 27.4% increase in the sums of the QRS complexes from the 12 ECG leads ( summation operator SQRS). In addition the patient revealed excellent correlations between weights and summation operator SQRS (r = -.91, P =.013), weights and resistance (r = -.95, P =.004), reactance (r = -.86, P =.029), and impedance (r = -.95, P =.004). Other ECG sets including fewer leads were also employed and correlated with weights and the body electrical properties. It is concluded that loss of peripheral edema in patients with CHF is associated with augmentation of body R/R/I leading to augmented ECG QRS complexes. These findings link etiologically changes of ECG potentials to alteration of body electrical properties, and suggest that serial ECGs could be used in the monitoring of therapy of patients with CHF.