Successful Balloon Aortic Valvotomy as a Bridge to Aortic Valve Replacement Surgery [At Lilavati Hospital]

Dr. Pavan Kumar, Dr. Suresh Vijan, Dr. Ravi Bhatnagar, Dr. Amit Modi,
Dr. Hitendra Mevada

Department Of Cardiac Surgery

A 45yr old gentleman, K/C/O severe critical Aortic stenosis [gradient of 110 mmHg] severe LV dysfunction presented to us at Lilavati Hospital with severe breathlessness with hemoptysis.

His general condition was poor, afebrile on presentation with pulse of 120/min regular and B. P. of 80 / 50 mm Hg [ RUL]. He was absolutely pale with RR of of 40 / min, cold peripheries and had B / L coarse crepitations.

He was admitted to the ICU and ventilated. Inotropic support was started. Chest X – Ray showed florid pulmonary edema inspite of a very high Inotrapic support. Tissue perfusion continued to remain low as indicated by a fall in urine output and prerenal azotemia. Lasix infusion was initiated and patient was taken up for an emergency balloon aortic valvotomy + CAG by Dr. Suresh Vijan.

Coronary angiogram was ( N ) and balloon aortic valvotomy was carried out successfully. Inotropic support decreased and urine output increased in few hrs. Patient was stabilized and prepared for aortic valve replacement.

Mr. ZN was operated by Dr. Pavan Kumar and team, four days after aortic valvotomy. Aortic valve was excised and replaced using # 21 St Jude Bileaflet Metal prosthesis with 2 – 0 interrupted pledgeted Ethibond sutures. Patient tolerated the procedure well and was extubated on the following day.

He was shifted to the ward on post op day – four and discharged home on POD – 10 without any neurological deficit. Post op follow up 2 D – Echo showed normally functioning prosthetic aortic valve with LV function of 35% This demonstrates that Aortic balloon valvotomy Can be used as a Bridge to buy time and stabilize critically ill patients with A. S. to undergo successful A.V.R.