From July, 1971, through February, 1979, thirty-eight highly selected adult patients with symptomatic aortic stenosis (N.Y.H.A. Class III to IV) underwent aortic valvuloplasty rather than valve replacement. The choice of aortic valvuloplasty was based on the presence of one or more of the following factors: advanced age (over 75 years), calcification of the aorta and/or aortic annulus, small aortic annulus, severe coronary artery disease, poor left ventricular function (ejection fraction less than 25%), difficulty in coronary cannulation, or contraindication to anticoagulation. In addition, patients with the combination of severe coronary artery disease and aortic stenosis of insufficient severity to warrant valve replacement were teated by aortic valvuloplasty at the time of coronary artery bypass. The gradient across the aortic valve averaged 61.7 mmHg preoperatively and 8.4 mmHg postoperatively. There were two operative deaths (one from pre-existing renal failure) and two late deaths (pulmonary embolus and CHF). No patients were lost to follow-up. Thirty-two of thirty-four surviving patients experienced initial functional improvement. Five patients developed recurrent aortic stenosis (mean time 42.8 months after operation); and four required reoperation. The five year actuarial survival was 85.7% with a mean follow-up period of 24.8 months (range 1 to 91 months). The results in this high-risk subset of patients suggest that aortic valvuloplasty has a definite place in the treatment of selected cases of aortic stenosis.

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PubMedDate not supplied

Postinfarctional rupture of the interventricular septum.

During a nine year period, 36 patients have been treated at the Mid-America Heart Institute for postinfarctional rupture of the interventricular septum. Twenty-two (61%) of the patients were male and the average age was 68.9 years. Coronary angiography revealed that 48% of the patients had single vessel coronary artery disease. Eight patients, under medical treatment, stabilized with congestive heart failure. One of these patients was operated upon early and six patients initially managed medically underwent delayed operation 1-6 months after septal rupture without operative mortality. Twenty-eight patients presented with or acutely developed the low cardiac output syndrome following septal rupture. None of eight such patients managed by medical treatment alone survived. The other twenty patients underwent emergency operation within seven days of occurrence of the ventricular septal rupture with seven operative deaths. In the entire surgical group, there were six late deaths and fourteen patients are currently surviving five months to six years and seven months postoperatively. It is concluded that patients who develop postinfarctional ventricular septal rupture and resultant low cardiac output syndrome should undergo prompt diagnostic studies and emergency surgical therapy. Those patients who stabilize with congestive heart failure are initially best managed medically and should undergo delayed surgical repair.

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