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| {{Aortic stenosis}}
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| {{CMG}}
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| '''Associate Editors-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]; [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com]; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]]
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| '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
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| ==Overview==
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| Surgical intervention may be a necessary component of treatment. Intervention methods may include utilizing various techniques of aortic valvuloplasty.
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| ==Aortic valvuloplasty===
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| ===Patient selection and treatment choices===
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| * Surgical Aortic valve replacement is the treatment of choice for aortic stenosis but many patients are not good candidates due to advanced age and multiple co-morbidities
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| * Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure
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| * It can be performed emergently in patients with end-stage heart failure due to aortic stenosis: patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis
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| * Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
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| * Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina
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| ====Technique====
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| The retrograde technique is the most commonly used technique.
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| *8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
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| *Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
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| *The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
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| *0.035” straight wire is commonly used to cross the valve and advance via pig-tail or Amplatz catheter; Right heart catheterization is done and transaortic gradient is typically measured pre-procedure
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| *The 0.035” wire is then exchanged for a stiffer 0.038”Amplatz exchange length wire with the tip shaped into a pig-tail shape so as not to injure the LV
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| *The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
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| *The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
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| *Meticulous control of balloon position must be maintained at all times by backward traction on the balloon to prevent jumping forward and injuring/perforating the LV apex
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| ==References==
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| {{reflist|2}}
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| [[Category:DiseaseState]]
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| [[Category:Signs and symptoms]]
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| [[Category:Physical Examination]]
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| [[Category:Valvular heart disease]]
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| [[Category:Cardiology]]
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| [[Category:Congenital heart disease]]
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| [[Category:Mature chapter]]
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| {{WH}}
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| {{WS}}
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