The Effects of Successful Percutaneous Mitral Balloon Valvuloplasty on Acute and Intermediate Term Aortic Stiffness

Effect of successful percutaneous balloon mitral valvotomy on aortic elastic properties in mitral stenosis

Background: Aortic elastic properties in mitral stenosis have not been much studied. To date, only a few studies have studied the effect of percutaneous balloon mitral valvotomy (BMV) on aortic elastic properties. This was the first study done in Indian subcontinent in a tertiary care hospital in South India studying the effect of BMV on aortic stiffness in severe rheumatic mitral stenosis. We studied the relationship between aortic elastic properties and mitral stenosis and the effect of BMV on the same. Results: A total of thirty-two patients satisfying the criteria for severe mitral stenosis underwent balloon mitral valvotomy. All parameters were compared with age and sex-matched healthy volunteers. Aortic elastic properties were assessed by aortic strain and aortic stiffness index (ASI). The aortic strain was significantly higher in the patients with mitral stenosis 24-48 h after BMV, whereas the ASI was significantly lower. There was a significant decrease in mitral mean gradient and systolic pulmonary artery pressure after BMV. Mitral valve area significantly increased after BMV. Conclusions: Aortic elastic properties, as assessed by aortic stiffness, are usually impaired in patients with mitral stenosis, which improves following balloon mitral valvotomy.

Dynamic Changes in Aortic Vascular Stiffness in Patients Bridged to Transplant With Continuous-Flow Left Ventricular Assist Devices

OBJECTIVES

The aim of this study was to measure aortic vascular stiffness from orthotopic heart transplant (OHT) patients exposed to varying types of flow as a result of the presence or absence of left ventricular assist device (LVAD) support pre-OHT.

BACKGROUND

The effects of continuous-flow LVADs (CF-LVADs) on vascular properties are unknown, but may contribute to the pathophysiology of CF-LVAD complications such as stroke, hypertension, and bleeding.

METHODS

Echocardiograms were reviewed from 172 OHT patients immediately before LVAD and at 3 time points post-OHT: baseline, 6 months, and 1 year. For each study, pulse pressure and aortic end-systolic and end-diastolic dimensions were used to calculate aortic strain, distensibility, and stiffness index. Patients were categorized into 3 groups based on the presence or absence of a LVAD and a pulse pre-OHT: No LVAD (n = 111), LVAD No Pulse (n = 30), and LVAD With Pulse (n = 31).

RESULTS

The aortic stiffness index among LVAD No Pulse patients increased from 2.8 ± 1.1 pre-CF-LVAD to 10.9 ± 4.7 immediately post-OHT (p < 0.001). This aortic stiffness index was also significantly higher compared with No LVAD (3.4 ± 1.1; p < 0.001) and LVAD With Pulse (3.7 ± 1.4; p < 0.001) immediately post-OHT with attenuation of these differences by 1 year post-OHT. Similar findings were noted for the other indices of aortic stiffness.

CONCLUSIONS

Aortic stiffness is markedly increased immediately post-OHT among patients bridged with CF-LVADs, with attenuation of this increased stiffness over the first year after transplant. These results suggest that aortic vascular properties are dynamic and may be influenced by alterations in flow pulsatility. As more patients are supported with CF-LVADs and as newer pump technology attempts to modulate pulsatility, further research examining the role of alterations in flow patterns on vascular function and the potential resultant systemic sequelae are needed.