A case of severe aortic stenosis with severe coronary artery disease that was successfully treated by balloon aortic valvuloplasty and percutaneous coronary intervention

摘要

We describe an 85-year-old woman with severe aortic stenosis, who also had severe coronary artery disease. She suffered from dyspnea on exertion and frequent syncope. Echocardiography revealed an immobile and heavily calcified aortic valve, and coronary angiography revealed two-vessel disease including chronic total occlusion. Openheart surgery was refused and she was referred to our department. She underwent percutaneous coronary intervention (PCI) for the right coronary artery and left anterior descending artery. Following PCI, percutaneous balloon aortic valvuloplasty (BAV) was performed on the same day. We chose balloons of 15 × 60 mm, 18 × 60 mm, and 20 × 60 mm, respectively. Improvement in the mean aortic valve pressure gradient (PG) and calculated aortic valve area (mean PG 48-23 mmHg, 0.8-1.2 cm 2, respectively) was observed after the final balloon dilatation. No significant complications occurred. The combination of BAV with PCI may be a useful treatment for relief of the associated symptoms of severe aortic stenosis and coronary artery disease, though it does not improve the long-term prognosis. cardiovascular disease is growing, and coronary artery disease and aortic stenosis are frequently observed in elderly patients [1, 2]. Elderly patients also have more concomitant diseases, including peripheral artery disease, cerebrovascular disease, and chronic kidney disease. These diseases strongly affect the perioperative risk for elderly patients and contribute to the prognosis of elderly patients. In inoperable patients with severe aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) is an effective treatment modality [3]. High-risk inoperable patients with severe AS as well as significant coronary artery disease (CAD) requiring revascularization, however, are not eligible for TAVI. In these patients, balloon aortic valvuloplasty (BAV) is currently the only method used to alleviate symptoms associated with severe AS, such as dyspnea and syncope, though long-term survival after BAV is poor. Here we report the case of an elderly female patient with severe AS and CAD including chronic total occlusion, who underwent BAV and percutaneous coronary intervention (PCI) on the same day.