Retrograde catheterization of left ventricle through mechanical aortic prostheses

Twenty-three patients who had undergone aortic valve replacementwith a mechanical aortic vlave prosthesis (ball-valve: 17, tilting-disc:6) were investigated by retrograde left ventricular catheterizationusing a 6 F pigtail catheter. Tweleve of these 23 patients alsohad combined aortic and mitral valve replacement. To assessthe magnitude of the catheter-induced aortic regurgitation andits effect on left ventricular and mitral valve function, 10patients (group 1) were simultaneously investigated by the transseptalroute (8 patients) or direct left ventricular puncture. The13 other patients (group 2) were studied only by the retrogradecrossing of the aortic valve prosthesis. In group 1, placementof the catheter across the valve induced an increase in heartrate (+ 12%), in left ventricular end-diastolic pressure (from17.2±9.6 to 33.3±12.0 mmHg), a decrease om aorticsystolic (–19%) and diastolic (–25%) pressures,and left ventricular systolic pressure (–10%). Transvalvularaortic pressure gradient increased from 15.4±8.2 to 23±12.1mmHg. Pre- and post-crossing pressure gradients were linearlycorrelated (r=0.98). Hence, the magnitude of catheter-inducedaortic regurgitation averaged 27% whether or not a pre-crossingregurgitation was noted. In group 2, retrograde crossing ofthe aortic valve prosthesis induced similar hemodynamic changes.There were no catheterization-related complications.On the basisof catheterizations studies, re-operation was contraindicatedin 2 patients because of severe left ventricular depression,and recommended in 18: aortic valve dysfunction in 14 patients,mitral valve incompetence in 4 patients. In 3 patients, thehemodynamic study ruled out any aortic valve prosthesis dysfunction,associated mitral valve disease and depressed left ventricularfunction. Intraoperative findings (15 patients) and postmortemexamination (7 patients) were consistent with catheterizationdata. Left ventricular retrograde catheterization is an alternativetechnique of investigation for patients with mechanical valvesin both mitral and aortic positions or in centers where theusual approach (transseptal catheterization or direct LV puncture)are not performed.