Feasibility of a pressure wire and single arterial puncture for assessing aortic valve area in patients with aortic stenosis

BACKGROUND: Determination of a transvalvular pressure gradient for measurement of aortic valve area (AVA) by hemodynamic cardiac catheterization usually requires 2 catheters and 2 arterial access sites. We assessed the feasibility of using a single arterial puncture and a 0.014 inch pressure wire for evaluation of aortic stenosis. METHODS: Eighteen patients (mean age, 76 years; 10 men) underwent hemodynamic catheterization for assessment of AVA. Cardiac output was determined by thermodilution (using a pulmonary artery catheter), and the transvalvular pressure gradient was obtained from simultaneous pressure recordings (using a pressure wire to measure left ventricular pressure and a 5 Fr catheter to measure ascending aortic pressure). RESULTS: This novel technique was technically feasible in all patients. Calibration of the pressure wire with the pressure of the fluid-filled catheter was possible and accurate in the left ventricle and aorta. The method required 36.4 ± 9.6 minutes from injection of a local anesthetic to completion of AVA measurement; 53.3 ± 18.6 minutes were required to finish all catheterization procedures, including coronary angiography. Measurements of AVA (mean, 1.01 ± 0.43 cm2) and pressure gradients (mean, 27.5 ± 10.5 mmHg) taken by a pressure wire were similar to measurements taken by Doppler echocardiography (1.07 ± 0.58 cm2 and 32.9 ± 12.1 mmHg, respectively); the correlation was significant (r = 0.856; p < 0.001, and r = 0.741; p < 0.001, respectively). CONCLUSIONS: Our findings suggest that a single arterial approach using a pressure wire is feasible, safe, accurate and rapid for the invasive assessment of aortic stenosis.