Ultrasonic aortic valve decalcification: Serial Doppler echocardiographic follow-up

Serial two-dimensional and Doppler echocardiography was performed on 61 patients who had surgical ultrasonic aortic valve decalcification for calcific aortic stenosis. The mean patient age at the time of operation was 77.4 ± 7.0 years; 93% had moderate to severe preoperative symptomatic limitation. Compared with preoperative studies, Doppler echocardsographic evaluation before hospital discharge revealed a significant reduction in the mean aortic valve pressure gradient (45.3 ± 16.2 to 14.4 ± 6.5 mm Hg, p < 0.0001) and improvement in aortic valve area (0.62 ± 0.17 to 1.33 ± 0.33 cm², p < 0.0001). There was no initial change in aortic regnrgitation grade. Follow-up Doppler echocardiographic evaluation was passible in 43 patients alive at 9.3 ± 3.9 months. A small but statistically significant trend toward aortic restenosis was found; only one patient had severe restenosis. Severe aortic regurgitation had developed in 26% of patients and moderate aortic regurgitation in 37%. Aortic valve replacement was performed in six patients (14%) wiyh severe symptomatic aortic regurgitation. Significant deficiency in central coaptation as a result of cusp scarification and retraction appeared to be the mechanism of postdecalcification regurgitate. Attempted salvage of the native aortic valve in severe calcific stenosis by ultrasonic decalcification adequately relieves stenosis but leads to an unacceptable incidence of significant aortic regurgitation at follow-up study.