Retrograde catheterization of left ventricle through mechanical aortic prostheses

Twenty-three patients who had undergone aortic valve replacement with a mechanical aortic vlave prosthesis (ball-valve: 17, tilting-disc: 6) were investigated by retrograde left ventricular catheterization using a 6 F pigtail catheter. Tweleve of these 23 patients also had combined aortic and mitral valve replacement. To assess the magnitude of the catheter-induced aortic regurgitation and its effect on left ventricular and mitral valve function, 10 patients (group 1) were simultaneously investigated by the transseptal route (8 patients) or direct left ventricular puncture. The 13 other patients (group 2) were studied only by the retrograde crossing of the aortic valve prosthesis. In group 1, placement of the catheter across the valve induced an increase in heart rate (+ 12%), in left ventricular end-diastolic pressure (from 17.2±9.6 to 33.3±12.0 mmHg), a decrease om aortic systolic (−19%) and diastolic (−25%) pressures, and left ventricular systolic pressure (−10%). Transvalvular aortic pressure gradient increased from 15.4±8.2 to 23±12.1 mmHg. Pre- and post-crossing pressure gradients were linearly correlated (r=0.98). Hence, the magnitude of catheter-induced aortic regurgitation averaged 27% whether or not a pre-crossing regurgitation was noted. In group 2, retrograde crossing of the aortic valve prosthesis induced similar hemodynamic changes. There were no catheterization-related complications. On the basis of catheterizations studies, re-operation was contraindicated in 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, the hemodynamic study ruled out any aortic valve prosthesis dysfunction, associated mitral valve disease and depressed left ventricular function. Intraoperative findings (15 patients) and postmortem examination (7 patients) were consistent with catheterization data. Left ventricular retrograde catheterization is an alternative technique of investigation for patients with mechanical valves in both mitral and aortic positions or in centers where the usual approach (transseptal catheterization or direct LV puncture) are not performed.