Aortic Valvular Stenosis
Congenital aortic stenosis (CAS) is a relatively common congenital heart disease (1.1–4.3 per 10,000 live births). The aortic annulus of patients with CAS is usually hypoplastic to some extent; the leaflets are thickened, and the commissures, to different degrees, are fused. Usually newborns with critical CAS suffer from low cardiac output and shock secondary to poor left ventricular function. In older children and adolescents with severe CAS, the main symptoms are angina chest pain, syncope and dyspnea, or other symptoms of heart failure such as orthopnea, paroxysmal nocturnal dyspnea, and pedal edema. Currently, percutaneous balloon valvuloplasty has become an important procedure for the treatment of CAS.
Angiography in the left anterior oblique (LAO) in the ascending aorta from a right internal carotid artery approach. Blood accelerating through the stenotic aortic valve is seen as a negative jet within the contrast dye injected in the ascending aorta (WMV 2368 kb)
Left ventricular angiography in LAO showing a hypertrophic left ventricle and dysplastic and thick aortic valve. Mitral valve is seen as a negative scado on the right of the aortic valve (WMV 2240 kb)
Fluoroscopy showing balloon inflation. The guidewire is looped within the left ventricle. During balloon inflation, waist appears at the level of the aortic valve. When the balloon is fully inflated and valve well opened, the waist disappears (WMV 2304 kb)
Left ventricular angiography in LAO after balloon dilation. The left ventricle is hyperdynamic and hypertrophic. The apex of the left ventricle is almost completely filled by the muscle during systole. The aortic valve shows a significantly improved opening. No signs of extravasation are seen (WMV 1632 kb)
Ascending aortography in LAO after valvuloplasty. The injection is performed with an over the wire approach. No aortic regurgitation is seen (WMV 1536 kb)