Severe aortic stenosis in the sick octogenarian. A clear indicator for balloon valvuloplasty as the initial procedure.

T he introduction of balloon valvuloplasty for aortic stenosis first reported by Cribier and colleagues in 19861 was initially greeted with enthusiasm, especially by the interventional cardiologists who had in Samsonlike tradition2 crushed the pillars of atherosclerotic coronary arteries with balloon catheters and were now anxious to do the same to calcified aortic valve leaflets. The success of a similar procedure for pulmonic valvular stenosis was a further spur. The procedure can be done with low periprocedure mortality and morbidity and evidence of some substantial increase in valve area, especially if presented as percentage increase over initial valve area, and marked relief of symptoms. For instance, Letac and colleagues3 report 218 patients with aortic stenosis in whom the peak-to-peak aortic valve gradient changed from 72±25 to 29±14 mm Hg and the calculated aortic valve area changed from 0.52±0.18 to 0.93±0.33 cm2. In 69 patients (32%), the achieved aortic valve areas was 1.0 cm2 or