Key result
PPM insertion for complete heart block linked to ~41% lower peak bioprosthetic aortic valve gradient.
Why the study?
Does insertion of a permanent pacemaker reduce transvalvular pressure gradients in a patient with complete heart block and an aortic valve bioprosthesis?
Case Report (n=1)
Does insertion of a permanent pacemaker reduce transvalvular pressure gradients in a patient with complete heart block and an aortic valve bioprosthesis?
Complete heart block can significantly elevate transvalvular pressure gradients across bioprosthetic aortic valves, which can be reversed with permanent pacemaker insertion.
High post-AVR gradients may reflect reversible factors like heart block before degeneration; leaves open standardized diagnostic algorithms for bioprostheses.
High transvalvular pressure gradients following aortic valve replacement can be caused by several possible mechanisms. We present the case of an elderly woman with an elevated pressure gradient across an aortic valve bioprosthesis in the setting of complete heart block. After consideration of the presence of complete heart block, the hemodynamic profile of the specific prosthesis, and patient-prosthesis mismatch, only a mild degree of stenosis was found to be attributable to degeneration of the prosthesis. There is no literature quantifying the hemodynamic effect of complete heart block on the pressure gradients across bioprosthetic aortic valves. In the case presented, the transvalvular peak and mean pressure gradients were reduced by 41% and 39%, respectively, following treatment of complete heart block by insertion of a permanent pacemaker.
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Buchholz et al. (2012) conducted a case report in Elevated pressure gradient across an aortic valve bioprosthesis with complete heart block (n=1). Insertion of a permanent pacemaker was evaluated on Transvalvular peak and mean pressure gradients. Insertion of a permanent pacemaker to treat complete heart block reduced transvalvular peak and mean pressure gradients across a bioprosthetic aortic valve by 41% and 39%, respectively.
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