Balloon aortic valvuloplasty for rapid progression of aortic stenosis in patient on dialysis： A case report

Abstract

Aortic stenosis (AS) can cause difficulties in patients undergoing dialysis and affect their prognosis. Renal failure is also known as a factor accelerating the progression of AS. We report a 77-year-old male with a history of dialysis whose AS rapidly progressed in a short period of time, leading to cardiac dysfunction and difficulty in dialysis, who was managed with a comprehensive approach. The patient was admitted for investigation of chest pain, and echocardiography revealed discordant severe AS with normal flow and a low-pressure gradient. In accordance with the guidelines, we determined that he did not have true severe AS, and scheduled follow-up. However, he developed cardiac dysfunction and dialysis became difficult four months later. Due to his poor general condition, it was not possible to assess the severity of AS using dobutamine stress echocardiography. The evaluation taking into account the velocity ratio suggested that it was true severe AS. Therefore, balloon aortic valvuloplasty was performed as the bridging therapy to transcatheter aortic valve implantation (TAVI), followed by TAVI as definitive treatment. There are some cases of rapid progression of AS and limitations to examination and treatment available for AS patients associated with dialysis due to its complexity and uniqueness of the pathology. For patients with AS associated with dialysis, individualized treatment approaches must be considered based on the specific situation.