[Usefulness of Balloon Aortic Valvuloplasty for Determining the Operative Procedure in a Patient with Severe Aortic Stenosis Complicated with Secondary Mitral Regurgitation;Report of a Case].

A 59-year-old man on chronic hemodialysis presented with severe aortic stenosis(AS) and moderate mitral regurgitation (MR). Although aortic valve replacement was scheduled, his status deteriorated into New York Heart Association(NYHA) class III heart failure due to the exacerbation of AS and concomitant MR. Double valve replacement was considered to be too high risk for the patient, and balloon aortic valvuloplasty(BAV) was initially performed. As a result, the mean pressure gradient of the aortic valve decreased from 65 to 28 mmHg and the mean pulmonary pressure also from 52 to 33 mmHg. Furthermore, MR improved from severe to moderate following BAV. We considered the alleviation of aortic stenosis was sufficient treatment for the patient. He underwent aortic valve replacement on the following day of BAV. Postoperative echocardiogram after 1 month showed mild MR, and the estimated pulmonary systolic pressure was 35 mmHg. During the 1-year follow up, MR was not aggravated. BAV might be a useful diagnostic method to determine the operative strategy for severe AS complicated with secondary MR.