Israel Medical Association Journal

Surgical aortic valve replacement (SAVR) is the treatment of choice for patients with severe aortic stenosis (sAS). Balloon aortic valvuloplasty (BAV) was developed 40 years ago, and it was an alternative to conventional SAVR in elderly and frail patients for whom there were no other effective therapeutic options [1].

Transcatheter aortic valve intervention (TAVI) has expanded its indications during the last 20 years, from prohibitively high surgical risk of mortality to intermediate risk patients [2].

We reported a case of BAV that was used as a bridge to TAVI in an elderly patient with sAS, congestive heart failure (CHF), and ischemic hepatitis (IH).

Background: Hepatotoxicity due to intravenous amiodarone (HIVAD) is a rare side effect with a distinct pattern of enzyme disturbances compared to liver damage from oral amiodarone. Intravenous amiodarone is administered for acute arrhythmias often causing heart failure. The enzyme abnormalities and clinical setting are very similar to that of ischemic hepatitis, a far more common condition.

Objectives:  To ascertain if acute HIVAD exists as a separate entity or whether reported cases may be explained by ischemic hepatitis.

Methods: In this case-control retrospective study the files of hospitalized patients with markedly elevated aminotransferases were reviewed for the diagnoses of HIVAD or ischemic hepatitis. Medline was searched for published cases of HIVAD. Pooled data of all patients with HIVAD were compared to a control group with ischemic hepatitis.

Results: There were no significant differences in the clinical characteristics, laboratory results or histological findings between HIVAD and ischemic hepatitis patients.

Conclusions: In our opinion, there is currently insufficient data to support the existence of distinct HIVAD, and ischemic hepatitis is a more probable diagnosis in most reported cases. Withdrawing amiodarone because of assumed hepatic damage could deprive patients of a life-saving therapy.