Between October 1986 and January 1989, 57 attempts of percutaneous transluminal valvuloplasty were made in 51 elderly patients, mean age 76.7 +/- 6.2 years, with symptomatic aortic stenosis; this included 3 failures and 6 repeat valvuloplasties. The procedure resulted in a significant immediate decrease of the peak-to-peak transaortic pressure gradient from 94.6 +/- 26.5 to 42.6 +/- 17.9 mm Hg (p less than 0.002) and an increase of the surface of the aortic valve from 0.4 +/- 0.1 to 0.6 +/- 0.2 cm2 (p less than 0.001). Cardiac output remained unchanged: 3.8 +/- 0.9 vs 3.8 +/- 0.8 lit/min. Complications included local vascular injury requiring surgical repair in 7 patients, cerebral events in 3 patients and disruption of the aortic annulus, the aortic wall and the pulmonary artery each in 1 patient, and resulted in 4 in-hospital deaths (8%). Follow-up data were available for all patients for a mean duration of 12.7 +/- 5.4 months. Fifteen patients (30%) died on average 9.0 +/- 4.9 months after discharge. Recurrence of symptoms and early restenosis were documented in the majority of the patients. Restenosis was successfully treated by repeat valvuloplasty in 4 and by valve replacement in 4 patients. Doppler echocardiography predicted the severity of the aortic stenosis before valvuloplasty and was very useful to assess follow-up results. Because of the limited hemodynamic results, the numerous procedural complications and the development of early restenosis balloon valvuloplasty of aortic stenosis should be restricted to selected symptomatic elderly patients.