This study reports clinical (84 patients) and catheterization (15 patients) follow-up of the first 90 patients who underwent percutaneous balloon aortic valvuloplasty (PBAV) at Massachusetts General Hospital. Eight patients died within 1 week in-hospital; 1 patient was lost to follow-up. Mean age of the group was 79 +/- 1 year (range 52 to 95). Before PBAV 25% of the patients were in New York Heart Association class III and 73% were in class IV. Endpoints were aortic valve surgery, death, second PBAV or interview. Mean follow-up was 5.5 +/- 0.3 months after PBAV. Although all patients improved symptomatically immediately after PBAV, at follow-up 16% were in New York Heart Association class I, 20% were in class II, 11% were in class III and 25% were in class IV. Twenty-three (28%) patients died during the follow-up period. A second PBAV was performed in 15 patients who had repeat catheterization. All had restenosis but only 13 of 15 had recurrent symptoms. Repeat PBAV produced results similar to the first PBAV despite the use of larger or double balloons. Although PBAV improves most patients' symptoms, recurrence of clinical symptoms and a high mortality within 6 months should limit the procedure to selected patients.