Balloon valvuloplasty

Mitral stenosis is seen typically as a consequence of chronic rheumatic fever. Isolated congenital mitral stenosis is very rare and not suitable for balloon valvuloplasty. Clinical symptoms depend on the degree of obstruction. Dyspnea, atrial fibrillation, embolic events, pulmonary edema, and right heart decompensation may occur and are all indications for treatment. Surgery and catheter intervention provide similar results. Balloon valvuloplasty produces best results in patients with little or no calcification of the mitral leaflets (20—23). 

Hywel Davies reported of temporarily treatment of aortic regurgitation with a parachute valve mounted onto a catheter tip in 1965 (34). Twenty-seven years later Andersen and his colleagues described the first experience with a bioprosthetic valve attached to a wire-based stent and mounted on a balloon valvuloplasty catheter (35). In 2002, Alain Cribier performed the first transcatheter valve implantation in an elderly patient with inoperable aortic stenosis using a prototype of a stent-mounted, pericardial, tricuspid aortic valve (36). 

Kan JS, White Rl Jr, Mitchell SE, et al. Percutaneous balloon valvuloplasty a new method for treating congenital pulmonary-valve stenosis. N Engl J Med 1982 307(9) 540-542. 

Against this backdrop, research into less invasive approaches to treat valvular disease has been intensified. In the surgical realm, minimally invasive techniques, with its attendant patient and procedural related limitations, have been tried with some success but traditional valvular operations still remain the norm. At the same time, great strides have been made in percutaneous approaches to treatment of valvular disease. Two valvular disease states in which percutaneous balloon valvuloplasty have had great success are in the treatment of pulmonic stenosis and mitral stenosis. 

The first use of percutaneous balloon valvuloplasty was described in 1982 for patients with pulmonic stenosis (3). By the late 1980s, this treatment modality... 

The limited clinical efficacy of balloon valvuloplasty alone in the treatment of aortic stenosis and... 

The prototypic percutaneous aortic valve was implanted in a 57-year-old male with calcified critical aortic stenosis who failed previous balloon valvuloplasty and was in cardiogenic shock as well as leg ischemia at the time of procedure. Following the procedure, the aortic pressure rose from a 70 mmHg systolic to 120 mm Hg with the aortic valve gradient decreased from 30 to 6 mm Hg. The calculated valve... 

Chen CR, Cheng TO, Huang T, et al. Percutaneous balloon valvuloplasty for pulmonic stenosis in adolescents and adults. N Eng J Med 1996 335 21-5. 

Reyes VP, Raju BS, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. NEJM 1994 331 961-7. 

Palacios IF, Sanchez PL, Harrell LC, et al. Which patients benefit from percutaneous mitral balloon valvuloplasty. Circulation 2002 105 1465-71. 

American Heart Assn. Percutaneous balloon aortic valvuloplasty. Acute and 30-day follow-up results in 674 patients from the NHLBI Balloon Valvuloplasty Registry. Circulation 1991 Dec 84(6) 2383-97. 

Agarwal A, Kini AS, Attanti S, et al. Results of repeat balloon valvuloplasty for treatment of aortic stenosis in patients aged 59 to 104 years. Am J Cardiol 2005 Jan 1 95(l) 43-7. 

Transcutaneous aortic valve replacements emerge as a bail-out option for nonsurgical candidates. The procedure is based on a stent mounted bioprosthetic valve that unfolds in aortic position after balloon valvuloplasty. One of the risks associated with this procedure is to push calcified patches located on the native valve... 

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