Valvular heart disease: percutaneous alternatives

Percutaneous and minimally invasive treatment of valvular heart disease is becoming rapidly established as an attractive, less invasive option to conventional valve surgery. Severe aortic stenosis can be treated with balloon aortic valvuloplasty (BAV) and more definitively with transcatheter aortic valve implantation (TAVI). However, TAVI as a definitive treatment should currently be performed only in patients with severe symptomatic aortic stenosis who are deemed unfit or high risk for conventional, surgical aortic valve replacement. Rheumatic mitral stenosis is effectively treated with balloon mitral valvuloplasty (BMV), which is the procedure of choice in symptomatic patients with favourable valve anatomy. Interventions for mitral regurgitation are emerging and include percutaneous annuloplasty (via the coronary sinus) and edge-to-edge valve leaflet repair. Congenital pulmonary stenosis can also be treated percutaneously with balloon pulmonary valvuloplasty. Transcatheter pulmonary valve implantation is used for the treatment of pulmonary valve stenosis and/or regurgitation in a right ventricle-to-pulmonary artery conduit. The key to successful outcome in all of these techniques is appropriate case selection – sophisticated cardiac imaging and a multidisciplinary approach are fundamental.