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(Circulation. 2004;109:1572-1579.)
© 2004 American Heart Association, Inc.

Review: Clinical Cardiology: New Frontiers

Percutaneous Approaches to Valvular Disease

Alec Vahanian, MD; Igor F. Palacios, MD

From the Cardiology Department, Bichat Hospital, AP-HP, Paris, France (A.V.), and the Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (I.F.P.).

Correspondence to Alec Vahanian, MD, Cardiology Department, Bichat Hospital, 46, rue Henri Huchard, 75018 Paris, France. E-mail alec.vahanian@bch.ap-hop-paris.fr

Key Words: valves • valvuloplasty • balloon • mitral valve

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Until the early 1980s, surgery was the only possible treatment for severe valvular lesions; then, a new alternative appeared: percutaneous balloon valvuloplasty.

We deal here with percutaneous valvuloplasty for acquired valvular stenoses and also briefly describe the first steps of percutaneous valve replacement and repair.

	Percutaneous Mitral Commissurotomy

 
Rheumatic mitral stenosis continues to be endemic in developing countries, where mitral stenosis is the most frequent valve disease.¹ Although the prevalence of rheumatic fever has greatly decreased in Western countries, it continues to represent an important clinical entity because of outmigration from developing countries. The figure given by the registry Euro Heart Survey, run in 2001, shows that mitral stenosis accounts for 12% of the single native valve disease.²

K. Inoue and colleagues³ were the first to perform percutaneous mitral commissurotomy (PMC) in 1982.³ The good results obtained by the technique have led to its increasing worldwide use.

Evaluation Before PMC
Clinical evaluation is the first step of the decision to intervene. Under particular scrutiny here are functional disability and any possible risks with surgery. The assessment of anatomy aims to eliminate contraindications and define prognostic considerations. The presence of left atrial thrombosis is the main contraindication for the technique and requires the performance of transesophageal echocardiography before the procedure. Echocardiographic assessment allows the classification of patients into anatomic groups with a view to predicting the results. Most authors use the Wilkins score⁴ (Table 1), although others use a more general assessment of valve anatomy⁵ (Table 2). More recently, scores have been developed . . . [Full Text of this Article]

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