Structural Heart Intervention. Beyond Transcatheter Valve Therapy Intervencionismo en cardiopatı́a estructural. Más allá de la terapia valvular transcatéter

Andreas Gruentzig pioneered coronary angioplasty, but we are probably indebted to him for far more than this. He instigated a more creative approach to percutaneous intervention, thus inspiring other ‘‘revolutionaries’’ such as Amplatz, Lock, Bonhoeffer and Cribier, who extended the field of cardiac intervention to territories other than that of the coronary circulation. Structural heart disease interventions represent a new branch of percutaneous treatments covering a wide range of congenital and acquired diseases that were previously treated surgically or simply not addressed. The term structural heart disease has been widely used to refer to a group of noncoronary heart diseases ranging from septal defects to acquired valvular disease. This new branch of percutaneous intervention has several distinguishing characteristics: a) most of the disorders require a multidisciplinary approach that includes cardiac imaging specialists, clinical cardiologists, interventional cardiologists, interventional pediatricians, and cardiac surgeons among others; b) a thorough study is essential to select the patients who will benefit from percutaneous intervention; c) it requires continuous training and knowledge of the different materials and devices needed to treat the different diseases, and d) the cardiac catheterization laboratory should be adapted to perform hybrid procedures. The following structural conditions can be grouped together: a) septal defects; b) valvular heart disease; c) vascular obstructions; d) fistulas, and e) other conditions. Roughly speaking, the approach can be simplified into 2 groups of interventions: a) those involving the removal of an obstruction in a vascular channel or valve using dilatation procedures with balloons, stents, or valved stents, and b) those involving the occlusion of an abnormal communication between 2 cardiac chambers or vascular channels treated with closure devices or coils (Fig. 1). Although structural heart disease interventions are wellestablished due to transcatheter aortic valve implantation, in this review we leave aside valvular surgery because it has already been addressed in the Revista Española de Cardiologı́a and is better known. Thus, this article briefly describes several conditions for which percutaneous intervention has become a first-line treatment option.