Coronary/cardiac Interventions

FEBRUARY 2004 I ENDOVASCULAR TODAY I 31 D uring the last 2 decades, percutaneous endovascular therapies have revolutionized the treatment of coronary artery disease. However, the development and dissemination of percutaneous approaches to heart valve disease have been less rapid. Whereas rheumatic mitral stenosis and congenital aortic stenosis are effectively managed by balloon valvuloplasty in many instances,1,2 and pulmonary regurgitation can be treated by percutaneous pulmonary valve insertion,3 progress with more common valvular lesions—mitral regurgitation and acquired aortic stenosis—requires development of new techniques and technology. Recent advances promise to facilitate application of endovascular therapies for these lesions. Although technological challenges remain, it is likely that many patients with mitral regurgitation and aortic stenosis will soon be candidates for percutaneous heart valve repair or replacement. SURGI C AL M ANAG E MENT O F H E A RT VALV E D I S E A SE Percutaneous approaches to heart valve disease are modeled upon successful surgical techniques for valve repair and replacement. Since the development of cardiopulmonary bypass, open-heart surgery has been the standard definitive treatment for heart valve disease. The most common valvular lesions—mitral regurgitation and aortic stenosis—are effectively treated by cardiac surgery, extending longevity and improving quality of life in hundreds of thousands of patients annually. Mortality associated with primary heart Percutaneous Heart Valve Repair and Replacement