Interventional Therapy (continuance)

Mitral valvuloplasty and trancatheter aortioc valve replacement

In pure mitral stenosis with symmetric commissural fusion verified by TEE and 3D image reconstruction and without valvular calcification and chordal retraction, balloon valvuloplasty is a suitable therapeutic option. After precise echocardiographic measurement of commissural and annular dimensions, transvenous puncture of the interatrial septum is carried out under echocardiographic (see above) guidance. A coil wire is introduced into the left atrium via the puncture cannula. Then, the puncture site is dilated and an Inoue balloon catheter introduced into the left atrium. The stenotic mitral valve opening is probed and the balloon advanced into the left ventricle. After inflating the distal part of the balloon, the catheter system is withdrawn and the proximal portion of the balloon shortly inflated. The balloon waist causes the actual valvuloplasty. After deflation, the balloon is withdrawn into the left atrium. Using TTE and invasive pressure readings, the efficacy of the procedure is verified by pressure measurements. Occasionally, valvuloplasty must be repeated. As a result, iatrogenic mitral regurgitation may occur and this can later lead to mitral valve replacement. However, in the majority of patients, heart surgery can be avoided or postponed by years. Transcatheter aortic valve replacement has been successfully started in March ´08. This therapy is carried out in cooperation with the Dept. of Cardiac Surgery. Indications for this therapy are limited up to now.

Balloon valvuloplasty (left: inflation of the distal balloon)	Balloon valvuloplasty (right: complete inflation and plastic dilatation of the valve)