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Percutaneous balloon valvuloplasty in adult patients with valvular heart disease.

Percutaneous balloon valvuloplasty is a new, nonsurgical technique for treatment of acquired mitral or aortic valvular stenosis. The procedure is still investigational and performed following approved research protocols. Although technically more difficult and at times impossible to perform, percutaneous BV of the mitral valve has been shown to be both safe and effective for increasing the mitral valve orifice area and for relief of symptoms associated with severe rheumatic mitral stenosis. Because of the relative infancy of the procedure, long-term data are available for only 1 to 2 years following BV. Thus far, however results obtained with mitral BV are similar to those obtained using surgical commissurotomy. From a long-term perspective, results of aortic BV in the elderly population are less impressive. The procedure appears to be only palliative and is associated with high rates of restenosis occurring fairly soon after the procedure. However, in the very elderly patient who is a nonsurgical candidate, aortic BV can provide improvement in aortic valve orifice size and in relief of debilitating symptoms associated with severe aortic stenosis. As with surgical aortic valve replacement, aortic BV also provides improvement over the natural course of the disease. More data are needed to aid in better definition and selection of patients who are suitable candidates for this procedure.