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Balloon valvuloplasty
  1. Alec Vahanian
  1. Bichat Hospital, Paris, France
  1. Professor Alec Vahanian, Groupe Hospitalier Bichat—Claude Bernard, 46, rue Henri-Huchard, 75877 Paris Cedex 18, Francealec.vahanian{at}

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Until the early 1980s surgery was the only possible treatment for severe valvar stenosis. Then a new alternative appeared—percutaneous balloon valvuloplasty.

I will deal here with percutaneous valvuloplasty for acquired valvar stenoses in the fields of mitral stenosis, aortic stenosis, and, although it occurs far less frequently, tricuspid or bioprosthetic stenoses.

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 immigration from developing countries.

The first to perform percutaneous mitral commissurotomy (PMC) as an alternative to surgery was Inoue in 1982.2 The good results obtained with the technique have led to its increasing worldwide use and its positioning as the second most important technique in the field of interventional cardiology.

Evaluation before PMC

Clinical evaluation is the first step when deciding whether to operate or 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. Echographic assessment allows the classification of patients into anatomic groups with a view to predicting the results. Most authors use the Wilkins score (table 1) while others, like Cormier (table 2), use a more general assessment of valve anatomy.3 More recently, scores which take into account the uneven distribution of anatomic abnormalities, particularly in regard to commissural areas, have been developed. In fact, none of the scores available has been shown to be superior to any of the others, and we can only recommend the use of the score with which one is most familiar and at ease.

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Table 1

Anatomic classification of the mitral valve (Wilkins' score, Massachusetts General Hospital)

View this table:
Table 2

Anatomic classification of the mitral valve (Cormier's score, …

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