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  1. Louise Coats,
  2. Philipp Bonhoeffer
  1. Great Ormond Street Hospital for Children, London, UK
  1. Correspondence to:
    Professor Philipp Bonhoeffer
    Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK; bonhop{at}

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Rapid progress in interventional cardiology has recently seen the rate of percutaneous coronary intervention overtake that of coronary artery bypass surgery. Now attention is directed towards the treatment of valvular heart disease, with exciting developments in balloon and stent technology having the potential to transform the management of many common heart conditions.


Valvular heart disease is an important cause of cardiovascular morbidity and mortality worldwide. In many countries, though improved living conditions and better access to antibiotics and healthcare have seen a decline in rheumatic heart disease, the prevalence of degenerative valve disease has escalated with ageing of the population. In addition, the number of long-term survivors of surgery for congenital cardiac malformations is growing, with these patients frequently affected by valve dysfunction in later life. Increasing availability of cardiopulmonary bypass, surgical expertise and intensive care facilities has seen valve repair and replacement widely performed to relieve symptoms and improve prognosis, despite associated morbidity and mortality. Many patients, however, particularly the elderly with major co-morbidities, still do not undergo potentially beneficial interventions because of their high surgical risk.1 Development of a transcatheter alternative could significantly reduce morbidity and mortality, thus extending treatment to those who are not currently considered for surgery. Conversely, a less invasive therapy may also permit treatment of valvular heart disease at an earlier stage in its natural history and avoid the onset of progressive ventricular dysfunction. Patient preference for minimally invasive therapies is strong, particularly in those who have often undergone many operations. Furthermore, the success of these technologies could have an important economic impact due to associated reduction in intensive care and hospital stay.


Normal mitral valve performance requires thin, mobile leaflets with unrestricted commissures and chordae tendinae and papillary muscles of appropriate size and position. Dysfunction may arise when there is a primary …

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