Percutaneous interventions for valvular heart disease
The major interventions performed in patients with valvular heart disease are:
Percutaneous valvuloplasty in mitral valve stenosis
If a patient suffers from the mitral valve stenosis without serious problem in another valve or the coronary vessels, he is a candidate for the intervention. Before the intervention we do a transesophageal echocardiogram to check if the valve meets some specific anatomical and functional criteria (for example, the coexistence of moderate or severe regurgitation and the degree of calcification). The operation is performed from the femoral vein under local anesthesia, and one day of hospitalization is required.
Percutaneous valvuloplasty in pulmonary valve stenosis
The pulmonary valve stenosis is usually of congenital etiology. Percutaneous valvuloplasty is currently considered the treatment of choice for severe stenosis. It is done by puncturing the femoral vein, under local anesthesia, and one day of hospitalization is required.
Percutaneous valvuloplasty in aortic valve stenosis
Aortic valve stenosis can have congenital or degenerative etiology. In congenital stenosis, percutaneous valvuloplasty is usually the first treatment option. In degenerative stenosis, which normally occurs in the elderly, the treatment of choice is surgical valve replacement. We only do percutaneous valvuloplasty in severely ill patients as a “bridge” (preparation) for either surgery or percutaneous valve replacement (see below) and this is because despite the initially good results, the disease usually recurs within a few months.
- Percutaneous replacement in aortic valve stenosis – transcatheter aortic valve implantation (TAVI).
It is a new method in which we implant a bioprosthetic valve in the place of the diseased, stenotic aortic valve via a special catheter, which enters the body from the femoral artery, using local anesthesia. At present, the method is intended for patients who are at very high risk for open-heart surgery or those deemed inoperable.
- Percutaneous implantation of the Melody valve
The intervention is usually done in patients who have previously had surgery for Tetralogy Fallot and exhibit degeneration of their conduit (graft). The Melody valve is bioprosthetic and is placed through a special catheter from the femoral vein.
- Repair of severe mitral valve regurgitation with the MitraClip device
With this technique we put clips and connect the valve leaflets through a special catheter and regurgitation either disappears or its severity is significantly reduced. The method is intended for patients who are at too high risk for open-heart surgery or for those deemed inoperable and is done by puncturing the femoral vein, under general anesthesia.