Treatment is not necessary in asymptomatic patients. The treatment options for<unk>  include<unk>  valve replacement by surgery, and percutaneous<unk>  valvuloplasty by balloon catheter. The indication for invasive treatment with either a<unk>  valve replacement or valvuloplasty is NYHA functional class III or IV symptoms. Another option is balloon dilatation. To determine which patients would benefit from percutaneous balloon<unk>  valvuloplasty, a scoring system has been developed. Scoring is based on 4 echocardiographic criteria: leaflet mobility, leaflet thickening, subvalvular thickening, and calcification. Individuals with a score of ≥ 8 tended to have suboptimal results. Superb results with valvotomy are seen in individuals with a crisp opening snap, score < 8, and no calcium in the commissures. Treatment also focuses on concomitant conditions often seen in<unk> : * Any angina is treated with short-acting nitrovasodilators, beta-blockers and/or calcium blockers * Any hypertension is treated aggressively, but caution must be taken in administering beta-blockers * Any heart failure is treated with digoxin, diuretics, nitrovasodilators and, if not contraindicated, cautious inpatient administration of ACE inhibitors Illustration of<unk>  valvuloplasty<unk>  valvuloplasty<unk>  valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated<unk>  by dilating the valve using a balloon. Under local anaesthetic, a catheter with a special balloon is passed from the right femoral vein, up the inferior vena cava and into the right atrium. The interatrial septum is punctured and the catheter passed into the left atrium using a "trans-septal technique." The balloon is sub-divided into 3 segments and is dilated in 3 stages. First, the distal portion (lying in the left ventricle) is inflated and pulled against the valve cusps. Second, the proximal portion is dilated, in order to fix the centre segment at the valve orifice. Finally, the central section is inflated, this should take no longer than 30 seconds, since full inflation obstructs the valve and causes congestion, leading to circulatory arrest and flash pulmonary edema. With careful patient pre-selection, percutaneous balloon<unk>  valvuloplasty (PBMV) is associated with good success rates and a low rate of complications. By far the most serious adverse event is the occurrence of acute severe<unk>  regurgitation. Severe<unk>  regurgitation usually results from a tear in one of the valve leaflets or the subvalvular apparatus. It can lead to pulmonary edema and hemodynamic compromise, necessitating urgent surgical<unk>  valve replacement. Other serious complications with PBMV usually relate to the technique of trans-septal puncture (TSP). The ideal site for TSP is the region of the fossa ovalis in the inter-atrial septum. Occasionally, however, the sharp needle used for TSP may inadvertently traumatize other cardiac structures, leading to cardiac tamponade or serious blood loss. Although the immediate results of PBMV are often quite gratifying, the procedure does not provide permanent relief from<unk> . Regular follow-up is mandatory, to detect restenosis. Long-term follow-up data from patients undergoing PBMV indicates that up to 70–75% individuals can be free of restenosis 10 years following the procedure. The number falls to about 40% 15 years post-PBMV.
Mitral stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Aortic stenosis
Pulmonary valve stenosis
Tricuspid valve stenosis
Systolic hypertension