Percutaneous aortic valve dilatation: Indications and results in adult acquired calcified aortic stenosis

Percutaneous transluminal aortic valvuloplasty is a new high quality therapeutic weapon in the treatment of severe adult aortic stenosis. It is obvious that the indications for PTAV will be better known in the future, when long-term follow-up will be available, and the incidence and risk of restenosis better known, by the repetition of Doppler effect ultrasonography and/or catheterizations. Nevertheless, the present results show that PTAV is a relatively simple, low cost and low risk procedure, requiring only a few days in hospital, which can be useful in all the cases where surgical valve replacement appears unfeasible or carries a high risk. Elderly patients, especially with severe aortic stenosis and left ventricular dysfunction, remain first concerned. The functional improvement which follows PTAV is undeniable, rapid and spectacular, especially in the worst patients. It is remarkable that a small increase in valve area can result in such marked and durable clinical improvement. This should get even better with the improvement of the immediate post-PTAV results that are now being obtained. With increasing experience of each team, and with the development of new specific dilatation catheters, better adapted and more efficient, it is highly probable that PTAV, after the dilatation of congenital aortic and pulmonary stenoses (6, 7, 10) and in parallel with mitral valve dilatation in adults (5, 8), will in the near future, become a common therapeutic catheterization procedure.