Percutaneous transluminal aortic valvuloplasty: Indications and results in adult 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 of 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 ultrasonography and/or catheterization. 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 not to be feasible or carries a high risk. Elderly patients, especially with severe aortic stenosis and left ventricular dysfunction, remain of primary concern. 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 improved 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, as with the dilatation of congenital aortic and pulmonary stenoses and in parallel with mitral valve dilatation in adults will become a common therapeutic catheterisation procedure in the near future.