الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 167 |  |  |
| | | from | 167 | | |
Abstract
As life expectancy increases, valvular heart disease is becoming more common Management of heart disease and primarily valvular heart disease is expected to
represent a significant proportion of healthcare provided to the elderly population.
Recent years have brought a progression of surgical treatments toward less invasive
strategies. This has given rise to percutaneous approaches for the correction of
valvular heart disease. Percutaneous mitral valve repair using the MitraClip system
(Abbott Vascular, Santa Clara, CA, USA) creates a double orifice and has been
successfully used in selected patients with mitral regurgitation.and there are other
procedures for correction of mitral valve diseases
Percutaneous mitral valve repair (MVR) is used to treat mitral regurgitation
Percutaneous procedures used to treat valvular heart disease were first developed
decades ago; the first pulmonic balloon valvuloplasty was reported in 1982 and was
quickly followed by applications to the aortic and mitral valves. Mitral stenosis was
the first pathologic condition of a heart valve to be treated both surgically and
percutaneously.
Over the past 20 years, percutaneous mitral balloon valvuloplasty used to treat
mitral stenosis has yielded excellent success rates in patients with suitable valvular
and subvalvular morphology. However, clinically viable percutaneous treatments for
mitral regurgitation have become available only recently.
Newer approaches have progressed far beyond balloon valvuloplasty to include
catheter techniques for emulating surgical annuloplasty and edge-to-edge repair of
regurgitant mitral valves. These are still in early-stage clinical (or preclinical) testing,
and the ultimate degree of clinical success and adoption is still unclear. Given the
outstanding results of open valve repair, surgery is likely to remain the criterion
standard for most cases of symptomatic valvular heart disease. In the near term, percutaneous valve intervention will probably have two
indications, as follows:
· Severe disease deemed inoperable owing to comorbid disease
· Early-stage regurgitant lesions if less-invasive valve repair may prevent
progressive ventricular enlargement
Although definitive catheter-based therapies for valvular heart disease are
clearly in their infancy, various percutaneous approaches are now being evaluated and
used. The field is likely to develop rapidly over the next several years, with refinement
of the above approaches and emergence of still newer technologies.
The landscape of clinical trials is also still under active discussion; if these
percutaneous techniques are to be considered as alternatives to traditional surgical
methodologies in low-risk to medium-risk patients, they must demonstrate
hemodynamic effects, safety, and durability comparable to those of the current highly
refined surgical techniques. Conversely, these percutaneous techniques may be best
applied to patients at the margins of current surgical indications.