Non-coronary percutaneous intervention

doi:10.1136/bmj.327.7406.97

BMJ 2003;327:97-100 (12 July), doi:10.1136/bmj.327.7406.97

Clinical review

ABC of interventional cardiology

Non-coronary percutaneous intervention

Ever D Grech, interventional cardiologist, assistant professor

the Health Sciences Centre and St Boniface Hospital, Winnipeg, Manitoba, Canada, the University of Manitoba, Winnipeg.

The first 150 words of the full text of this article appear below.

Introduction

Although most percutaneous interventional procedures involvethe coronary arteries, major developments in non-coronary transcathetercardiac procedures have occurred in the past 20 years. In adultsthe commonest procedures are balloon mitral valvuloplasty,ethanol septal ablation, and septal defect closure. These problemswere once treatable only by surgery, but selected patientsmay now be offered less invasive alternatives. Carrying outsuch transcatheter procedures requires supplementary trainingto that for coronary intervention.

Balloon mitral valvuloplasty

Acquired mitral stenosis is a consequence of rheumatic feverand is commonest in developing countries. Commissural fusion,thickening, and calcification of the mitral valve leafletstypically occur, as well as thickening and shortening of thechordae tendinae. The mitral valve stenosis leads to left atrialenlargement, which predisposes patients to atrial fibrillationand the formation of left atrial thrombus.

View larger version (142K):
[in this window]
[in a new window]

Stenotic mitral valve showing distorted, fused, and calcified valve leaflets. (AMVL=anterior mitral valve leaflet, PMVL=posterior mitral valve leaflet, LC=lateral commissure, MC=medial . . . [Full text of this article]

Patient selection