Perspective Chapter: Transcatheter Interventions in the Management of Aortic Valve Stenosis

Transcatheter interventions that are useful in the management of valvar aortic stenosis will be reviewed. This chapter focuses on congenital aortic valve stenosis. The procedure of balloon aortic valvuloplasty (BAV) and the results were reviewed; BAV offers good relief of aortic valve obstruction and serves as substitute to surgery and is considered a favored option in the management of aortic stenosis in all age groups. However, BAV in elderly patients with calcific aortic stenosis offers only a temporary relief of aortic valve obstruction and BAV is not recommended for this subgroup of patients. Except for neonates, most patients are discharged home within 24-hours after BAV. While there is conclusive data for provision of pressure gradient relief both acutely and at follow-up as well as deferral of any surgery after BAV, the development of aortic insufficiency (AI) at long-term follow-up is a most important drawback. In neonates, severe AI may develop necessitating surgical intervention. Notwithstanding these drawbacks, BAV is presently believed to be a therapeutic procedure of option in the treatment of valvar aortic stenosis in pediatric and young adult patients. Methodical follow-up to identify reappearance of aortic obstruction and development of substantial AI is suggested.