Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.

中文翻译：

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先天性心脏病半月瓣介入治疗

近 40 年前首次描述了经导管球囊瓣膜成形术治疗主动脉瓣和肺动脉瓣狭窄。从那时起，该技术得到了改进，以优化急性结果，同时减少对再干预和瓣膜置换术的长期需求。球囊肺瓣膜成形术被认为是肺动脉瓣狭窄的一线治疗方法，通常可以成功缓解瓣膜阻塞。较大的球囊与瓣环 (BAR) 直径比会增加显着瓣膜反流的风险。然而，导致右心室扩张和功能障碍而需要更换肺动脉瓣的反流的发展在长期随访中并不常见。球囊主动脉瓣成形术通常是主动脉瓣狭窄的一线治疗方法，尽管一些当代研究记录了在手术修复后获得三叶瓣形态的一部分患者的手术瓣膜成形术后的改善结果。随着时间的推移，进行性主动脉瓣关闭不全很常见并且经常导致需要更换主动脉瓣。患有严重主动脉瓣狭窄的新生儿仍然是一个特别高风险的群体。更现代的数据表明，在轻度主动脉瓣关闭不全的情况下，迅速实现主动脉瓣梯度 <35 mm Hg 可以改善长期瓣膜性能并减少瓣膜置换术的需要。继续研究将有助于进一步改善结果并减少对未来再次干预的需求。