Percutaneous mitral valve commissurotomy

Transcatheter therapies have progressively assumed a major role in the treatment of valve heart disease. The major drivers have been population ageing, the high prevalence of valve disease in the elderly, and the consequent need of less invasive treatments for this fragile patient population. While transcatheter aortic valve implantation (TAVI) has achieved a central role in the treatment of severe aortic stenosis across any surgical risk category, transcatheter treatment of mitral valve disease is still the object of intense debate and investigation. The reasons are that the mitral valve apparatus anatomy is more complex, involving valve leaflets, subvalvular apparatus and the left ventricle. Further, the most frequent mitral valve disease, i.e. mitral regurgitation, has different etiologies and is frequently a consequence rather than the cause of left ventricular dysfunction and heart failure. Hence, clinical efficacy of its correction is uncertain. Beyond the varying clinical scenarios, there are a miriad of devices under developement or at different stages of clinical investigations. This book describes the state of the art in the filed of percutaneous treatment of mitral valve disease. It provides a comprehensive review including anatomical basis, in-depth diagnostics, patophysiology, summary of available evidence for transcatheter treatments, state-of-the art of cardiac surgery,description of devices commercially available or under investigation, and clinical examples.