Nonsurgical pulmonary valve replacement: why, when, and how?

Percutaneous transcatheter interventions for valve replacement or implantation is one of the most exciting developments in the field of interventional cardiology. Valvular stenosis has been treated by balloon dilatation with early and late results; however, treatment for valvular regurgitation has remained surgical until now. Most new designs have been investigated for implantation of valves in the left or right ventricular outflow tracts. Patients with surgery on the right ventricular outflow tract for congenital heart disease constitute the most common group for reoperations during late follow-up. Surgical pulmonary valve replacement can be performed with low mortality; however, it sets up a substrate for future operations. Also, the risk of cardiopulmonary bypass, infection, bleeding, and ventricular dysfunction remains. A transcatheter technique is likely to have more acceptance and may expand the indications for early intervention for right ventricular outflow tract dysfunction.