Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

Advances in cardiovascular interventional techniques have allowed percutaneous treatment of conditions that either previously required open operations or have not been amenable to any treatment.Aortic stenosis (AS) is the most common valvular abnormality in the western world and it is more frequent in elderly patients with comorbidities. Transcatheter Aortic Valve Implantation (TAVI) offers an alternative to patients with severe symptomatic AS and contraindications for surgery or high risk for surgery [1].Mitral regurgitation (MR) has a prevalence of 1-2% in the general population and there are several percutaneous techniques for the treatment of it, such as direct annuloplasty, indirect annuloplasty-coronary sinus and ventricular remodeling, however only repair by using Mitraclip has been extensively evaluated [2]. Patent foramen ovale (PFO) and atrial septal defects (ASD) are interruption of atrial septum [3] and their percutaneous closure is a safe and accepted alternative to surgery [4-7].Atrial fibrillation (AF) is the most common cardiac arrhythmias. At present, percutaneous left atrial appendage (LAA) occlusion may be an acceptable option in selected high-risk patients with AF who are not candidates to oral anticoagulation [8].Para-valvular leaks (PVLs) represent a complication of cardiac valve replacement and their surgical repair is associated with a high mortality and morbidity rate, thus, in selected cases, percutaneous repair can be performed [9]. This review emphasizes particularly the role of 2D echocardiography in selection, guidance and follow up of patients candidates to percutaneous treatment.The severity of AS is usually assessed by TTE according to AHA/ACC [10] and to ESC Guidelines [11] (Figure 1, Panel A and B). Low-dose dobutamine echocardiography can be useful to differentiate between severe and the rare "pseudo severe" AS in patients with low LV ejection fraction and low gradient [10,11].To date, there is a lack of pharmacological therapies