[Interventional cardiology in adults]

Interventional cardiology has become an alternative to surgery in the treatment of coronary artery and stenotic valvular diseases. Percutaneous transluminal coronary angioplasty is a method of treating severe coronary stenoses under simple local anaesthesia with a primary success rate of 90% and a mortality of about 1%--nearly zero in single vessel disease. These results have to be tempered by the relatively common occurrence of restenosis (30 to 40%) which are treatable by repeat angioplasty. Amongst the new techniques under evaluation at present, coronary endoprostheses (stents) seem to be the most effective in reducing the rate of restenosis. Percutaneous mitral valvuloplasty with an inflatable balloon catheter is associated with excellent results in cases of mitral stenosis when the valvular and subvalvular apparatus is not stiff and not calcified. On the other hand, the results of aortic valve dilatation are often inadequate and temporary, and this technique is now reserved for very elderly patients with severe aortic stenosis and irreducible cardiac failure, inoperable, and for patients with symptomatic calcific aortic stenosis who have to undergo urgent extracardiac surgery and who could benefit from valvular replacement at a later date. Interventional cardiology may replace or postpone surgery and allows effective treatment of patients too old or too ill to undergo cardiac surgery.