1980–1990: Structural Heart Interventions

Abstract

Adult cardiac structural heart interventions performed in the 1980s included aortic and mitral balloon valvuloplasty, atrial septostomy, and early attempts at atrial septal defect closure. The first aortic balloon valvuloplasty with performed in 1986 by Cribier. Later that year this procedure was performed at Mayo Clinic. Mayo’s contribution to the knowledge base included delineation of the mechanism of gradient reduction by demonstrating fracture of calcific deposits in a detailed pathology-based study. Additionally, there were developments in Doppler methodology used to determine aortic stenosis severity, and these methods were refined in studies involving a close collaboration between the echocardiographic laboratory and the cardiac catheterization laboratory. Follow-up echo Doppler studies demonstrated the transient nature of the benefit of aortic balloon valvuloplasty, with occurrence of restenosis within 3–6 months. The first mitral balloon valvuloplasty at Mayo Clinic was performed in 1987. Unlike aortic balloon valvuloplasty, the mitral dilation procedure was shown to give more lasting results in most patients. The role of commissural calcification as a negative factor for valvuloplasty success was well defined in a Mayo study. Echocardiographic monitoring during the procedure became an important and well-established method of assessing both successful results and avoidance of complications. Balloon atrial septostomy had been performed in pediatric patients for several years, but rarely in adult patients. The observation that patients with primary pulmonary hypertension survived longer if there was an atrial septal communication gave rise to the concept of therapeutic atrial septostomy in this patient population. There was initial enthusiasm and utilization of this procedure, but it gradually became less important with the advent of more powerful pulmonary vasodilator drugs. Early devices for atrial septal defect closure were available in the late 1980s, and cases were performed at Mayo Clinic under the guidance of the pediatric cardiologists. Better devices were available in the next decade and became more widely utilized.