The History of Balloon Valvuloplasty

Abstract

The birth of therapeutic balloon dilation in the management of cardiovascular disease can be traced to Rashkind who in 1966 developed balloon atrial septostomy for palliation of patients with complete transposition of the great vessels. Actually, Dotter and Judkins anteceded Rashkind by coaxial sequential dilation of iliofemoral atherosclerotic obstruction in 1964. However, it was not until the development by Grüntzig in 1978 of a miniaturized flexible balloon catheter for percutaneous transluminal coronary angioplasty that therapeutic balloon dilation began to be applied to stenotic heart valves. The development of percutaneous balloon valvuloplasty was the natural consequence of the early success of surgical mechanical dilation of stenotic heart valves; first the pulmonic valve, then the mitral valve, and finally the aortic valve. The successful relief of valvular stenosis by percutaneous balloon valvuloplasty is a remarkable example of how the pioneering cardiac surgeons paved the way for interventional cardiologists to take over the treatment of heretofore, surgically managed diseases.

Heart valve disease: a journey of discovery

“…When asked why he did not repeat the procedure given its relative success, he volunteered that he was never referred another patient, physicians declaring it ‘all non-sense’6 and failing to believe that the symptoms of mitral stenosis could be ascribed to a simple obstruction between the left atrium and ventricle. Indeed, Carey Coombs was among these sceptics, declaring that ‘the operation can never become a general method of treatment for a disease of which the mitral lesion is only one feature—to say nothing of the technical difficulties attending surgical approach to this structure’ 7. Sir Thomas Lewis was also dismissive, writing 20 years later that ‘although many symptoms may be complained of by the patients suffering of mitral stenosis, there are none that can be ascribed properly and usefully to this deformity of the valve’ 7.…”

“…Indeed, Carey Coombs was among these sceptics, declaring that ‘the operation can never become a general method of treatment for a disease of which the mitral lesion is only one feature—to say nothing of the technical difficulties attending surgical approach to this structure’ 7. Sir Thomas Lewis was also dismissive, writing 20 years later that ‘although many symptoms may be complained of by the patients suffering of mitral stenosis, there are none that can be ascribed properly and usefully to this deformity of the valve’ 7. Souttar became a BCS member and eventually spoke about the operation at the 1957 Autumn Meeting.…”

“…The same year, Brock joined with Cardiac Club Secretary, Dr Maurice Campbell, to form the ‘Peacock Club’ at Guy’s Hospital following a visit to the unit by Blalock (of Blalock-Taussig shunt fame) to educate on all matters concerning congenital heart disease 9. Over 30 years later in 1984, the first transcatheter mitral balloon valvuloplasty was performed by Inoue using his innovative balloon catheter,7 and 6 years later, Wilkins published his mitral echocardiographic score in the British Heart Journal , paving the way for current selection algorithms 10…”