Pulmonary valve is situated between the right ventricle and pulmonary artery. Pulmonary valvar stenosis is a birth defect where there is restriction to the complete opening of the pulmonary valve as a result of this the right ventricle has to pump harder for sufficient blood to reach the lungs for oxygenation. Generally well tolerated in most up to adulthood but rarely can present at birth with critical pulmonary stenosis requiring urgent treatment. The treatment involves opening the pulmonary valve. The treatment of choice is balloon pulmonary valvotomy where through the vein a ballon is advanced into the heart a placed across the pulmonary valve and inflated. This results in a tear along the commissure of the valve resulting in adequate opening of the valve.

Mitral stenosis is almost always a result of Rheumatic fever in childhood is common in our country. The mitral valve separates the left atrium from the left ventricle. In mitral stenosis there is narrowing of the mitral valve orifice resulting in increase resistance to flow of blood from the left atrium to the left ventricle. One of the best treatment option is balloon mitral valvotomy where a balloon is placed across the mitral valve and inflated resulting in tear of the commissures. To reach the mitral valve from the venous side a puncture has to be made in the atrial septum. Complications associated with the procedure include need for emergency mitral valve replacement due to excess tear of the valve resulting in severe mitral valve leaking, and accidental puncture of the atrial free wall resulting in collection of blood in the pericardial space (pericardial tamponade).

The aortic valve is situated between the left ventricle and aorta. Narrowing of the valve orifice is known as aortic stenosis. The narrowing of the valve could be due to a birth defect or acquired. The common acquired causes are rheumatic or degenerative. In children balloon dilatation of the aortic valve is a good treatment option, but in adults surgery is the treatment of choice. Balloon dilatation in adults is done only in individuals who are high risk for surgery as a palliative measure. During balloon aortic valvotomy a balloon is placed across the stenotic aortic valve and dilated. To stabilize the balloon during inflation the heart is paced at a rate of 200 to 250 beats per minute.