Balloon valvuloplasty

Definition

Balloon valvuloplasty is a procedure in which a narrowed heart valve is stretched open using a procedure that does not require open heart surgery.

Purpose

There are four valves in the heart, which are located at the exit of each of the four chambers of the heart. They are called aortic valve, pulmonary valve, mitral valve, and tricuspid valve. The valves open and close to regulate the blood flow from one chamber to the next. They are vital to the efficient functioning of the heart.


In some people the valves are too narrow (a condition called stenosis). Balloon valvuloplasty is performed on children and adults to improve valve function and blood flow by enlarging the valve opening. It is a treatment for aortic, mitral, and pulmonary stenosis. Balloon valvuloplasty has the best results as a treatment for narrowed pulmonary valves. Results in treating narrowing of the mitral valve are generally good. It is more difficult to perform and less successful in treating narrowing of the aortic valve.



Description

Balloon valvuloplasty is a procedure in which a thin tube (catheter) that has a small deflated balloon at the tip is inserted through the skin in the groin area into a blood vessel, and then is threaded up to the opening of the narrowed heart valve. The balloon is inflated, which stretches the valve open. This procedure cures many valve obstructions. It is also called balloon enlargement of a narrowed heart valve.

The procedure is performed in a cardiac catheterization laboratory and takes up to four hours. The patient is usually awake, but is given local anesthesia to make the area where the catheter is inserted numb. After the sitewhere the catheterwill be inserted is preparedand anesthetized, the cardiologist inserts a catheter into the appropriate blood vessel, then passes a balloon-tipped catheter through the first catheter. Guided by a video monitor and an x ray, the physician slowly threads the catheter into the heart. The deflated balloon is positioned in the valve opening, then is inflated repeatedly. The inflated balloon widens the valve's opening by splitting the valve leaflets apart. Once the valve is widened, the balloon-tipped catheter is removed. The other catheter remains in place for 6 to 12 hours because in some cases the procedure must be repeated.

Preparation

For at least six hours before balloon valvuloplasty, the patient will have to avoid eating or drinking anything. An intravenous line is inserted so that medications can be administered. The patient's groin area is shaved and cleaned with an antiseptic. About an hour before the procedure, the patient is given an oral sedative such as diazepam (Valium).

Aftercare

After balloon valvuloplasty, the patient is sent to the recovery room for several hours, where he or she is monitored for vital signs (such as pulse and breathing) and heart sounds. An electrocardiogram, which is a record of the electrical impulses in the heart, is done. The leg in which the catheter was inserted is temporarily prevented from moving. The skin condition is monitored. The insertion site, which will be covered by a sandbag, is observed for bleeding until the catheter is removed. Intravenous fluids will be given to help eliminate the x-ray dye; intravenous blood thinners or other medications to dilate the coronary arteries may be given. Pain medication is available.

For at least 30 minutes after removal of the catheter, direct pressure is applied to the site of insertion; after this a pressure dressing will be applied. Following discharge from the hospital, the patient can usually resume normal activities. After balloon valvuloplasty lifelong follow-up is necessary because valves sometimes degenerate or narrowing recurs, making surgery necessary.

Risks

Balloon valvuloplasty can have serious complications. For example, the valve can become misshapen so that it doesn't close completely, which makes the condition worse. Embolism, where pieces of the valve break off and travel to the brain or the lungs, is another possible risk. If the procedure causes severe damage to the valve leaflets, immediate surgery is required. Less frequent complications are bleeding and hematoma (a local collection of clotted blood) at the puncture site, abnormal heart rhythms, reduced blood flow, heart attack, heart puncture, infection, and circulatory problems.