Balloon valvuloplasty





Definition

Balloon valvuloplasty, also called percutaneous balloon valvuloplasty, is a surgical procedure used to open a narrowed heart valve. The procedure is sometimes referred to as balloon enlargement of a narrowed heart valve.


Purpose

Balloon valvuloplasty is performed on children and adults who have a narrowed heart valve, a condition called stenosis. The goal of the procedure is to improve valve function and blood flow by enlarging the valve opening. It is sometimes used to avoid or delay open heart surgery and valve replacement.

There are four valves in the heart—the aortic valve, pulmonary valve, mitral valve, and tricuspid valve—each at the exit of one of the heart's four chambers. These valves open and close to regulate the blood flow from one chamber to the next and are vital to the efficient functioning of the heart and circulatory system. Balloon valvuloplasty is used primarily to treat pulmonary, mitral, and aortic valves when narrowing is present and medical treatment has not corrected or relieved the related problems. With mitral stenosis, for example, medical solutions are typically tried first, such as diuretic therapy (reducing excess fluid), anticoagulant therapy (thinning the blood and preventing blood clots), or blood pressure medications. Valvuloplasty is recommended for those patients whose symptoms continue to progress even after taking such medications for a period of time.

Valvular stenosis can be a congenital defect (develops in the fetus and is present at birth) or can be acquired, that is to stem from other conditions. Mitral valve stenosis in adults, for example, is rarely congenital and is usually acquired, either a result of having rheumatic fever as a child or developing calcium obstruction in the valve later in life. Pulmonary stenosis is almost entirely congenital. Aortic stenosis usually does not produce symptoms until the valve is 75% blocked; this occurs over time and is consequently found in people between the ages of 40 and 70. Tricuspid stenosis is usually the result of rheumatic fever; it occurs less frequently than other valve defects.

Childhood symptoms of valve narrowing may include heart dysfunction, heart failure, blood pressure abnormalities, or a murmur. Adult symptoms will likely mimic heart disease and may include blood pressure abnormalities, shortness of breath, chest pain (angina), irregular heart beat (arrhythmia), or fainting spells (syncope). Electrocardiogram (EKG), x ray, and angiography (a special x-ray examination using dye in the vascular system) may be performed to identify valvular heart problems. Depending on the severity of symptoms, cardiac catheterization may also be performed to examine heart valve function prior to recommending a surgical procedure. Valvular angioplasty is performed in children and adults to relieve stenosis. While it offers relief, it does not always cure the problem, particularly in adults, and often valvotomy (cutting the valve leaflets to correct the opening) or valve replacement is necessary at a later date.


Demographics

Congenital heart-valve disease occurs in one of every 1,000 newborns and is thought to be caused by inherited factors. In 2–4% of valve problems, health or environmental factors affecting the mother during pregnancy are believed to contribute to the defect. Pulmonary valve stenosis represents about 10% of all congenital heart problems. About 5% of all cardiac defects are stenosis of the aortic valve. Valve abnormalities are diagnosed in children and adults of both sexes; 80% of adult patients with stenosis are male, most adults with mitral stenosis are women who had rheumatic fever as a child. Tricuspid stenosis is rarely found in North America and Europe.


Description

In balloon valvuloplasty, a thin tube (catheter) with a small deflated balloon at its tip (balloon-tipped catheter) 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 to stretch the valve open and relieve the valve obstruction.

The procedure, which takes up to four hours, is performed in a cardiac catheterization laboratory that has a special x-ray machine and an x-ray monitor that looks like a regular TV screen. The patient will be placed on an x-ray table and covered with a sterile sheet. An area on the inside of the upper leg will be washed and treated with an antibacterial solution to prepare for the insertion of a catheter. The patient is given local anesthesia to numb the insertion site and will usually remain awake, able to watch the procedure on the monitor. After the insertion site is prepared and anesthetized, the cardiologist inserts a catheter into the appropriate blood vessel, then passes the smaller balloon-tipped catheter through the first catheter. Guided by the xray monitor that allows visualization of the catheter in the blood vessel, the physician slowly threads the catheter up into the coronary artery to the heart. The deflated balloon is carefully positioned in the opening of the valve that is being treated, and then is inflated repeatedly, which applies pressure to dilate the valve. The inflated balloon widens the valve 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 six to 12 hours because, in some cases, the procedure must be repeated. A double-balloon valvuloplasty procedure is often performed on certain high-risk patients because it is considered more effective in restoring blood flow.


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 (anticoagulants to prevent clot formation and radioactive dye for x rays) 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) to ensure that he or she will relax sufficiently for the procedure.

Aftercare

After balloon valvuloplasty, the patient will spend several hours in the recovery room to be monitored for vital signs (such as heart rate and breathing) and heart sounds. During this time, electrical leads attached to an EKG machine will be placed on the patient's chest and limbs, and a monitor will display the electrical impulses of the heart continuously, alerting nurses quickly if any abnormality occurs. 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. The skin condition is monitored. The insertion site will be observed for bleeding until the catheter is removed. The leg in which the catheter was inserted is temporarily prevented from moving. Intravenous fluids will be given to help eliminate the x-ray dye; intravenous anticoagulants or other medications may be administered to improve blood flow and to keep coronary arteries open. Pain medication is administered as-needed. Some patients will continue to take anticoagulant medications for months or years after the surgery and will have regular blood tests to monitor the effectiveness of the medication.

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, a condition called restenosis, which will likely require repeat valvulplasty, valvotomy, or valve replacement.


Risks

Balloon valvuloplasty can have serious complications. For example, the valve can become misshapen so that it does not close completely, which makes the condition worse. Embolism, where either clots or pieces of valve tissue break off and travel to the brain or the lungs causing blockage, is another possible risk. If the procedure causes severe damage to the valve leaflets, immediate valve replacement 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. Because restenosis is frequent in adult patients with valvular disease, particularly when underlying heart disease or other conditions are present, the procedure is recommended only as an emergency rescue for high-risk patients who are not candidates for valve replacement.


Normal results

Balloon valvuloplasty is considered a safe, effective treatment in children with congenital stenosis, improving heart function and blood flow. In adults, balloon valvuloplasty may give temporary relief and improve heart function and blood flow, but underlying coronary artery disease or other disease conditions may encourage restenosis, making valve replacement eventually necessary. The most successful valvuloplasty results are achieved in treating narrowed pulmonary valves, although the treatment of mitral valve stenosis is also generally good. The aortic valve procedure is more difficult to perform and is generally less successful.

Resources

BOOKS

Heart Owner's Handbook: Congenital Heart Disease and Diseases of the Heart Valves. Texas Heart Institute, New York: John Wiley & Sons, 1996.

Mayo Clinic Practice of Cardiology: Balloon Valvuloplasty. 3rd ed. Edited by Emilio R. Giuliani, et al. St. Louis: Mosby, 1996.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org .

OTHER

"Heart Valve Problems." Aetna Intelihealth. [cited April 2003]. http://www.intelihealth.com .


Lori De Milto L. Lee Culvert

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Balloon valvuloplasty is performed in a hospital cardiac catheterization laboratory, a special room much like an operating room , by a cardiologist or vascular surgeon.

QUESTIONS TO ASK THE DOCTOR


  • Why do I need this procedure?
  • What will I gain by having the procedure?
  • What kind of anesthesia will I have?
  • Will I be uncomfortable during or after the procedure?
  • Will I be able to continue all my normal activities when I go home? How soon after the surgery can I return to school/work?
  • Will I need any follow-up care or tests after the surgery?
  • How often do you perform this procedure?
  • Do most people who have this procedure feel better afterwards?


User Contributions:

Erin Beatie
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Jun 22, 2008 @ 8:08 am
THE ARTICLE IS VERY INFORMATIVE. I ESPECIALLY FOUND USEFUL THE PARAGRAPHS ON THE EFFECTIVENESS AND SUCCESS OF BALLOON VALULOPLASY FOR DIFFERENT VALVES. I WOULD RECOMMEND THIS SITE TO ANYONE WHO MAY HAVE STENOSIS. THANK YOU.
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Feb 26, 2010 @ 12:12 pm
Please can you send pictures of the valvuplasty procedure
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Mar 17, 2010 @ 12:12 pm
Dear Sir/Madam.My sister gone through this valvuplasty surgery last year. Now she is normal. I would like to ask that Whether she have to tell this to doctor everytime about her valvuplasty surgery while taking the treatment for other reasons (for example while consulting a dental doctor). I kindly request you to answer to my mail address.. Thank you..
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Mar 23, 2010 @ 12:12 pm
Good Afternoon,

My mother age 86 just recently had a successful Balloon Valvuloplasty done on the Aortic Valve. After careful evaluation it was discovered that no coronary artery disease or other disease conditions were present. Could stenosis reaccur?

Please reply,Thank you
Eddie
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Sep 15, 2010 @ 11:11 am
thank you for a most informative article on balloon mitral valvuloplasty. I am at present awaiting the call from the hospital informing me of the date of admission for this procedure. In my case a little knowledge is very beneficial, as I am aware of the steps involved.However, I wonder if anyone can answer just one question that is lingering within me?
My mitral valve was repaired by Prof.Magdi Yacoub in 1978 via open heart surgery. In my case it was a resounding success. However my question is this; What happens to any calcium that may be causing the cusps of the valve to stick when the balloon breaks open the sealed areas?
I find it unlikely that medical science in recent years has ignored such an unfortunate outcome as to cause a stroke or heart attack and must have a deterrent. Would someone enlighten me, from a medical point of view?

Thanks for your fine web site. Just a brother.
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Oct 20, 2010 @ 10:22 pm
I FOUND THE ARTICLE VERY INFORMATIVE. I WAS LOOKING FOR A SYMPTOM ONE COULD GET, THE RIGHT CHAMBER BECOMES ENLARGED BECAUSE THE VALVE ISN'T CLOSING COMPLETELY AFTER EMTYING THE BLOOD SUPPLY. I DID NOT FIND THAT. MY DOCTOR TOLD ME MY CHILD HAS BEGUN TO EXPERIENCE THIS. HE DID NOT SEEM ALARMED AND MADE OUR FOLLOW-UP FOR 2 YEARS, BUT STILL I AM CONCERNED. I WISH I COULD READ MORE ON THIS SIDE-EFFECT OF THE VALVOPLasty.
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Nov 30, 2010 @ 6:18 pm
I found this info very informative, glad it was here for me to view. I found myself a week before Thanksgiving very short of breath and had to be rushed to the ER. I have been on meds for A-Fib for several years and have a bad valve from Rhumatic Fever when I was 12 years old. I have known for quite a few years that valve replacement was in my future but hoped by the time I needed it that medical procedures would be far more advanced and thank god and science I believe it was. I had the valvoplasty a few days before Thanksgiving and was released about 3 days after procedure, spending the holiday with my family. I feel pretty good, still a little weak, not back to work yet, but had the procedure only 10 days ago, and not sure I am ready to resume my normal work routine, but I assume I will with in the next week or two. I was not aware that the valve may still need replaced until I read these articles. I guess I just need to hope and pray it is a long time before needed and pray all is well in the mean time. God Bless and my prayers go out to all going through this, family and patients.
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Mar 1, 2011 @ 7:19 pm
I am a radiological student in a Special Procedures class this semester and we are required to do a paper on interventional procedures. I picked Percutaneous Balloon Aortic Valvuloplasty. My brother had an aortic valve replacement when he was 27 so this topic hits home to me. But we can only do an interventional study for our paper, not something like surgery. My question is- can you tell me in a step-by-step way on how the procedure is done, from the insertion of the needle, wire, sheath, catheter, into the heart and the steps afterward? I am currently doing a rotation at a children's hospital but they are so busy and thus do not have time to go over it with me. And the procedure would be for a child since they have already given me some material from their supply room. We have to do a "show and tell" during our procedure and talk about the instruments used. Thank you in advance, Lori Diaz
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Sep 14, 2011 @ 10:10 am
Thank you for the very informative article. My 62yr old husband is an end renal failure (dialysis patient) who also only has 40% lung function and is on 5 to 6L O2 98% of the time. He also had a triple bypass in 2007, AAA stent in that same year. According to the heart surgeon he is not a canidate for open heart aortic valve replacement at this time and has suggested BAV/PBV to buy some time, and hopefully get better blood flow so a total valve replacement can be attempted a few months down the road.

He goes into fluid overload/repartory disstress every few weeks due to the AS.

My question is: what is the survival rate of this procedure for someone in his medical condition and should it even be attempted at this time. He basicly has no life at all and thinks attempt this procedure is better than trying to live as he is.

You may email your response to my email address above. Also, forward any websites that may be of help in making this decision.

Thank You
Susan
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Sep 19, 2011 @ 1:13 pm
i AM GONNA NEED THIS PROCEDURE PRETTY SOON, AND I WANT TO SPEAK SOMEONE WHO HAD THAT PROCEDURE, WOULD SOMEONE SNED ME MESSAGE PLEASE, THANKS.
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Sep 26, 2011 @ 7:19 pm
My husband just had balloon valvuplasty. So far he has not seen any improvement.
Is is a gradual improvement? Thank you very much.
Amanda
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Oct 18, 2012 @ 3:15 pm
I was 29 years old and 7 months pregnant when I had balloon valvuplasty on my aortic valve. I was born with a Bicuspid Aortic Valve with (mild) aortic stenosis. It was first discovered when I was only 6 months old when my family doctor discovered a heart murmor. I've been watched closely by the doctors at Toronot Sick Kids and now at Toronto General ever since.

I was lucky to have never had surgery until I went into heart failure when I was 7 months pregnant. That's when my stenosis became severe. Before I got pregnant I lived an active lifestyle. I ran half a marathon and climbed the CN tower under 20 minutes and every type of sport.

Now it's been 3 years since my valvuplasty was done. It got me through my delivery which went well. My daughter is full of energy and is showing no signs of having my heart condition so far (she has a 4% chance of inheriting it). I've lived an active lifestyle again up until now.

Unfortunately, I'm showing symptoms again and my ECHO results are showing high gradients again. It looks like another balloon valvuplasty is required in the new year. I do want to have more children. I'm in good hands of the best doctors in the world so I have hope that I can expand my family and live a long and active lifestyle. I know one day I will have to have my aortic valve replaced...but hopefully the balloon valvuplasty can by me some more time.
Sudhansu Rath
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Nov 29, 2012 @ 11:11 am
Thanks for the helpful info..My cousin sister(age:25) is having Mitral stenosis( MAV 1.16cm2,moderate).Can any one suggest me the best hospital in India for BMV ??
pauline stubbs
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Jan 11, 2013 @ 5:05 am
My mum had just had a balloon valvuloplasty last week, she's suffering from cold feet and toes? Is it normal?
nate almond
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Jan 29, 2013 @ 11:23 pm
Thank you for the great article on balloon valvuloplasty. I'm a real healthy guy even at 92 y/o. Recently it was discovered that my aortic valve didn't open sufficiently and I ran out of breath when going up hill. I believe they are considering doing the balloon valvuloplasty on me. Meanwhile I'm trying to improve my bravery as I have never had any kind of operation or procedure prior to now. Thank to those of you who have shared your own experiences. It proves there can be life after such a procedure. Thanks once more.
An
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Feb 15, 2013 @ 11:11 am
Mine is scheduled for March. I'm 17...for anyone who has had this, please tell me how it is. Is it painful? I'm really nervous.
Pat McChesney
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May 27, 2013 @ 9:21 pm
I'm to have this procedure soon. Where is the best hosptal to have it done. I'm told to go where they are performed the most and have the best results. Where is the best place?
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May 28, 2013 @ 10:10 am
I am aged 86 and have had a failed TAVI operation as my valve is 15mm and the smallest valve implant is 18mm. Would Valvulopasty
Increase the diameter of the annulus.thus enabling me to have a replaced valve to cure my leaking prosthetic Valve
inserted 12 years ago.
I would like your advice
Thanks Kath

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