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Heart Care |
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Balloon Valvuloplasty
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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
site where the catheter will be inserted is prepared
and 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.
Special
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