balloon valvuloplasty


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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.

Key terms

Cardiac catheterization — A technique used to evaluate the heart and fix certain problems. Catheterization is far less invasive than traditional surgery.
Stenosis — The narrowing of any valve, especially one of the heart valves or the opening into the pulmonary artery from the right ventricle.
Valve — Tissue in the passageways between the heart's upper and lower chambers that controls passage of blood and prevents regurgitation.
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.

Resources

Organizations

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

valvuloplasty

 [val´vu-lo-plas″te]
plastic repair of a valve, especially a valve of the heart.
balloon valvuloplasty dilation of a stenotic cardiac valve by means of a balloon-tipped catheter that is introduced into the valve and inflated.

balloon valvuloplasty

The use of a balloon catheter to overcome narrowing (stenosis) of a heart valve.

valvuloplasty

plastic repair of a valve, especially a valve of the heart.

balloon valvuloplasty
use of an intracardiac catheter with an inflatable balloon to dilate stenotic cardiac valves.
References in periodicals archive ?
Effect of percutaneous mitral balloon valvuloplasty on right ventricular functions in mitral stenosis: Short-and mid-term results Anadolu Kardiyol Derg.
Complete patient profile, echocardiographic findings and pre and post balloon valvuloplasty findings were recorded.
Since the first introduction of pulmonary balloon valvuloplasty (PBV) by Kanetal in 1982, PBV has become the treatment of choice for pulmonary valvular stenosis in newborns and children.
He has performed over 300 pulmonary balloon valvuloplasty procedures in the last two decades.
He started the procedure of Balloon dilation of the Atrial Septum and Mitral Balloon Valvuloplasty for the first time in the world at AIIMS, New Delhi.
We should not promote one procedure, we should promote a program of taking care of high-risk valvular heart disease patients--this may be surgical treatment, percutaneous treatment, or optimization of the patient's clinical status in the critical care unit, balloon valvuloplasty, or a wise solution to the patient's concomitant problems," he says.
Another striking feature was that the valve operated early in the deployment process, providing us some comfort and time to consider the valve position, as well as the immediate and almost complete obliteration of aortic regurgitation even in patients who had moderately severe aortic regurgitation after balloon valvuloplasty.
Some cardiologists have used a minimally invasive procedure known as balloon valvuloplasty, in which a balloon at the end of a catheter is inflated to dilate the aortic valve.
If a person is too ill to undergo surgery, a procedure called balloon valvuloplasty may be used to open the narrowed valve.
If severe symptoms occur, such as syncope, uncontrolled dyspnea and chest pain, percutaneous balloon valvuloplasty may be performed after the first 12 weeks of gestation.