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.
References in periodicals archive ?
Multimodality Imaging of Bioprosthetic Percutaneous Balloon Valvuloplasty followed by Valve in Valve Implantation for Mitral Stenosis Due to Commissural Leaflet Fusion.
* Surgical commissurotomy may be carried out in patients who are not good candidates for balloon valvuloplasty due to severe valve calcification.
The efficiency and safety of balloon valvuloplasty in patients with mitral stenosis and a high echo score: midand short-term echocardiographic and echocardiographic results.
Infants under 1 month of age who underwent balloon valvuloplasty, particularly CAS patients, are at a higher risk for complications.
Percutaneous pulmonary balloon valvuloplasty was performed on day 18.
During pregnancy, ESC guidelines on the management of cardiovascular diseases during pregnancy (7) provide follow-up recommendations for patients with mild or moderate PS, but balloon valvuloplasty should be advised for symptomatic severe PS with RV dysfunction as in our patient.
Effect of percutaneous mitral balloon valvuloplasty on right ventricular functions in mitral stenosis: Short-and mid-term results Anadolu Kardiyol Derg.
The company said the clinical study will assess the safety and effectiveness of the XPro System, its large bore closure device, to facilitate hemostasis in patients undergoing percutaneous endovascular procedures utilising 8-18 Fr introducer sheaths via the common femoral artery, including Transcatheter Aortic Valve Implementation (TAVI), Endovascular Aneurysm Repair (EVAR), Thoracic Endovascular Aneurysm Repair (TEVAR) as well as Percutaneous Balloon Valvuloplasty (PBV) procedures.
NHLBI Balloon Valvuloplasty Registry Report on immediate and 30-day follow-up results.
After the development of percutaneous mitral balloon valvuloplasty (PMBV) technique, it has become the first choice for the treatment of patients with mitral stenosis who have Wilkins score < 8.
performed a prospective pilot study and found the use of adenosine safe and feasible to achieve cardiac arrest in 20 patients who underwent TAVI with balloon valvuloplasty in whom rapid pacing would be not well tolerated [5].
The second arm of the PARTNER study randomized more than 350 inoperable patients to standard treatment with medical therapy or balloon valvuloplasty, or to TAVR.