This article has been reviewed and approved by Dr Manish Hinduja for authenticity and medical correctness on 02 Jul 2020

All about Balloon Valvotomy

Balloon valvotomy, or a Balloon valvuloplasty, is a medical procedure to open heart valves that have become narrow or stiff.

You have four heart valves that let the blood to flow in one direction. These are the tricuspid, pulmonary, mitral, and aortic valves. Once the blood passes through these, the valves close and do not allow blood to flow back. If the valves are stiff or narrow, there will be a decrease in the amount of blood that can flow through it.

Balloon valvotomy can help to correct the narrowing of all heart valves. But doctors commonly do it for stenosis of mitral, pulmonary, and tricuspid valves, respectively. At times, doctors may use it to treat aortic valve stenosis as well.

During the procedure, the doctor will open the narrow valves with the help of a small balloon at the end of a thin wire called a catheter. The doctor will insert the wire through a blood vessel in the arm or the leg and then slowly screw it up to the heart. After reaching the valve, the doctor will inflate the balloon to open the leaflets of the valves.

A balloon valvotomy is an option for those with heart valve problems that are not very severe. The procedure is a minimally invasive one. The surgeon will make only a small cut in the skin over the blood vessel to insert the catheter. It helps to avoid surgery to replace the valve.

The procedure will take around one to two hours. You will need to stay in the hospital for about two days. Your recovery will be quick, and there are fewer chances for complications.

Why to do a Valvotomy?

Your heart has four valves that help to control the flow of blood.

The tricuspid and mitral valves lie between the atria or upper chambers of the heart and the ventricles or lower chambers of the heart.The pulmonary and aortic valve lies between the ventricles and the two major blood vessels that leave from these.

All these valves have two or three leaflets. These leaflets open only to allow the flow of blood in a single direction. These valves close as soon as blood passes through it and prevents the backflow of blood.

The leaflets of the valves are elastic by nature that allows them to open and close properly. Due to some reasons, the leaflets may get stiff or hard. It makes the valves narrow.

A narrowing or stenosis of the heart valve will decrease the blood flow through it. It can cause problems with the normal functioning of the heart and lungs. The heart muscles will have to work harder to push blood through the narrow valve. Also, there will be a build-up of blood in the lungs, as in the case of mitral valve stenosis. 

By a balloon valvotomy, the surgeon can increase the width of the heart valves. The wider valve allows the blood to flow freely through the valve. It reduces the workload of the heart. Also, it improves the blood flow through the lungs and the rest of the body. 

As said, a balloon valvotomy is not heart surgery. It is a minimally invasive procedure that does not need a surgical incision. It is also a very safe procedure with very few risks and complications. Your recovery from it will also be very fast. 

Causes and symptoms of valve stenosis 

A valvotomy helps to open up narrow heart valves. Your heart valve may become narrow or stenosed due to various reasons. 

Mostly aortic and pulmonary stenosis are often present at birth. It happens due to a change in the shape and structure of the valve while the heart develops.

Rheumatic fever and infective endocarditis are the most common causes of mitral and tricuspid valve stenosis. Both of these conditions occur due to bacterial infections. These cause swelling in the heart valves, making them hard and less elastic. So the valves do not open enough to allow blood to pass through.

As the valves get stiffer, you will start having various problems. Your heart will start working hard to push the blood through the narrowed valve. Your symptoms will depend on the valve that has the problem.

The general symptoms include

  • Chest pain or discomfort
  • Fatigue
  • Swelling of the ankles or feet
  • Difficulty in breathing
  • Tendency to faint 

 

Your doctor will be able to hear a murmur or an abnormal heart sound while listening with a stethoscope. A chest x-ray will help the doctor to know about changes in heart shape or structure.

When to do a valvotomy?

You will have a valvotomy if you have stenosis on any of your heart valves. 

It is an ideal option to treat moderate to severe mitral stenosis.

In pulmonary or tricuspid stenosis, the doctor will look into the structure of the valve and the cause of narrowing. If you have stenosis of the aortic valve, you may have a valvotomy as a temporary measure.

You should know that a valvotomy cannot treat all valve problems. If your valves are leaky, a valvotomy is not for you. It will only increase the problem. Also, the treatment is not possible in those who have blood clots in the heart chambers.

A valvotomy does not need surgery on the heart. So, it is ideal for those who want to avoid surgery. Also, there are fewer risks, and recovery is very quick.

Valvotomy procedure

Before the procedure

You will have a few tests to help the doctor know about the condition of your valve. The tests will include chest x-rays, ECGs, and blood tests.

You will have an echocardiogram, which helps the doctor to get a clear picture of the heart valve. The doctor will look into the extent of stenosis, the shape of your heart valve, etc.

You will stop any blood thinners or herbal supplements a few days before. It helps to avoid any chances of bleeding. You will be in the hospital the night before the procedure.

During the procedure

You will have the procedure at a cath lab, a special room for performing minimally-invasive heart treatments. Once everything is fine, the doctor will start by applying a local anesthetic on the skin over a blood vessel in the groin. Once you feel numb, the doctor will make a small puncture in your blood vessel.

The doctor will then slowly insert a small flexible tube called a catheter into it. The catheter will have a deflated balloon at its tips. 

The next step is to guide the catheter to the heart. The doctor will be able to see the moving catheter on a screen. Once the catheter reaches the heart valve, the doctor will slowly inflate the balloon. It helps to separate the leaflets of the heart valve and to improve its opening. 

The doctor will do it two or three times and then take an echo of the heart. It will help to know the amount of blood flow through it.

Once this is over, the doctor will slowly withdraw the catheter and take it out of the blood vessel. You will have a pressure bandage over the skin to arrest any bleeding. You will go back to the room after two or three hours.

Recovery

Once in your room, you will have to lie down flat for a few hours. It is essential to avoid the bending of legs to prevent bleeding. After some time, you will be able to sit up. 

The next day morning, you will have another echocardiogram to know how well the valve is doing. If everything is fine, your doctor will allow you to go home. You will have to take some medicines as well as avoid strenuous activity for a few days. You will be able to go back to your routine within three to four days.

The doctor will look into the extent of stenosis, the shape of your heart valve, etc.

Risks of valvotomy procedure

A valvotomy is usually a safe procedure but has some risks as well. Some of the common ones are

  • Bleeding at the site of catheter placement
  • Damage to the blood vessel by the catheter
  • Infection at the site
  • Damage to the heart valve
  • Restenosis of the valve

Valvotomy procedure in India
Valvotomy procedure in India

References / Additional Reading
This article has been reviewed by Dr Manish Hinduja for authenticity and medical correctness on 02 Jul 2020
Dr Manish Hinduja
Dr Manish Hinduja
MBBS,M.S,M.Ch.-CTVS,D.N.B.(CTS) Gold medalist, Fellowship Advanced cardiac surgery, Ottawa, Canada
Dr Manish Hinduja is Consultant Cardiothoracic and Vascular Surgeon at Fortis Hospitals, Mulund and Vashi, Mumbai. He has special interests in minimally invasive cardiac surgery and heart transplant surgery. His skills include total arterial coronary artery bypass surgery, valve repair surgery, valve-sparing aortic root surgeries. He is highly skilled in minimally invasive CABG and minimally invasive valve surgeries. He has various publications in important international journals. He has remained a gold medalist during his training has won the prestigious " C S Sadasivam Award" from the national board.
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