What is Balloon valvotomy or balloon valvuloplasty?
Balloon valvotomy or valvuloplasty is a minimally invasive cardiac surgical procedure. It is used to correct the narrowing or stenosis of the valves. Pulmonary, aortic and mitral stenosis can be treated by balloon valvotomy or valvuloplasty. Balloon valvotomy is an alternative for open heart surgery to correct valve defects. Being a minimally invasive procedure the recovery is faster. But all cases of valve stenosis cannot be treated by balloon valvotomy.
What is valve stenosis?
Valve stenosis refers to the narrowing of the heart valves. The narrowing of valves can cause problem with blood flow to and from the heart. There are four valves in the heart. They are:
the tricuspid valve - between the right atrium and right ventricle, the pulmonary valve- between the right ventricle and pulmonary artery, the mitral valve - between the left atrium and left ventricle and the aortic valve - between the left ventricle and aorta.
All these valves open only in one direction. Once these valves open to allow the flow of blood, they close immediately to prevent its back flow. This allows for the optimal flow of blood to and from the heart. A lot of problems can happen when they become stenosed or narrowed. The most important one is the build up of pressure in the upper chambers. Similarly the output from the lower chambers will be reduced leading to circulatory problems.
Causes of valve stenosis:
• Aortic stenosis- effects of aging like scarring and calcium deposition in the valve. May be present at birth.
• Mitral stenosis- occurs on those who suffered rheumatic fever in childhood. Rheumatic fever is a complication of untreated strep throat and scarlet fever. Can also be caused by aging. Balloon Mitral Valvotomy is performed in this case.
• Tricuspid stenosis- occurs in those with a history of bacterial endocarditis or rheumatic fever. May be present at birth.
• Pulmonary stenosis- is always present at birth.
Symptoms of valve stenosis:
Symptoms common to all types of valve stenosis are:
• Shortness of breath
• Irregular heart beats
• Chest pain
• Abnormal blood pressure
• Heart dysfunction
• Heart failure
Cases eligible for balloon valvotomy:
A balloon valvotomy can be performed to correct pulmonary, aortic or mitral stenosis of mild to moderate intensity. Valve stenosis along with regurgitation is not usually treated with balloon valvotomy. Balloon valvotomy is attempted only if the morphology of the valve is favourable to the procedure.
A balloon valvotomy may be done at times in certain situations as an alternative to open surgery. The aim is to delay the surgery till the health condition of the person permits him to undergo surgery. This may be done as a palliative measure to alleviate the symptoms and prevent further complications.
This may be done in:
• Children with aortic stenosis till they become old enough to undergo valve replacement surgery
• In pregnant women
• In persons with other illnesses who cannot undergo a major surgery
• In persons who need to undergo emergency surgeries for other non-cardiac health conditions
• In persons who refuse to undergo surgery for valve replacement for whatsoever reasons
Types of balloon valvotomy:
The three major types of valvotomy procedures are:
• Balloon mitral valvotomy
• Balloon aortic valvotomy
• Balloon pulmonary valvotomy
Balloon valvotomy procedure:
As said, there are three types of valvotomy procedures depending on the valve treated. The procedure for all the three is more or less the same. The difference lies only on the way to access the valve. The access to the valve is gained through the blood vessels that reach the particular chamber of the heart. The blood vessels in the arms or groin are used to gain access to the valve. A catheter containing an inflatable balloon in the tip is used to reach the valve. A contrast dye is administered during the procedure to get a clear picture of blood flow through the valve.
It takes about two hours to complete the procedure. A valvotomy procedure is usually done under sedation to relax the patient. The major steps in a valvotomy procedure are:
1. Sedating the patient
2. Identification of the blood vessel to be catheterised
3. Application of a local anaesthetic on the skin over the blood vessel to be catheterised
4. Placement of a sheath to introduce the catheter in the blood vessel
5. Manoeuvring the catheter to the valve through the blood vessel
6. Administration of the contrast dye
7. Positioning of the catheter tip containing the balloon in the valve
8. Inflation of the balloon
9. Deflation of the balloon
10. Repetition of inflation and deflation till the valve is sufficiently widened
11. Assessment of the blood flow through the valve with the help of contrast dye
12. Withdrawal of the catheter on achieving satisfactory blood flow through the valve
13. Removal of the catheter from the blood vessel
14. Placement of a dressing over the catheterisation site
Once this is done, the patient is shifted to recovery room for observation. The patient will then be shifted to the hospital room. Discharge from the hospital will be done in a day or two.
Balloon valvotomy risks and complications:
The procedure is usually a safe one and well tolerated. But like other invasive procedures there are certain risks and complications. They include minor risks like pain, swelling, bleeding and infection in the catheterised site. Major risks, though very rare are:
• Severe blood loss
• Rupture of the blood vessels or the valve itself
• Chances of embolism
• Kidney failure due to the presence of contrast dye
The complications are
• Regurgitation due to the inability of the valve to close properly
• Restenosis where the valve gets narrowed down again
• Need for an open surgery due to unforeseen occurrences
Dos and don’ts after procedure:
• Keep the catheterised site clean and dry
• Drink lots of fluids to flush out the dye from the body
• Keep the catheterised limb elevated
• Frequently and gently move the limb to boost circulation
• Avoid strenuous activities for a few days