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Balloon Valvuloplasty : Why is it done, On Whom is it done, Benefits, Risks, Recovery Period

A balloon valvuloplasty, also called balloon valvotomy, percutaneous balloon valvuloplasty, valve dilation, or just a valvuloplasty, is a type of surgical procedure that is used to repair a heart valve that has become narrowed. This procedure is a common surgical technique used for the repair of a heart valve that has developed a narrowed opening.(1, 2)

Humans have four valves in the heart known as the aortic, tricuspid, mitral, and pulmonary valves. These four valves are located at the exit points of the four chambers of the heart. These valves function by opening and closing to allow the blood to flow through the heart.(3) You can think of them to be like gates that monitor and regulate how much blood flows between the upper and lower chambers of the heart, as well as how much blood flows out of the heart. However, when the heart valve becomes narrowed, a condition known as stenosis, the valve flaps, known as leaflets, start becoming stiff or thick. In extreme cases of narrowing, they may even fuse together. This narrowing of the heart valves decreases the blood flow through the valve to the heart. If the blood does not flow properly from one chamber of the heart to the other, it impacts the proper functioning of the heart and the entire system.(4, 5)

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This is where the procedure known as balloon valvuloplasty comes in. A balloon valvuloplasty helps improve the flow of blood through the valves of the heart and may also help improve the symptoms of heart valve disease, including chest pain and shortness of breath. Read on to find out everything there is to know about balloon valvuloplasty.

What is a Balloon Valvuloplasty?

A balloon valvuloplasty is a type of minimally invasive interventional technique where a catheter is inserted through an artery in the groin. In some cases, the catheter might be inserted through an artery in the arm or shoulder, though this is rare. When compared to open surgery, this minimally invasive approach causes lesser pain and also has a quicker recovery time.

Why Is Balloon Valvuloplasty Done & On Whom Is It Done?

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Balloon valvuloplasty is done to repair valve stenosis or a narrowed heart valve. If you have a narrowed heart valve, the valve flaps, or the gates of the valve may become thick or stiff, which reduces the flow of blood through the valve, which affects the functioning of the heart and circulatory system. Balloon valvuloplasty helps improve the blood flow through the valve.

It brings about an improvement in your symptoms, especially in patients who are not considered to be fit candidates for undergoing a transcatheter aortic valve replacement (TAVR) or an aortic valve surgery.(6, 7, 8, 9)

Balloon valvuloplasty is used to repair the narrowed heart valve and is often recommended for the treatment of the following conditions:

  • Aortic valve stenosis
  • Tricuspid valve stenosis
  • Pulmonary valve stenosis, also known as pulmonic stenosis
  • Mitral valve stenosis
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If such heart conditions are not treated, they can cause many types of complications, including arrhythmias (irregular heartbeats) and even heart failure if the valves narrow so much that they become fused.

Your doctor will discuss the various treatment options with you and whether a balloon valvuloplasty is a suitable treatment for the specific type and stage of heart valve disease that you have. A balloon valvuloplasty is usually recommended for those who have severe heart valve narrowing that is causing various signs and symptoms. However, this does not mean that a balloon valvuloplasty cannot be used in other cases. Some people with heart valve disease may need to undergo a balloon valvuloplasty even if their condition is not severe or not causing symptoms.

Some of the symptoms you may experience if you have heart valve stenosis include:

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  • Chest pain
  • Swelling of the ankles or feet
  • Swelling of the abdomen
  • Feeling dizzy
  • Difficulty in breathing
  • Unexplained weight gain

The reason for whether or not a valvuloplasty is needed also depends on the exact heart valve that has narrowed. For example, a balloon valvuloplasty might be recommended for people who are experiencing an aortic valve stenosis for the second time and have undergone a valvuloplasty as the chosen treatment the first time. Narrowing of the aortic valve is actually common in adults who have already had one valvuloplasty before, which is why during the second time also, the same procedure is repeated. For high-risk patients, balloon valvuloplasty is only done to provide emergency protection.

Balloon valvuloplasty can also be recommended for children and young adults with congenital aortic stenosis. The procedure is also carried out in individuals who are too sick to undergo open surgery or who are waiting to undergo a valve replacement to get temporary relief from their symptoms.(10, 11)

What Happens During Balloon Valvuloplasty?

This procedure is carried out in a hospital and is usually performed under a sedative to help the patient relax but remain awake. Valvuloplasty is typically done during a process known as cardiac catheterization. During this procedure, a cardiologist puts a soft, thin tube known as a catheter or sheath that has a balloon attached at one end into an artery in the groin, arm, or shoulder.(12)

The cardiologist then carefully maneuvers the catheter to guide it to the narrowed valve of the heart with the help of a contrast dye and imaging devices like X-rays. Once it is in position, the balloon is inflated to widen the narrowed valve. This improved blood flow through that valve. Once the narrowed valve is opened, the balloon is deflated, and the catheter with the balloon attached at the tip is removed from the artery. Once the catheter is removed, the insertion site is closed with a special surgical glue or small stitches. In some cases, the cardiologist leaves the catheter in place for six to eight hours if the patient is at a risk of bleeding or there is a need to wait for the patient’s blood thinning medication to wear off.(13, 14)

You usually need to spend the night in the hospital after the procedure. Following a balloon valvuloplasty, you will also need to undergo regular health checkups as well as imaging tests of the heart to ensure that the heart valve has not narrowed again.

A balloon valvuloplasty helps improve blood flow to the heart and reduces the symptoms caused by heart valve stenosis. Since there is a risk of the heart valve narrowing again, there is always a chance that you might need to undergo another valvuloplasty or some other heart procedure, such as a valve replacement or repair, in the future.

If the catheter is inserted through the groin, the patient has to wait for a few hours before they can bend their leg. Depending on your individual condition, you may need to lie in bed for at least two to six hours after the surgery. You will also need to drink a lot of water to flush out the contrast dye from the body. You will be allowed to get out of bed and move about a few hours after the valvuloplasty and return home the next day if all goes well.

What Are The Benefits and Risks of Balloon Valvuloplasty?

A balloon valvuloplasty helps improve the blood flow to the heart valves, getting the heart to function properly again. This also helps avoid or at least postpone the need for a heart valve replacement. Since valvuloplasty is a minimally invasive procedure, there are several benefits of such type of treatment, including:

  • Lesser pain
  • Faster recovery time
  • Reduced risk of complications
  • Less scarring

It is important to remember, though, that a balloon valvuloplasty is not an alternative to surgery if your doctor recommends the same.

Just like all medical procedures, there are some risks associated with balloon valvuloplasty as well, including a risk of bleeding or infection.(15, 16, 17)

The procedure can be risky for pregnant women as the radiation exposure from the X-rays used in the procedure can be harmful to the fetus as well as the pregnant woman.

There is also the risk of the heart valve narrowing again following the valvuloplasty. Though, of course, the specific risk factors of this happening depend on your overall health and what kind of lifestyle you follow after the procedure. Your doctor will help you understand all the potential risks or complications associated with a balloon valvuloplasty.

What Is The Recovery Time After A Balloon Valvuloplasty?

Being a minimally invasive procedure, the recovery time after a balloon valvuloplasty is usually faster than an open heart valve surgery. However, the exact recovery time depends on many factors, including your heart health, overall health, age, and the kind of lifestyle you follow after the procedure. You also need to follow the recommendations of your doctor and avoid indulging in any strenuous activity and swimming for at least the first week after the procedure.

Most people are able to get back to work after one week, but you may need to take some more time off from work if your work involves heavy manual labor or physical activity. It may take up to eight to ten weeks for a patient to get back to doing all their usual activity.

Conclusion

While a balloon valvuloplasty is considered to be a safe procedure, you still need to follow certain precautions after the procedure, as advised by your doctor. You should also call your doctor right away if you experience any kind of chest pain, fever, chills, dizziness, fainting, nausea or vomiting, pain or swelling that gets worse or tends to persist, bleeding or drainage at the catheter insertion site, or an unexplained weight gain of over three pounds a day. A balloon valvuloplasty will open the narrowed heart valve, improving blood flow to the heart valve and allowing your heart to pump blood more effectively. This procedure can help you delay or even avoid a valve replacement surgery.

References:

  1. Vahanian, A., 2001. Balloon valvuloplasty. Heart, 85(2), pp.223-228.
  2. Kan, J.S., White Jr, R.I., Mitchell, S.E. and Gardner, T.J., 1982. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary-valve stenosis. New England Journal of Medicine, 307(9), pp.540-542.
  3. NISHIMURA, R.A., HOLMES Jr, D.R. and REEDER, G.S., 1990, February. Percutaneous balloon valvuloplasty. In Mayo Clinic Proceedings (Vol. 65, No. 2, pp. 198-220). Elsevier.
  4. Buchanan, J.W., Anderson, J.H. and White, R.I., 2002. The 1st balloon valvuloplasty: an historical note. Journal of veterinary internal medicine, 16(1), pp.116-117.
  5. Savory, W., 1854, December. On the valves of the heart. In Abstracts of the Papers Communicated to the Royal Society of London (No. 6, pp. 133-137). London: The Royal Society.
  6. Ross, D.N., 1966. Aortic valve surgery. Annals of the Royal College of Surgeons of England, 39(3), p.192.
  7. Otto, C.M., 2000. Timing of aortic valve surgery. Heart, 84(2), pp.211-218.
  8. Webb, J.G. and Wood, D.A., 2012. Current status of transcatheter aortic valve replacement. Journal of the American College of Cardiology, 60(6), pp.483-492.
  9. Makkar, R.R., Fontana, G.P., Jilaihawi, H., Kapadia, S., Pichard, A.D., Douglas, P.S., Thourani, V.H., Babaliaros, V.C., Webb, J.G., Herrmann, H.C. and Bavaria, J.E., 2012. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. New England Journal of Medicine, 366(18), pp.1696-1704.
  10. Otto, C.M. and Prendergast, B., 2014. Aortic-valve stenosis—from patients at risk to severe valve obstruction. New England Journal of Medicine, 371(8), pp.744-756.
  11. Kanwar, A., Thaden, J.J. and Nkomo, V.T., 2018, April. Management of patients with aortic valve stenosis. In Mayo Clinic Proceedings (Vol. 93, No. 4, pp. 488-508). Elsevier.
  12. Cosgrove, D.M., Rosenkranz, E.R., Hendren, W.G., Bartlett, J.C. and Stewart, W.J., 1991. Valvuloplasty for aortic insufficiency. The Journal of Thoracic and Cardiovascular Surgery, 102(4), pp.571-577.
  13. Lababidi, Z., Wu, J.R. and Walls, J.T., 1984. Percutaneous balloon aortic valvuloplasty: results in 23 patients. The American journal of cardiology, 53(1), pp.194-197.
  14. Harken, D.E., Ellis, L.B., Ware, P.F. and Norman, L.R., 1948. The surgical treatment of mitral stenosis: valvuloplasty. New England Journal of Medicine, 239(22), pp.801-809.
  15. Ben-Dor, I., Pichard, A.D., Satler, L.F., Goldstein, S.A., Syed, A.I., Gaglia, M.A., Weissman, G., Maluenda, G., Gonzalez, M.A., Wakabayashi, K. and Collins, S.D., 2010. Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC:
  16. Cardiovascular Interventions, 3(11), pp.1150-1156.
  17. Shareghi, S., Rasouli, L., Shavelle, D.M., Burstein, S. and Matthews, R.V., 2007. Current results of balloon aortic valvuloplasty in high-risk patients. The Journal of invasive cardiology, 19(1), pp.1-5.
  18. Eltchantnoff, H., Cribier, A., Tron, C., Anselme, F., Koning, R., Soyer, R. and Letac, B., 1995. Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable: immediate and mid-term results. European heart journal, 16(8), pp.1079-1084.
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