What is valvuloplasty?

Valvuloplasty is a treatment for mitral valve stenosis. It is a procedure that widens the mitral valve so that blood flows more easily through the heart. It's also called a balloon commissurotomy or valvotomy.

It's a minimally invasive procedure. You may get medicine that relaxes you or puts you in a light sleep. You won't feel pain when the catheter is put in the blood vessel. A doctor uses a thin flexible tube (catheter) that is inserted through an artery in the groin and threaded into the heart.

When the tube reaches the narrowed mitral valve, a balloon device located on the tip of the catheter is quickly inflated. The narrowed or fused mitral valve leaflets are separated and stretched open as the balloon presses against them. This process increases the size of the mitral valve opening. And it allows more blood to flow from the left atrium into the left ventricle.

Activity

• If the doctor gave you a sedative:
  • For 24 hours, don't do anything that requires attention to detail, such as going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off.
  • For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
• Don't do strenuous exercise, and don't lift, pull, or push anything heavy until your doctor says it is okay. This may be for several days. You can walk around the house and do light activity, such as cooking.
• Try not to walk up stairs for the first couple of days.
• Be active. Walking is a good choice.

Diet

• Drink plenty of fluids to help your body flush out the dye. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. They will tell you if and when to start taking this medicine again. Make sure that you understand exactly what your doctor wants you to do.

Care of the catheter site

• For 1 or 2 days, keep a bandage over the spot where the catheter was inserted. The bandage probably will fall off in this time.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
• Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
• Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
• If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding doesn't stop, call your doctor or seek immediate medical care.

Balloon valvuloplasty is generally an effective treatment for aortic valve stenosis in children, teens, and young adults. But it doesn't work as well for older adults. In most older adults, the valve becomes narrowed again (restenosis) within 6 to 12 months after this procedure.

Balloon valvuloplasty works better in younger people because of the difference in the causes of aortic valve stenosis in younger and older people. Young people typically have the condition because they were born with a bicuspid valve. This is an aortic valve that has two leaflets instead of three. But older people typically get stenosis over many years through a gradual hardening and buildup of calcium on their valves. This is a process called aortic sclerosis. It's similar to atherosclerosis, the buildup of hard plaque inside the arteries.

After the procedure in a young person, the aortic valve is wider, but it's still not normal. Over time, the valve can get narrow again, so another procedure or valve replacement might be done.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

During the procedure

Risks during the procedure aren't common. But problems can include injury to the heart and stroke.

Problems caused by the catheter may include:

• Pain, swelling, and tenderness at the catheter insertion site.
• Irritation of the blood vessel by the catheter. This can often be treated with warm compresses.
• Bleeding at the catheter site.
• A bruise where the catheter was inserted. This usually goes away in a few days.

After the procedure

Complications that happen after a valvuloplasty include:

• Mitral valve regurgitation. The valve might be damaged so that it doesn't close normally and allows blood to leak backward in the heart.
• Restenosis. The valve can become narrow again. You may choose to have another valvuloplasty or valve replacement surgery.

You had a procedure to open a narrow aortic valve in the heart. Your doctor did this by putting a thin tube called a catheter into your heart through a blood vessel in the groin.

Your groin may have a bruise and feel sore for a few days. You can do light activities around the house. But don't do anything strenuous until your doctor says it is okay. This may be for several days.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure will take a few hours.
• After the procedure, pressure may be applied to the area where the catheter was put into your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. You may have a bandage or a compression device at the catheter insertion site. You might also have stitches there.
• Nurses will check your heart rate and blood pressure. The nurse also will check the catheter site for bleeding.
• You will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg to help you keep it still.

Valvuloplasty is done to help the valve work better and improve blood flow through the valve. It may be done to relieve symptoms such as chest pain, shortness of breath, or passing out (syncope).

Valvuloplasty is not an option for most people who have aortic valve stenosis.

Children, teens, and young adults

Valvuloplasty might be used in some children, teens, and young adults in their 20s who have aortic valve stenosis. This group typically has aortic valve stenosis because of a congenital heart defect such as a bicuspid aortic valve.

Pregnant women

Valvuloplasty may be used for pregnant women who get aortic valve stenosis symptoms during their pregnancy. After the baby is born, the aortic valve may be replaced.

Older adults

Valvuloplasty is not appropriate for most older people who have stenosis. These people typically need an aortic valve replacement procedure. But valvuloplasty might be done to relieve severe symptoms if a person has to wait before having the valve replaced.