102956 Health Library | Health and Wellness | Wellmont Health System
  • Percutaneous Balloon Valvuloplasty

    (Percutaneous Commissurotomy)

    Definition

    Percutaneous balloon valvuloplasty is done to open a constricted heart valve with a balloon.
    Mitral Valve Stenosis
    Nucleus image
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Any of the heart’s four valves can become deformed. It may happen because of congenital conditions (from birth) or scarring from disease. A damaged valve can decrease the amount of blood that flows through it. This condition is called stenosis . Low blood flow can lead to heart failure and death. The valve will need to be opened to restore full blood flow.
    Rheumatic fever and congenital birth defects are two top causes of stenosis. It can also happen due to aging and calcium deposits.
    Depending on the overall condition of the valve, relief of symptoms can be expected to last at least two years. Some people have relief of symptoms much longer.

    Possible Complications

    If you are planning to have a valvuloplasty, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Leaking valve
    • Damage to the heart or other organs
    • Blood clot formation
    • Stroke
    Even patients who are too weak or ill to undergo major surgery have less than a 5% chance of dying during this procedure. Some factors that may increase the risk of complications include:
    • Smoking
    • Blood clots in the heart
    • The anatomy of the valve
    • Overall health status

    What to Expect

    Prior to Procedure

    You will have a thorough evaluation to determine your overall condition, the health of your heart, and the exact nature of your valve defect. The success of the procedure depends a great deal on the condition of the valve. This includes whether the valve is calcified, how thick it is, and how narrow the opening is. Many valves cannot be fixed with this technique. They will require open heart surgery instead.
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

    Anesthesia

    Only local anesthesia and perhaps mild sedation are used. Local anesthesia will numb the area. Sedation will help you relax.

    Description of the Procedure

    You will be lying down in a special procedure room. There will be x-ray machines and surgical equipment. Depending on the valve that needs work, a blood vessel in your groin or arm will be prepared. A thin device (wire) will be placed through your skin to the blood vessel. It will be passed through the blood vessel until it reaches the valve. Progress will be monitored by x-rays. A tube with a balloon tip will be threaded over the wire. A contrast material may be injected through the device. This will help to visualize the area and make sure the device is in the right place. Once the balloon is in the valve, it will be inflated and deflated. Your doctor may need to repeat the inflation. The device will then be pulled back out of the blood vessel.

    Immediately After Procedure

    You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the puncture area. It is important to follow the nurses' directions.

    How Long Will It Take?

    Between 30 minutes and two hours

    How Much Will It Hurt?

    You may feel some minor discomfort when the balloon is inflated. Some people report a flushing sensation if contrast is injected.

    Average Hospital Stay

    Most people are kept overnight for observation. Your doctor may choose to keep you longer if complications arise.

    Postoperative Care

    Recovery time is minimal. There will be a bandage over the puncture site. You may be prescribed a blood thinner, like aspirin . Certain strenuous activities will be limited. Other activities, like exercises and fluid intake, may be encouraged. Your doctor will want to see you several days or weeks later.
    Be sure to follow your doctor's instructions .

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the puncture site
    • Pain that you cannot control with the medicines you have been given
    • Dizziness, fainting, or inability to talk
    • Cough, shortness of breath, or chest pain
    • An arm or a leg that turns blue or feels cold
    • Any other new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    The Society of Thoracic Surgeons http://www.sts.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/splash/

    References

    American Heart Association. Percutaneous balloon aortic valvuloplasty: acute and 30-day follow-up results in 674 patients from the NHLBI balloon valvuloplasty registry. Circulation . 1991;84:2383-2397.

    Chen CR, et al. Percutaneous balloon valvuloplasty for pulmonic stenosis in adolescents and adults. N Engl J Med . 1996;33:21-25.

    Kiwan Y, et al. Mitral balloon valvuloplasty by Inoue technique without echocardiographic standby. Available at: http://www.kfshrc.edu.sa/annals/145/93189.html . Accessed August 23, 2005.

    The Merck Manual of Geriatrics website. Available at: http://www.merck.com/mrkshared/mmg/sec11/ch96/ch96e.jsp . Accessed August 23, 2005.

    Tarka EA, Blitz L, Herrmann HC. Hemodynamic effects and long-term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation. Clin Cardiol . 2000;23:673-677.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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