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VNA of Care New England

Percutaneous Balloon Valvuloplasty

(Percutaneous Commissurotomy)

Definition

Percutaneous balloon valvuloplasty is done to open a constricted heart valve with a balloon.
Mitral Valve Stenosis
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Reasons for Procedure

Any of the heart’s four valves can become damaged. It may happen because of conditions at 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 main 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 2 years. Some people have relief of symptoms much longer.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Leaking valve
  • Damage to the heart or other organs
  • Blood clot formation
  • Stroke
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
Your risk of complications may be increased if you have blood clots in your heart or the anatomy of your heart is unusual.

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 medications. You may be asked to stop taking some medications up to one week before the procedure.

Anesthesia

Only local anesthesia and, sometimes, 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 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. When the balloon is in the valve, it will be inflated and deflated. The inflation may need to be repeated. The device will then be removed from 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.

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

During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
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 to weeks later.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • 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
  • Lightheadedness, fainting, or inability to talk
  • Cough, shortness of breath, or chest pain
  • An arm or a leg that turns blue or feels cold
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

American Heart Association http://www.heart.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://www.heartandstroke.ca

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. Ann Saudi Med. 1994 Sep;14(5):375-378.

Tarka EA, Blitz L, et al. 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 http://www.ebscohost.com/dynamed: Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

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