What Is A Valvuloplasty?

Introduction

A valvuloplasty (or valvotomy) is a procedure that repairs and widens narrowed heart valves.¹ During a valvuloplasty, a surgeon stretches open a stiffened or thickened heart valve using a balloon catheter or other instruments or techniques.² This allows more blood to flow through the valve and reduces symptoms caused by the abnormal narrowing of the valves.³

Valvular heart disease and defective heart valves affect over 5 million Americans each year.⁴ The four main heart valves (the aortic, mitral, pulmonary, and tricuspid valves) have flap-like tissues that open and close with each heartbeat, allowing blood to flow in only one direction through the heart.⁵ These valves may become narrow or leak if they become damaged from health conditions, infections, or age-related changes.⁶ This prevents them from opening fully and reduces or blocks blood flow.⁷ 

Valvuloplasty is often recommended to open narrow heart valves when medication alone no longer controls symptoms.¹ By improving blood circulation, this procedure can relieve chest pain, shortness of breath, fatigue, dizziness, and other issues caused by defective valves.²

Types of heart valve conditions

There are several main categories of heart valve disease: 

• Stenosis: stenosis causes the flaps of heart valves to stiffen and thicken, narrowing the opening and restricting blood flow.⁴ This increases the heart's workload as it strains to pump blood through the smaller valve opening.⁵
• Prolapse: when a valve prolapses, its flaps stretch or bulge back into the upper heart chamber as the supporting structures become too weak to hold them in place.⁶ This causes backflow and regurgitation of blood.⁷
• Atresia: atresia refers to the condition where a heart valve has a defective opening that did not properly form before birth.¹ Some blood can pass through, but often atresia requires surgical repair.²

The most common heart valve conditions include:

• Mitral valve stenosis: the narrowing of the mitral valve's opening on the left side of the heart. If the flaps of this valve become stiff or fuse, they cannot open fully, which restricts oxygenated blood from entering the heart from the lungs.⁵  
• Aortic valve stenosis: the narrowing of the aortic valve opening on the left side of the heart. This reduces blood flow from the heart to the rest of the body. It is often caused by a buildup of calcium deposits that prevent the valve from fully opening.⁷  
• Pulmonary valve stenosis causes the pulmonary valve, which connects the heart to the lungs, to narrow. This makes it harder for blood to pick up oxygen in the lungs because of obstructed flow through the tightened valve.²  
• Tricuspid valve stenosis: stops the tricuspid valve on the right side of the heart from opening fully, limiting blood flow into the heart and reducing its efficiency.⁴  

What is a valvuloplasty?

Valvuloplasty is a procedure that repairs a defective heart valve using a balloon catheter or open-heart surgical techniques.⁶ It aims to open a stenotic or narrowed valve to restore normal blood flow.⁷ By stretching the valve open, valvuloplasty reduces the blockage causing many of the symptoms associated with valvular heart disease.¹ After the valve is widened, the heart can pump blood more normally.²

Types of valvuloplasty 

A balloon valvuloplasty is the most common type of valvuloplasty performed today. It uses a tiny balloon attached to a slender catheter, which is threaded through the blood vessels to the site of the affected valve.⁴ As the balloon inflates, it presses outward against stiff valve leaflets to stretch the opening wider.

An open-heart valvuloplasty involves making an incision in the chest to access and manipulate the damaged heart valve.⁶ The valve opening is enlarged by removing excess tissue and freeing fused commissures rather than inflating a balloon catheter.⁷  

Valvuloplasty is typically recommended for symptomatic adolescents and adults with stenotic valves if other less invasive surgeries or valve repairs are unlikely to resolve the symptoms sufficiently.¹ It tends to provide good outcomes for pulmonary stenosis and decent results for aortic stenosis.² However, results are less consistent for mitral valve stenosis treatment.³ 

A typical valvuloplasty procedure

If valvuloplasty is recommended after diagnostic heart tests and medical evaluation, the patient will undergo the following procedural steps:  

• Preoperative preparation:
  • Pre-op tests will ensure you are healthy enough for anaesthesia and surgery. 
  • Your dosage(s) of blood thinners and other medications may need adjustment to prevent excessive bleeding or complications during surgery. 
  • For an open-heart valvuloplasty, chest hair will be clipped and skin sterilised.⁶ 
• Anaesthesia and Monitoring:
  • General anaesthesia induces total unconsciousness.
  • Transesophageal echocardiography (TEE) provides detailed ultrasound images during the procedure.¹ 
  • Cardiac catheterisation threads a thin tube with sensors into the heart to measure your blood pressure.² 

Depending on the procedure being performed, the next steps vary:

• For a balloon valvuloplasty, a tiny deflated balloon is passed via a catheter to the site of the narrowed valve.⁴ Saline (salt water) is used to inflate the balloon, pressing it against the valve leaflets several times to widen them. Finally, the balloon deflates, and the catheter is removed.⁵  
• For an open-heart valvuloplasty, after general anaesthesia, a surgeon cuts open the chest and accesses the heart.⁷ Narrowed or stiffened valve leaflets are carefully divided and repaired, restoring normal motion. Excess fibrous tissue is removed.¹ The chest incision then closes.²  

After the valvuloplasty, most patients remain in the hospital for 2-4 days for monitoring and pain control before discharge.³ 

Conditions treated with valvuloplasty

Some of the specific valve conditions best suited for balloon valvuloplasty or open valvuloplasty surgery include:  

Mitral valve stenosis

Rheumatic fever often causes mitral valve stenosis that progressively worsens over time.⁶ The gradual thickening and stiffening of the mitral valve flaps prohibit them from opening enough to permit proper blood flow into the heart.⁷ 

Symptoms of mitral stenosis include shortness of breath, fatigue, chest pain, palpitations, pulmonary oedema (build-up of fluid in the lungs), and heart arrhythmias (irregular heartbeat).¹ Before advanced mitral stenosis, medication and lifestyle modification can help control some early symptoms.² However, as stenosis worsens, most patients turn to valvuloplasty for permanent relief.³  

Aortic valve stenosis 

Senile degenerative calcific disease accounts for most aortic valve stenosis cases in elderly patients. Calcium deposit buildup on the valve interferes with normal functioning, worsening symptoms progressively.⁵ 

Patients often report experiencing angina (chest pain), syncope (loss of consciousness), dyspnea (the feeling of running out of air), and heart failure.⁶ For older adults with coexisting health issues, valve replacement poses higher surgical risks. Thus, balloon or open valvuloplasty serves as an effective treatment option instead.⁷ 

Pulmonary valve stenosis

Present from birth, pulmonary valve stenosis ranges from mild to severely life-threatening.² Balloon valvuloplasty successfully treats mild and moderate pulmonary stenosis in children and adults by cutting mortality rates by nearly half without open-heart surgery risks.³ 

Risks and complications

While valve repair surgery is common, these procedures still carry some risks during and after.⁵ Knowing the potential complications empowers patients to make educated choices regarding valvuloplasty procedures.⁶  

During a valvuloplasty, you may experience:  

• Heart arrhythmias, if the replacement valves do not fit perfectly
• Blood clots that may lead to stroke or embolism
• Damage to blood vessels used to insert replacement valves
• Abnormal heart rhythms from trauma during valve insertion

After a valvuloplasty, you may experience or be at risk of:

• Bleeding complications
• Infections near the chest incision or elsewhere
• Reaction to anaesthesia, including breathing difficulty
• Damage to red blood cells from the heart-lung bypass machine
• Death in 1-2% of high-risk patients

Younger and healthier patients typically tolerate valvuloplasty without complications.² However, patients with advanced age or extensive comorbidities face higher risks of complications.³  

Recovery and rehabilitation

The recovery duration and necessary lifestyle changes following valvuloplasty depend partially on whether a balloon catheter or open-heart surgery was performed.⁵ However, some commonalities exist: 

Hospital stay

After the surgery and initial recovery, most patients remain hospitalised for 2-4 days for monitoring.⁷ Doctors will keep a close eye on your heart rate and rhythm, watch for fever (signalling infections), ensure wounds heal properly, and manage any pain.¹ 

Medication and follow-up appointments

• Before being discharged from the hospital, patients receive prescriptions including antibiotics, anticoagulants, diuretics or beta-blockers.³ Regular cardiology appointments will help evaluate how well the repaired or reopened valves are functioning over time. These appointments will likely involve physical exams, which will determine if shortness of breath, fatigue or other symptoms persist.4 Doctors will also use imaging scans to gauge how your procedure went and check the condition of your heart valves. Most patients will need to continue medication in the long term.⁵ 

Lifestyle changes and rehab:

After open valvuloplasty surgery, you should not partake in any strenuous physical activity for 6 weeks to protect your incision and allow it to heal.⁷ After 6 weeks, you can begin physical therapy to rebuild your stamina and muscular strength. Appropriate low-impact exercise can also help improve your fitness once cleared by cardiology and primary care providers. Lifelong healthy lifestyle choices help maximise the long-term benefits and success of your surgery.¹  

Success rates and outcomes

Multiple studies have confirmed that balloon valvuloplasty offers very favourable short and longer-term outcomes for various types of defective valves with stenosis symptoms:³ 

• Pulmonary valve stenosis: 90-95% success rate; 95% valve area opening; 60-75% 10-year functionality.⁴  
• Aortic valve stenosis in older people: 75-90% success rate; 50% valve area opening; 50% 10-year functionality.⁵
• Mitral valve stenosis: 75-80% initial success rate; 50% valve area opening; 50% 10-year functionality.⁶ 

In specialised hospitals and medical centres, balloon valvuloplasty procedures have a <1% risk of mortality, and open-heart valvuloplasty mortality remains below 4%, even for higher-risk patients.⁷ Although comorbidities and pre-existing illnesses can negatively impact outcomes, overall success significantly reduces symptoms, rehospitalisation and death rates compared to medication alone.¹  Further, valvuloplasty can significantly improve lifespan and quality of life.³ 

Alternatives to valvuloplasty

Alternatives to valvuloplasty exist depending on the severity of the valve condition, the patient's age, and other factors.⁵ Discussing all your options is crucial and will help aid your decision-making. 

Surgical options  

• Open repair to eliminate valve backflow and stenosis
• Valve replacement with mechanical or bioprosthetic valves
• Ross's procedure to replace faulty aortic valves with the patient's pulmonary valve

Medication and lifestyle therapy 

• Anticoagulant medication to prevent clotting
• Diuretics and vasodilators decrease fluid retention
• Omega-3s and lipid-lowering medication stabilisation
• Smoking cessation and low sodium diet risk reduction

If your medication and lifestyle no longer adequately control your stenosis symptoms, repair or replacement surgery offers the only route for definitive treatment.^6,7  

Summary

Valvuloplasty is a minimally invasive and highly effective surgery used to stretch and unblock narrowed heart valves. Prior to surgery, narrowed heart valves can cause troubling symptoms, but by widening rigid or stenotic mitral, aortic, or pulmonary valves via a balloon catheter or open-heart technique, normal blood circulation can be restored. 

This valve repair procedure dramatically diminishes disabling chest pain, arrhythmias, and difficulties exercising and reduces your risk of heart failure. Hospital recovery time is generally short, and the risk of complications is low, especially for younger patients. Whilst anti-inflammatory and anti-clotting medications can slow the progression of valve stenosis, they cannot reverse the damage. As such, valvuloplasties are valuable techniques that can significantly improve the quality and longevity of your life.