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valvuloplasty

What is valvuloplasty?
Valvuloplasty is performed, in certain circumstances, to open a stenotic (stiff) heart valve. In valvuloplasty, a very small, narrow, hollow tube (known as a catheter) is advanced from a blood vessel in the groin through the aorta into the heart. Once the catheter is placed in the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets (flaps) of the valve are opened. Once the valve has been opened, the balloon is deflated and the catheter is removed.
Other related procedures that may be used to assess and treat the heart include resting and exercise electrocardiogram (ECG or EKG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, coronary artery bypass graft surgery, valve repair or replacement surgery, echocardiography, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and cardiac CT scan. Please see these procedures for additional information. Valves of the heart


To better understand how valvular heart disease affects the heart, a review of basic heart anatomy and valve function follows.
The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. The right atrium pumps blood into the right ventricle, which then pumps the blood into the lungs where carbon dioxide is given off and oxygen is taken into the blood.
From the lungs, the blood flows back into the left atrium, is pumped into the left ventricle, and then is pumped through the aorta out to the rest of the body and the coronary arteries. When the atria are pumping, the ventricles are relaxed in order to receive the blood from the atria. Once the atria have pumped their entire blood load into the ventricles, they relax while the ventricles pump the blood out to the lungs and to the rest of the body.

In order to keep the blood flowing forward during its journey through the heart, there are valves between each of the heart's pumping chambers:


If the heart valves become damaged or diseased, they may not function properly. Conditions that may cause dysfunction of heart valves are valvular stenosis and valvular insufficiency (regurgitation). When one (or more) valve(s) becomes stenotic (stiff), the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection (such as rheumatic fever or staphylococcus infections), congenital (present at birth) valve abnormalities, and aging. If one or more valves become insufficient (leaky), blood leaks backwards, which means that less blood is pumped in the proper direction.

Valvular heart disease may cause the following symptoms:

Reasons for the procedure
Valvuloplasty is performed in certain situations in order to open a heart valve that has become stiff. Not all conditions in which a heart valve becomes stiff are treatable with valvuloplasty.
There may be other reasons for your doctor to recommend a valvuloplasty.

Risks of the procedure
Possible risks associated with valvuloplasty include, but are not limited to, the following:

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider due to risk of injury to the fetus from a valvuloplasty. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your health care provider.
There is a risk of allergic reaction to the dye. Patients who are allergic or sensitive to medications, contrast dyes, iodine, or latex should notify their doctor. Also, patients with kidney failure or other kidney problems should notify their doctor.
For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain. There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

During the procedure
A valvuloplasty may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices. Generally, a valvuloplasty follows this process:

After the procedure
In the hospital
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your doctor placed a closure device, your bedrest may be of shorter duration.
In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may be given medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period. You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.
You may resume your usual diet after the procedure, unless your doctor decides otherwise.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You will most likely spend the night in the hospital after your procedure. Depending on your condition and the results of your procedure, your stay may be longer. You will receive detailed instructions for your discharge and recovery period.

At home
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the injection site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.
If your doctor used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin at the injection site. This is normal. The knot should gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions. You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.

Notify your doctor to report any of the following:

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.