Valvuloplasty
(Balloon
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, or 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/replacement surgery, echocardiography,
electrophysiological studies, magnetic resonance
imaging (MRI) of the heart, myocardial perfusion
scans, radionuclide angiography, and ultrafast
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
wastes such as carbon dioxide are given off and
oxygen and other nutrients are 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:
- tricuspid valve -
located between the right atrium and the right
ventricle
- pulmonary (or pulmonic)
valve - located between the right
ventricle and the pulmonary artery
- mitral valve -
located between the left atrium and the left
ventricle
- aortic valve -
located between the left ventricle and the aorta
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)
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:
- dizziness
- chest pain
- breathing difficulties
- palpitations
- edema (swelling) of
the feet, ankles, or abdomen
- rapid weight gain due
to fluid retention
Valvuloplasty
is performed in certain situations in order to
open a heart valve that has become stiff as a
result of disease or the aging process. Not all
conditions in which a heart valve becomes stiff
are treatable with valvuloplasty.
There
may be other reasons for your physician to recommend
a valvuloplasty.
Possible
risks associated with valvuloplasty include, but
are not limited to, the following:
- bleeding at the catheter
insertion site
- blood clot or damage
to the blood vessel at the insertion site
- infection at the catheter
insertion site
- cardiac dysrhythmias/arrhythmias
(abnormal heart rhythms)
- stroke
- rupture of the valve,
requiring open-heart surgery
The
amount of radiation used during a valvuloplasty
procedure is considered minimal; therefore, the
risk for radiation exposure is very low.
If you
are pregnant or suspect that you may be pregnant,
you should notify your physician 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 physician.
There
is a risk for allergic reaction to the dye. Patients
who are allergic to or sensitive to medications,
contrast dyes, iodine, shellfish, or latex should
notify their physician. Also, patients with kidney
failure or other kidney problems should notify
their physician.
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 upon your specific
medical condition. Be sure to discuss any concerns
with your physician prior to the procedure.
- Your physician will
explain the procedure to you and offer you the
opportunity to ask any questions that you might
have about the procedure.
- You will be asked to
sign a consent form that gives your permission
to do the test. Read the form carefully and
ask questions if something is not clear.
- Notify your physician
if you have ever had a reaction to any contrast
dye, or if you are allergic to iodine or seafood.
- Notify your physician
if you are sensitive to or are allergic to any
medications, latex, tape, or anesthetic agents
(local and general).
- You will need to fast
for a certain period of time prior to the procedure.
Your physician will notify you how long to fast,
usually overnight.
- If you are pregnant
or suspect that you may be pregnant, you should
notify your physician.
- Notify your physician
if you have any body piercings on your chest
and/or abdomen.
- Notify your physician
of all medications (prescription and over-the-counter)
and herbal supplements that you are taking.
- Notify your physician
if you have heart valve disease, as you may
need to receive an antibiotic prior to the procedure.
- Notify your physician
if you have a history of bleeding disorders
or if you are taking any anticoagulant (blood-thinning)
medications, aspirin, or other medications that
affect blood clotting. It may be necessary for
you to stop some of these medications prior
to the procedure.
- Your physician may
request a blood test prior to the procedure
to determine how long it takes your blood to
clot. Other blood tests may be done as well.
- Notify your physician
if you have a pacemaker.
- You may receive a sedative
prior to the procedure to help you relax.
- The area around the
catheter insertion (groin area) may be shaved.
- Based upon your medical
condition, your physician may request other
specific preparation.
A valvuloplasty
may be performed as part of your stay in a hospital.
Procedures may vary depending on your condition
and your physician’s practices.
Generally,
a valvuloplasty follows this process:
- You will be asked to
remove any jewelry or other objects that may
interfere with the procedure. You may wear your
dentures or hearing aids if you use either of
these.
- You will be asked to
remove clothing and will be given a gown to
wear.
- You will be asked to
empty your bladder prior to the procedure.
- An intravenous (IV)
line will be started in your hand or arm prior
to the procedure for injection of medication
and to administer IV fluids, if needed.
- You will be placed
in a supine (on your back) position on the procedure
table.
- You will be connected
to an ECG monitor that records the electrical
activity of the heart and monitors the heart
during the procedure using small, adhesive electrodes.
Your vital signs (heart rate, blood pressure,
breathing rate, and oxygenation level) will
be monitored during the procedure.
- There will be several
monitor screens in the room, showing your vital
signs, the images of the catheter being moved
through the body into the heart, and the structures
of the heart as the dye is injected.
- You will receive a
sedative medication in your IV before the procedure
to help you relax. However, you will likely
remain awake during the procedure
- Your pulses below the
injection site will be checked and marked so
that the circulation to the limb below the site
can be checked after the procedure.
- A local anesthetic
will be injected into the skin at the insertion
site. You may feel some stinging at the site
for a few seconds after the local anesthetic
is injected.
- Once the local anesthetic
has taken effect, a sheath, or introducer, will
be inserted into the blood vessel. This is a
plastic tube through which the catheter will
be inserted into the blood vessel and advanced
into the heart.
- The valvuloplasty catheter
will be inserted through the sheath into the
blood vessel. The physician will advance the
catheter through the aorta into the heart valve.
Fluoroscopy (a special type of x-ray that will
be displayed on a TV monitor) may be used to
assist in advancing the catheter to the heart.
- Once the catheter is
in place, contrast dye will be injected through
the catheter into the valve in order to look
at the area. You may feel some effects when
the contrast dye is injected into the IV line.
These effects include a flushing sensation,
a salty or metallic taste in the mouth, or a
brief headache. These effects usually last for
a few moments.
- You should notify the
physician if you feel any breathing difficulties,
sweating, numbness, itching, chills, nausea
and/or vomiting, or heart palpitations.
- The physician will
watch the contrast dye injection on a monitor.
The physician may ask you to take a deep breath
and hold it for a few seconds.
- Once the balloon is
in place and has been inflated, you may notice
some dizziness or even brief chest discomfort.
This should subside when the balloon is deflated.
However, if you notice any severe discomfort
or pain, such as chest pain, neck or jaw pain,
back pain, arm pain, shortness of breath, or
breathing difficulty, tell your physician.
- The balloon may be
inflated and deflated several times in order
open the valve.
- Once it has been determined
that the valve is opened sufficiently, the catheter
will be removed. The catheter insertion site
may be closed with a closure device that uses
collagen to seal the opening in the artery,
by the use of sutures, or by applying manual
pressure over the area to keep the blood vessel
from bleeding. Your physician will determine
which method is appropriate for your condition.
- If a closure device
is used, a sterile dressing will be applied
to the site. If manual pressure is used, the
physician (or an assistant) will hold pressure
on the insertion site so that a clot will form.
Once the bleeding has stopped, a very tight
bandage will be placed on the site. A small
sandbag or other type of weight may be placed
on top of the bandage for additional pressure
on the site, especially if the site is in the
groin.
- Your physician may
decide not to remove the sheath, or introducer,
from the insertion site for approximately four
to six hours, in order to allow the effects
of blood-thinning medication given during the
procedure to wear off. You will need to lie
flat during this time. If you become uncomfortable
in this position, your nurse may give you medication
to make you more comfortable.
- You will be assisted
to slide from the table onto a stretcher so
that you can be taken to the recovery area.
NOTE: If the insertion was in the groin, you
will not be allowed to bend your leg for several
hours. To help you remember to keep your leg
straight, the knee of the affected leg may be
covered with a sheet and the ends tucked under
the mattress on both sides of the bed to form
a type of loose restraint.
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/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 physician 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 pain 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 physician 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 will 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 physician.
If your
physician 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 physician will give you specific
bathing instructions.
You
may be advised not to participate in any strenuous
activities. Your physician will instruct you about
when you can return to work and resume normal
activities.
Notify
your physician to report any of the following:
- fever and/or chills
- increased pain, redness,
swelling, or bleeding or other drainage from
the insertion site
- coolness, numbness
and/or tingling, or other changes in the affected
extremity
- chest pain/pressure,
nausea and/or vomiting, profuse sweating, dizziness,
and/or fainting
Your
physician may give you additional or alternate
instructions after the procedure, depending on
your particular situation.
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