Balloon valvotomy: Balloon valvotomy, also known as balloon valvuloplasty, is a procedure in which balloons attached to the tip of small tubes known as catheters are used to enlarge the orifice of narrowed heart valves. The balloons catheters are introduced through the blood vessels in the groin and moved to the desired location using X-ray fluoroscopy (cine) guidance. Once the balloon is in position it is inflated using diluted radiocontrast (iodinated dye) so that the process can be seen on X-ray equipment live.

Which valves can be enlarged using balloon valvotomy?

Any of the four heart valves (mitral, aortic, tricuspid or pulmonary) can be enlarged using balloons of appropriate size. But the procedure is most commonly done for mitral stenosis in which the valve between the left upper and lower chambers of the heart is narrowed. In regions where rheumatic fever is common, mitral stenosis is frequently seen. This procedure is known as balloon mitral valvotomy (BMV). It is also known as percutaneous mitral commissurotomy (PTMC) in some centers. Next common is balloon aortic valvotomy (BAV) done for narrowing of the aortic valve (aortic stenosis). Aortic valve is between the left lower chamber of the heart and the aorta.

Inflated balloon across mitral valve
Inflated balloon across mitral valve

BMV: Balloon mitral valvotomy

Inflated balloon across aortic valve

Inflated balloon across aortic valve

LV: Left ventricle. Temp pacing lead: Temporary pacing lead

How long does it take for one to get the benefit of the procedure after balloon valvotomy?

Relief of symptoms is almost immediate. If there are no complications, the person can walk about the next day itself and go home soon after. There is no scar over the chest as there is no wound created on the chest.

Is there a radiation risk for balloon valvotomy?

As X-ray imaging is used to guide the procedure, there is a small amount of radiation risk. But this can be reduced by using radiation protection devices and minimizing the use of X-ray. Part of the procedure can be guided by ultrasound imaging (echocardiography) in order to reduce radiation exposure further. Radiation exposure is within safe limits so that the procedure is even permissible during middle period of pregnancy, with adequate shielding to the baby. It is not usually done during early pregnancy.

Is balloon valvotomy a safe procedure?

When undertaken with due precautions, it is a safe procedure in expert hands and complications are rare.

If the valve is too much damaged with a lot of calcium content, sometimes it may tear off, producing severe leaks. In such a situation emergency surgery for valve replacement may be required. In occasional cases injury to the wall of a heart chamber can cause bleeding into the space just outside the heart (pericardial space). Blood collecting in this space can compress the heart and cause severe fall in blood pressure. This can be tackled by immediate aspiration (pericardiocentesis). The aspirated blood can be given back to the patient as an emergency measure (auto transfusion). Sometimes the leak stops and no further treatment is required. If the leak continues, patient is taken for urgent surgery to repair the injury. Another very rare complication is development of infection of the valve, which can be prevented by giving good aseptic care.