Balloon aortic valvuloplasty – Cardiology Basics

Balloon aortic valvuloplasty – Cardiology Basics

Balloon aortic valvuloplasty is enlargement of a narrowed aortic valve using balloon catheters. It is also known as balloon aortic valvotomy.

Balloon aortic valvuloplasty has significant risks and lesser benefits compared other procedures for symptomatic severe aortic stenosis like surgical valve replacement and transcatheter aortic valve implantation or TAVI. Hence it is often considered as a bridge treatment or palliative treatment.

Three important scenarios in which balloon aortic valvuloplasty or BAV is considered are: Bridge to decision, bridge to planned treatment and as palliation. A decision for BAV is taken by a Heart Team comprising of interventional and non-interventional cardiologists and cardiac surgeons, who will weigh the risks and benefits. Bridging as the term implies, buys time for either the decision making process or planned treatment when the person is quite sick. Bridging can be done for planned non cardiac surgeries and even for tiding over pregnancy and labour. Palliation of course, is when the person is unlikely to be fit for either surgical aortic valve replacement or TAVI.

BAV catheter is introduced through the femoral artery. After femoral arterial puncture and insertion of the arterial sheath, a guide wire is passed, followed by the balloon catheter. Crossing the stenosed and often calcified aortic valve is likely to be difficult in critical aortic stenosis.

The balloon catheter is threaded over the guide wire and positioned across the narrowed aortic valve. The catheter is guided using fluoroscopy in a special procedure room known as cardiac catheterization laboratory.

Once the exact position across the narrowed aortic valve is confirmed, the balloon is inflated using a syringe from outside, relieving the obstruction. Pacing at fast rate can be used to stabilize the balloon during inflation to prevent it from slipping away. Potential risk of BAV is the development of aortic regurgitation, which may be poorly tolerated by the grossly hypertrophied and non-compliant left ventricle. Another potential risk is embolization of break-away calcific debris which may cause a stroke.

A good increase in the valve orifice will improve the condition of the sick person. This will permit a future surgical aortic valve replacement or TAVI. As mentioned earlier, it has also permitted safe transit through pregnancy and delivery in some instances. Another situation is someone waiting for a major surgery like extensive cancer surgery. Improvement in medical condition after balloon aortic valvuloplasty may also permit such surgeries.