Balloon Heart Valve Surgery (Balloon Valvuloplasty)

What is balloon valvuloplasty?

Valvuloplasty is a procedure for opening a blocked heart valve. Heart valves direct the flow of blood through the chambers of the heart and to the rest of the body. The procedure uses a balloon to stretch the valve or to break up scars in the valve. It may be done instead of surgery to fix some valve problems.

When is it used?

You may need this procedure if you have a scarred valve that cannot open all the way. The scarred valve may block the flow of blood to the lungs, to other chambers of the heart, or to the body.

Alternatives to this procedure include repairing or replacing the valve with open-chest surgery. Ask your healthcare provider about these choices.

How do I prepare for valvuloplasty?

Plan for your care and recovery after the operation. Come to the hospital prepared to stay for a day or two.

Tell your healthcare provider if you have had any kidney problems or reactions to iodine-containing foods or chemicals, such as seafood or X-ray contrast dye.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during the procedure. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your procedure.

Follow your provider's instructions about not smoking before and after the procedure.

Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Follow any other instructions your healthcare provider gives you.

What happens during the procedure?

You will be given a sedative to help you relax. A local anesthetic will be injected into your groin to help keep you from feeling pain when the catheter is inserted.

Your healthcare provider will put a needle into a groin vein or artery, depending on which heart valve has the problem, and guide a catheter into the blood vessel. A catheter is a very thin, flexible tube. It is used to inject fluid, to provide a pathway for other catheters and instruments, and to measure blood pressure.

Your provider will guide a wire through the catheter into your heart and through the problem valve. Then the catheter will be removed, and a larger catheter with a balloon at its tip will be guided through the blood vessel over the wire. Your healthcare provider will inject a contrast dye into the balloon so that it shows up with X-rays. The X-ray images help your healthcare provider make sure that the balloon is in the right place. Your provider will inflate the balloon to make the valve opening larger.

When the balloon is inflated, you may feel some pain. The pain is temporary, but tell your provider if you are feeling pain. The balloon inflation may be repeated several times until the valve opening is the right size. Then your provider may replace the large catheter with the smaller one and inject dye through the catheter. The smaller catheter may be used to measure the pressure in your blood vessels again and take another X-ray.

The catheter and the wire will be removed and pressure applied over your groin to control any bleeding.

What happens after the procedure?

You will be taken to a bed in the coronary care unit or the intensive care unit, where you will be carefully watched overnight. Your heart will be monitored for at least 24 hours. Your blood pressure and groin sites will be checked often.

While recovering from the procedure, don't bend your legs where the catheters were inserted and don't sit upright in bed or try to get out of bed. If you need to move, ask a healthcare provider to help you. Being careful with your movements will help prevent bleeding from the catheter site.

The next morning the IV drips (lines into the vein) may be stopped.

As you recover, a healthcare provider will help you walk around the room. Some time after this, you will be transferred from the coronary care unit or intensive care unit to a regular room. You will be encouraged to walk around the room to prepare for discharge. The entire stay in the hospital may last 1 to 3 days, depending on your condition.

Ask your healthcare provider if you should take antibiotics before you have dental work or procedures that involve the rectum, bladder, or vagina. Damaged valves are more likely to become infected by bacteria. Infection of the valve can damage it more and may destroy it. Antibiotics can prevent this.

Ask your healthcare provider what other guidelines you should follow and when you should come back for a checkup.

What are the benefits of this procedure?

Your heart may work normally again. You may avoid having open-chest surgery.

What are the risks associated with this procedure?

• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• You may have infection or bleeding from this procedure.
• Your heart may beat in an unusual way. You may need medicine, electrical cardioversion, or a temporary pacemaker to help your heart beat normally.
• You may have an allergic reaction to the dye. You could become nauseated or flushed. If your kidneys are not working well, the dye may make them worse.
• Blood may form a clot around the catheter. The clot could block the artery through which your healthcare provider inserted the catheter. You may need surgery to reopen the artery.
• You may form a clot where the catheter was inserted and lose the pulse in your groin. This may affect the circulation in your leg. You may be given medicine to dissolve the clot or, rarely, surgery may be needed to remove the clot.
• The valve may tear when the balloon is inflated. This may require valve replacement surgery.
• The catheter may puncture a vein or artery, or the heart itself, and cause internal bleeding. The problem may require surgical repair.
• When the catheter is inserted, debris on the wall of the artery may become dislodged and pass down your artery, causing a stroke or other blockage. You may need surgery if this happens.
• You may have some bruising or bleeding at the site where the catheter was inserted.
• During the procedure, your blood pressure could drop, causing dizziness or heart rhythm disturbances.
• There is a chance the procedure might not work.

There are risks with every treatment or procedure. Talk to your provider for complete information about how the risks apply to you.

When should I call my healthcare provider?

Call 911 right away if:

• You have a lot of chest pain.
• You have problems speaking or with your vision.
• Your arms or legs feel numb or you cannot move them.

Call your healthcare provider right away if:

• You have a fever over 101.5°F (38.6°C).
• You get short of breath.
• You have redness, swelling, pain, or drainage from your incision.
• You notice swelling in your legs or ankles.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.