Home > Encyclopedia of Nursing & Allied Health > Balloon Valvuloplasty

Definition

Balloon valvuloplasty is a minimally invasive procedure performed by an interventional radiologist and/or an interventional cardiologist in which a stenotic (narrowed) heart valve is stretched open using a special catheter with an inflatable balloon at its tip. The procedure is much less invasive than open heart surgery.

Purpose

There are four valves in the heart: the aortic valve, pulmonary valve, mitral valve, and tricuspid valve. The valves open and close to regulate the blood flow from one chamber to the next. They are vital to the efficient functioning of the heart.

Balloon valvuloplasty is performed on children and adults with stenosis (narrowing of the valves) to improve valve function and blood flow. The balloon stretches the thin muscular leaves of flaps of the valve, enlarging the valve opening. It is a treatment for aortic, mitral, and pulmonary stenosis. Balloon valvuloplasty is effective treatment for narrowed pulmonary valves, and results with mitral valve stenosis are generally good. For stenosis of the aortic valve, the procedure is more difficult to perform and less successful as a treatment.

Description

During balloon valvuloplasty, a contrast medium (dye) is administered to the patient to make the process visible. Then a catheter (thin tube) with a small deflated balloon at the tip is inserted in the groin area. It is then threaded back up to the heart, passing through the vessels leading to the chamber adjacent to the stenotic valve. The balloon is then inflated, which stretches the leaves of the valve open. The procedure repairs some valve obstructions quite successfully.

The procedure is performed in the cardiac catheterization laboratory and may take as long as four hours. About an hour before the procedure, the patient is given an oral sedative such as diazepam (Valium). The patient is also sedated intravenously, but is usually awake, and local anesthesia is administered to block pain sensation at the area of catheter insertion. After the insertion site is prepared and anesthetized, the cardiologist inserts a catheter, then passes a balloon-tipped catheter through the lumen (opening) of the first catheter. Guided by a video monitor and fluroscopy, the physician slowly threads the catheter into the heart. The deflated balloon is positioned in the valve opening, and inflated repeatedly. The inflated balloon widens the valve's opening by splitting the valve leaflets apart. Once the valve is widened, the balloon is deflated, and the balloon-tipped catheter is removed by sliding it back out the entry route. The other catheter remains in place for six to 12 hours because in some cases the procedure must be repeated.

Preparation

For at least six hours before balloon valvuloplasty, the patient is instructed to take nothing by mouth. An intravenous line is inserted in the arm as a medication administration route. The patient's groin area is shaved and scrubbed with an antiseptic solution.

Aftercare

After balloon valvuloplasty, the patient is sent to the recovery room for several hours, where vital signs and heart rhythms are monitored. A 12-lead ECG (electrocardiogram) is performed. The leg in which the catheter is inserted is temporarily immobilized, and the catheter itself is secured so that it cannot come out. The insertion site is covered by a sterile dressing, on top of which is a sandbag to maintain pressure. The site is observed for bleeding until the catheter is removed. Intravenous fluids are administered to help eliminate (flush) the contrast medium; intravenous anticoagulants (blood thinners) or other medications to dilate the coronary arteries may be given. Pain medication is available.

For at least 30 minutes after removal of the catheter, direct pressure (in the form of a sand bag) is applied to the dressing at the groin where the catheter was inserted; after this, a pressure dressing is applied. Following discharge from the hospital, the patient can usually resume normal activities. After balloon valvuloplasty, lifelong followup monitoring is necessary because valve leaflets sometimes degenerate or stenosis recurs, requiring more invasive surgery.

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KEY TERMS

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Aortic valve—One of several valves in the heart that regulate blood flow.

Cardiac catheterization—The process of running a catheter—a long, thin, hollow tube—into the area of the heart for a variety of medical treatments.

Hematoma—Blood that has escaped from blood vessels and collected below the surface of the skin or under the surface of an organ. Also known as a blood blister or bruise.

Pulmonary valve—Any of several valves regulating blood flow to the lungs.

Stenosis—The narrowing of any valve, especially one of the heart valves or the opening into the pulmonary artery from the right ventricle.

Valve—Tissue in the passageways between the heart's upper and lower chambers that controls passage of blood and prevents regurgitation.

Valve leaflets—The tissues that form the moveable parts of a valve.

Valvuloplasty—Widening or forcing open the valves of the circulatory system, usually with a catheter equipped with a balloon.

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Complications

Balloon valvuloplasty may have serious complications, such as cerebral or pulmonary embolism, in which pieces of the valve break off and travel to the brain or the lungs. Another complication is the potential for the valve opening to become distended so that it does not close completely. This condition is known as valvular incompetence. This condition permits blood backflow (regurgitation) and reduces the amount of blood pumped by the chamber through the valve, into the circulation. If the procedure causes severe damage to the valve leaflets, immediate surgery is required. Less frequent complications are bleeding and hematoma (a "bruise," or local collection of clotted blood) at the catheter insertion site, abnormal heart rhythms, reduced blood flow, myocardial infarction, cardiac rupture, infection, and circulatory problems.

Health care team roles

Balloon valvuloplasty is performed by interventional cardiologists in the cardiac catheterization laboratory. Clinical specialist nurses, radiology and laboratory technologists, and technicians assist during the procedures and provide pre-and postoperative education, monitoring, and supportive care.

Barbara Wexler