Valvuloplasty

What is a valvuloplasty?

A valvuloplasty (also called valvotomy) is a procedure to open a stiff (stenotic) heart valve. It's done by a cardiologist. This is a healthcare provider who specializes in treating the heart and blood vessels. In valvuloplasty, your provider inserts a very small, narrow, hollow tube (catheter) into a blood vessel in the groin and advances it into the heart through either an artery or a vein. Once the catheter reaches the stiff valve, your provider inflates a large balloon at the tip of the catheter until the flaps (leaflets) of the valve are pushed opened. Once the valve has been opened, the provider deflates the balloon and removes the catheter.

To keep the blood flowing forward through the heart, there are valves between each of the heart's pumping chambers:

• Tricuspid valve. Located between the right atrium, which receives blood from the body, and the right ventricle.

• Pulmonary, or pulmonic, valve. Located between the right ventricle and the pulmonary artery, which takes blood to the lungs to get oxygen.

• Mitral valve. Located between the left atrium, which receives blood from the lungs, and the left ventricle.

• Aortic valve. Located between the left ventricle and the aorta, which takes blood to the rest of the body.

Why might I need a valvuloplasty?

Valvuloplasty may be done to open a heart valve that has become narrow and stiff. But not all conditions in which a heart valve becomes stiff are treatable with valvuloplasty.

If the heart valves become damaged or diseased, they may not work correctly. Conditions that may cause problems with the heart valves are stiffened valve (valvular stenosis) and leaky valve (valvular regurgitation). When one or more valves become stiff, the heart muscle must work harder to pump the blood through the valve. Stiff valves may be caused by birth defects, scarring from radiation therapy to treat cancer, aging, and infections, such as rheumatic fever or staph (staphylococcus) infections. If one or more valves become leaky, blood leaks backward and less blood is pumped in the correct direction.

Heart valve disease may cause the following symptoms:

• Dizziness

• Chest pain

• Trouble breathing

• Palpitations (fast, hard, or irregular heartbeats)

• Swelling (edema) of the feet, ankles, or belly (abdomen)

• Rapid weight gain due to fluid retention

• Severe tiredness (fatigue)

• Less energy when doing regular activity

There may be other reasons for your healthcare provider to advise a valvuloplasty.

What are the risks of a valvuloplasty?

Possible risks of valvuloplasty include:

• Bleeding at the catheter insertion site

• Blood clot or damage to the blood vessel at the insertion site

• Infection at the catheter insertion site

• Significant blood loss that may need blood transfusion 

• Abnormal heart rhythms

• Kidney failure

• Stroke

• Valve regurgitation (leakage) that is new or gets worse

• Rupture of the valve or the soft tissue around the valve. This needs open-heart surgery.

• Slowed heartbeat that may need a pacemaker

• Death

If you're pregnant or think you could be, tell your provider. Valvuloplasty could injure you're unborn baby. Radiation exposure during pregnancy may lead to birth defects. Also tell your provider if you're lactating or breastfeeding.

There's a risk of allergic reaction to the dye that may be used to better see the parts of the heart. If you're allergic or sensitive to medicines, contrast dyes, iodine, or latex, tell your healthcare team. If you have kidney failure or other kidney problems, tell your provider.

Some people may have discomfort or pain caused by lying still on the procedure table for the length of the procedure.

There may be other risks depending on your specific medical condition. Be sure to talk with your healthcare provider about any concerns before the procedure.

How do I get ready for a valvuloplasty?

• Your healthcare provider will explain the procedure to you and ask if you have any questions.

• You'll 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 unclear.

• Tell your provider if you've ever had a reaction to any contrast dye or if you're allergic to iodine.

• Tell your provider if you're sensitive or allergic to any medicines, latex, tape, antibiotics, skin products, or anesthesia medicines (local and general).

• You'll need to stop eating and drinking (fast) for a certain period before the procedure. Your provider will tell you how long to fast. It's usually overnight.

• Tell your provider if you're pregnant or think you could be.

• Tell your provider if you have any body piercings on your chest or abdomen.

• Tell your provider about all prescription and over-the-counter medicines and herbal supplements that you take.

• Tell your provider if you have a history of bleeding disorders or are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop some of these medicines before the procedure.

• Your provider may request a blood test before the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.

• Tell your provider if you have a pacemaker.

• You may receive a sedative before the procedure to help you relax.

• Your provider may request other specific preparation based on your medical condition.

What happens during a valvuloplasty?

A valvuloplasty may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your provider's practices.

Generally, a valvuloplasty follows this process:

1. Remove any jewelry or other objects that may interfere with the procedure. Check with your healthcare provider to see if you may wear your dentures or hearing aids.

2. Change into a hospital gown and empty your bladder before the procedure.

3. A healthcare provider will start an IV (intravenous) line in your hand or arm to inject medicine or give IV fluids, if needed.

4. If there's excessive hair at the catheter insertion site (groin area), it may be shaved off.

5. A provider will connect you to an electrocardiogram to keep track of and record the electrical activity of the heart. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be tracked during the procedure.

6. There will be several monitor screens in the room. These will show your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as your provider injects the dye.

7. You'll get a sedative medicine in your IV before the procedure to help you relax. But you'll likely remain awake during the procedure

8. A provider will check and mark your pulses below the injection site and compare them to pulses after the procedure.

9. 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 injection.

10. Once the local anesthetic has taken effect, your provider will insert a sheath (introducer) 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.

11. Your provider will insert the valvuloplasty catheter through the sheath into the blood vessel and to the heart.

12. Once the catheter is in place, your provider will inject contrast dye through the catheter into the valve 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.

13. Heart ultrasound pictures will also be used to help guide the location of the catheter and see how well it's working.

14. Tell your provider if you have any difficulty breathing, sweating, numbness, itching, chills, nausea or vomiting, or heart palpitations.

15. The provider will watch the contrast dye injection on a monitor. They may ask you to take a deep breath and hold it for a few seconds. If the valvuloplasty procedure is being done on the aortic valve, your provider may use a temporary pacemaker to make your heart beat faster and lower your blood pressure. You can feel dizzy and confused after the pacemaker has been turned on and off.

16. Once the balloon is in place and has been inflated, you may notice some dizziness or brief chest discomfort. This should decrease or go away when the balloon is deflated. But tell your provider if you have any severe discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty.

17. Your provider may inflate and deflate the balloon several times to open the valve.

18. Once the valve is opened sufficiently, your provider will remove the catheter. They may close the catheter insertion site with a closure device that uses collagen to seal the opening in the artery, by the use of sutures (stitches), or by applying manual pressure over the area to keep the blood vessel from bleeding. Your provider will decide which method is appropriate for your condition.

19. If your provider uses a closure device, they'll apply a sterile dressing to the site. If manual pressure is used, the provider 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. 

20. Your provider may decide not to remove the introducer from the insertion site for about 4 to 6 hours. This allows the effects of blood-thinning medicine to wear off. You'll need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medicine to make you more comfortable. Your provider might also give a reversal medicine for the blood thinner to reduce the risk of bleeding and allow for the sheath to be removed from the artery site.

21. Next, you'll be taken to the recovery area. NOTE: If the insertion was in the groin, you won't be allowed to bend your leg for a few 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.

What happens after a valvuloplasty?

In the hospital

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You'll remain flat in bed for several hours after the procedure. A nurse will keep track of your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.

Tell your nurse right away if you feel any chest pain or tightness, any other pain, or any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.

Bed rest may vary from 2 to 6 hours depending on your specific condition. If your provider placed a closure device, you may spend less time on bed rest.

In some cases, the introducer may be left in the insertion site. If so, the time you spend in bed rest will be longer. After the sheath is removed, you may be given a light meal.

You may be given medicine for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You'll be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You'll need to use a bedpan or urinal while on bed rest so that you don't bend your affected leg or arm.

You may resume your usual diet after the procedure, unless your healthcare provider tells you otherwise.

After the specified period of bed rest, you may get out of bed. The nurse will help you the first time you get up and may check your blood pressure while you're lying in bed, sitting, and standing. Move slowly when getting up from the bed to prevent any dizziness.

You'll 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'll receive detailed instructions for your discharge and recovery period.

At home

Once at home, watch the insertion site for bleeding, unusual pain, swelling, and 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 can't be contained with a small dressing, call your healthcare provider.

If your provider used a closure device for your insertion site, you'll be given specific information about how to take care of the insertion site. There will be a small lump under the skin at the injection site. This is normal. It should gradually disappear over a few weeks.

It'll be important to keep the insertion site clean and dry. Your provider will give you specific bathing instructions. Don't soak in a bathtub or hot tub, or go swimming, until the skin has healed. This helps prevent infection.

Your provider may advise you not to do any strenuous activities. They will tell you when you can go back to work and resume normal activities.

Tell your healthcare provider if you have any of the following:

• Fever or chills

• Increased pain, redness, swelling, or bleeding or other drainage from the insertion site

• Coolness, numbness, tingling, or other changes in the affected leg or arm

• Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting

• Decreased peeing

• Swelling of the arms, legs, or abdomen

• Weight gain of more than 3 pounds in 1 day

Your provider may give you other instructions after the procedure, depending on your specific situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you're having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you're to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you didn't have the test or procedure

• Any alternative tests or procedures to think about

• When and how you'll get the results

• Who to call after the test or procedure if you have questions or problems

• How much you'll have to pay for the test or procedure