Definition and Overview
Pulmonary valvuloplasty is a procedure used to dilate a narrowed pulmonary valve. Nowadays, it is performed in a minimally invasive way with the use of a balloon catheter. Also called pulmonary balloon valvuloplasty, it is widely used for the treatment of moderate to severe valvar pulmonic stenosis.
Minimally invasive balloon pulmonary valvuloplasty was first used in 1982 and was quickly considered as a major milestone in interventional cardiology, successfully replacing open-heart surgery as the primary treatment option for pulmonary valve stenosis.
Who Should Undergo and Expected Results
Pulmonary valvuloplasty is the treatment of choice for valvar pulmonic stenosis or pulmonary valve stenosis, a heart disease in which the pulmonary valve is too narrow restricting blood flow from the heart to the lungs.
Pulmonary valve stenosis is often congenital, which means it develops before birth. The condition, which accounts for 8 to 10% of all congenital heart diseases, can also develop as a complication of another illness, such as carcinoid syndrome or rheumatic fever. Its symptoms include:
Shortness of breath
Loss of consciousness
Oedema, or when the feet, ankles, and abdomen become swollen
Fluid retention, which can lead to sudden, unexplained weight gain
When left untreated, the condition can progress and cause infection and arrhythmia. It can also increase patients’ risk of heart failure.
However, with the right treatment, patients who suffer from pulmonary valve stenosis can live normal lives even without using a defibrillator or pacemaker. Doctors recommend either balloon pulmonary valvuloplasty or open-heart surgery depending on the severity of the condition. While more severe cases may require an open-heart procedure, most cases can generally be treated using a balloon catheter. With this procedure, the risks of open-heart surgery can be minimised without compromising treatment outcomes. Studies show that both treatment methods offer the same results; both can effectively enlarge the valve opening, restore normal blood flow, and improve the valve’s function.
How is the Procedure Performed?
Percutaneous balloon pulmonary valvuloplasty is performed by inserting a balloon catheter into a large vein (either the femoral or jugular vein) and then guiding it towards the stenotic pulmonary valve. The catheter used in the procedure is a thin tube with a small, deflated balloon attached to one end. Once in place, the surgeon inflates the balloon to enlarge the pulmonary valve and improve blood flow. Once the valve has widened, the balloon catheter is removed and another catheter is left in place for up to 12 hours to drain excess fluid from the surgical site.
Pulmonary valvuloplasty may take up to four hours, during which the patient is placed under local anaesthesia that numbs the catheter insertion site. The patient is awake throughout the procedure and can watch it being performed on a monitor.
Following the procedure, patients are placed under close monitoring for several hours. During this time, they are attached to an EKG machine to check for abnormal heart rhythm. The skin around the insertion site is also closely observed for signs of infection.
Recovering from a pulmonary valvuloplasty is quick with most patients able to resume their normal activities soon after they are discharged from the hospital. However, they require lifelong follow-up appointments to monitor the condition of the treated valve.
Possible Risks and Complications
Despite its high success rates, there are potential complications linked with the procedure. These include:
Valve regurgitation, or when blood leaks back through the pulmonary valve
Bleeding at the site where the catheter was inserted
Blood clot in the leg or lungs
Embolism, or when pieces of valve tissue break off, travel to other parts of the body such as the brain or the lungs, and cause a blockage
Damage to nearby structures, such as neighbouring blood vessels
Patients may need to take anticoagulant medications for months or even years following the procedure. They are also advised to undergo regular blood tests to make sure their medications are producing the desired results.
There is also a risk of restenosis, in which the valve becomes narrow again. This is a common problem for patients who also suffer from valvular disease. In such cases, the patient can undergo a modified version of the procedure in which the balloon/annulus ratio is adjusted.
Rao PS. “Balloon pulmonary valvuloplasty: A review.” Clin Cardiol. 1989 Feb; 12(2): 55-74. https://www.ncbi.nlm.nih.gov/pubmed/2653678
McCrindle BW. “Long-term results after balloon pulmonary valvuloplasty.” http://circ.ahajournals.org/content/circulationaha/83/6/1915.full.pdf
Aldoss O, Gruenstein D (2012) “Percutaneous Balloon Pulmonary Valvuloplasty.” Pediat Therapeut S5:003. doi: 10.4172/2161-0665.S5-003. https://www.omicsonline.org/percutaneous-balloon-pulmonary-valvuloplasty-2161-0665.S5-003.php?aid=4019
What is Pulmonary Valvuloplasty?
Pulmonary valvuloplasty is a medical procedure used to repair abnormalities of the pulmonary valve, located between the right ventricle and the pulmonary artery of the heart. This procedure is used to treat problems such as pulmonary valve stenosis, a condition which occurs when the pulmonary valve of the heart becomes narrowed, decreasing the amount of blood that flows from the heart to the lungs. This procedure can also be used to treat pulmonary valve regurgitation, a condition in which the valve becomes weakened and blood flows backward in the direction of the heart.
Benefits of Pulmonary Valvuloplasty
Pulmonary valvuloplasty offers a number of benefits to those who suffer from pulmonary valve abnormalities. These include:
- Improved circulation of oxygenated blood throughout the body
- Reduced risk of stroke, heart failure, and other heart-related complications
- Improved quality of life overall
Expected Results of Pulmonary Valvuloplasty
The most common expected result of pulmonary valvuloplasty is an improved quality of life. Patients generally experience a reduction in symptoms such as shortness of breath, fatigue, and chest pain. Additionally, the procedure can reduce the risk of developing complications such as stroke and heart failure.
The outcome of the procedure depends on the severity of the valve abnormality prior to the procedure. In most cases, the patient will experience an immediate improvement in their condition, and their heart function will be restored to normal over the course of the recovery period. In some cases, pulmonary valvuloplasty may need to be repeated to maintain optimal results.
Risks and Complications of Pulmonary Valvuloplasty
As with any medical procedure, there are potential risks and complications associated with pulmonary valvuloplasty. These include:
- Temporary heart arrhythmia
- Post-procedural chest pain
- Incomplete valve repair
However, in experienced hands, the risk of these complications is low.
Preparation and Aftercare
Prior to the procedure, patients will need to undergo a series of medical tests to ensure their hearts are functioning properly and to assess their overall health. This will generally include an echocardiogram, chest X-ray, blood tests, and an electrocardiogram. Patients will also be instructed to eat a light meal several hours before the procedure and to avoid drinking alcohol for up to 24 hours before the procedure.
After the pulmonary valvuloplasty procedure, patients will need to be monitored closely for several days. This typically involves having regular checkups, stress tests, and chest X-rays. In most cases, patients will be able to resume their normal activities within days of the procedure, although strenuous activities should still be avoided for several weeks.
Pulmonary valvuloplasty is a medical procedure used to repair abnormalities of the pulmonary valve. In most cases, this procedure leads to an improved quality of life and a reduction in symptoms such as shortness of breath and chest pain. Additionally, pulmonary valvuloplasty can reduce the risk of developing heart-related complications such as stroke and heart failure. As with any medical procedure, there are potential risks and complications associated with pulmonary valvuloplasty, but these are rare in experienced hands. Patients should follow their doctor’s instructions before and after the procedure to ensure a successful outcome.