Balloon Valvuloplasty for Aortic Valve Stenosis

Balloon Valvuloplasty for Aortic Valve Stenosis

Treatment Overview

Balloon valvuloplasty (also called valvulotomy or valvotomy) is a procedure that widens a heart valve that is narrowed. The cause of this narrowing in the aortic valve is aortic valve stenosis.

During this procedure, a thin flexible tube called a catheter
is inserted through an artery in the groin or arm and threaded into the heart.
When the tube reaches the narrowed heart valve, a balloon at the end of the
tube is inflated. The balloon widens the valve opening.

During the procedure, you will be awake. But you will
receive local anesthesia where the catheter is inserted as well as intravenous
(IV) pain medicine along with a sedative to help you relax.

What To Expect After Treatment

You will likely stay overnight in the hospital after a valvuloplasty. You will be checked for any problems after the procedure, such as bleeding from the site where the catheter was inserted.

Why It Is Done

Balloon valvuloplasty is not an option for most people who have aortic valve stenosis.

Children, teens, and young adults

Balloon valvuloplasty might be used in some children, teens, and young adults in their 20s who
have
aortic valve stenosis. This group typically has aortic valve stenosis because of a congenital heart defect such as a bicuspid aortic valve.

Pregnant women

Valvuloplasty may be used for pregnant women who get aortic
valve stenosis symptoms during their pregnancy. After the woman delivers, she
may then have the aortic valve replaced.

Older adults

Valvuloplasty is not appropriate for most
older people who have stenosis. These people typically need an aortic valve replacement procedure.

How Well It Works

Balloon valvuloplasty is generally an effective treatment for aortic
valve stenosis in children, teens, and young adults but has very limited effectiveness in
older adults. In most older adults, the valve becomes narrowed again
(restenosis) within 6 to 12 months after this procedure.footnote 1

Balloon valvuloplasty works better in younger people because of
the difference in the causes of aortic valve stenosis in younger and older
people. Young people typically have the condition because they were born
with a bicuspid valve, which is an aortic valve that has two leaflets instead
of three. But older people typically get stenosis over many
years through a gradual hardening and buildup of calcium on their valves. This is a
process called aortic sclerosis, which is similar to atherosclerosis, the
buildup of hard plaque inside the arteries.

After a valvotomy procedure in a young person, the aortic valve is wider, but it is still not normal. After 10 to 20 years, the valve might get narrow again, and he or she might need to have the valve replaced.footnote 2

Risks

A valvotomy procedure for children, teens, and young adults has low risk for serious complications.footnote 3

But for older adults, serious complications happen in 1 or 2 out of 10 people who have this procedure. These problems include stroke, heart attack, and aortic valve regurgitation.footnote 4

Complications related to the catheter include:

  • Pain, swelling, and tenderness at the catheter
    insertion site.
  • Irritation of the vein by the catheter (superficial
    thrombophlebitis). This can usually be treated with warm
    compresses.
  • Bleeding at the catheter site.
  • A bruise
    where the catheter was inserted. This usually goes away in a few
    days.
  • Trouble urinating after the procedure.

What To Think About

For information about valve replacement surgery, see Aortic Valve Replacement Surgery.

Complete the special treatment information form (PDF) ( What is a PDF document? ) to help you understand this treatment.

References

Citations

  1. Nishimura RA, et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online March 3, 2014. DOI: 10.1161/CIR.0000000000000031. Accessed May 1, 2014.
  2. Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
  3. Feltes TF, et al. (2011). Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 123(22): 2607–2652.
  4. Freeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1692–1720. New York: McGraw-Hill.

Credits

ByHealthwise StaffPrimary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology Martin J. Gabica, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Michael P. Pignone, MD, MPH, FACP - Internal Medicine

Current as ofFebruary 23, 2018

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