What is valvuloplasty?
Valvuloplasty may be done to open a stenotic (stiff) heart valve. In valvuloplasty, a very small, narrow, hollow tube (known as a catheter) is advanced from a blood vessel in the groin through the aorta into the heart. Once the catheter is placed in the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets (flaps) of the valve are opened. Once the valve has been opened, the balloon is deflated and the catheter is removed.
To keep the blood flowing forward during its journey through the heart, there are valves between each of the heart's pumping chambers:
- Tricuspid valve. Located between the right atrium and the right ventricle
- Pulmonary (or pulmonic) valve. Located between the right ventricle and the pulmonary artery
- Mitral valve. Located between the left atrium and the left ventricle
- Aortic valve. Located between the left ventricle and the aorta
Why might I need valvuloplasty?
Valvuloplasty may be done to open a heart valve that has become stiff. 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 function properly. Conditions that may cause dysfunction of heart valves are valvular stenosis (stiffened valve) and valvular regurgitation (leaky valve). When one (or more) valve(s) becomes stenotic (stiff), the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection (such as rheumatic fever or staphylococcus infections), congenital (present at birth) valve abnormalities, and aging. If one or more valves become insufficient (leaky), blood leaks backwards, this means that less blood is pumped in the proper direction.
Valvular heart disease may cause the following symptoms:
- Chest pain
- Breathing difficulties
- Edema (swelling) of the feet, ankles, or abdomen
- Rapid weight gain due to fluid retention
There may be other reasons for your doctor to recommend a valvuloplasty.
What are the risks for valvuloplasty?
Possible risks associated with valvuloplasty include:
- Bleeding at the catheter insertion site
- Blood clot or damage to the blood vessel at the insertion site
- Significant blood loss that may require blood transfusion
- Infection at the catheter insertion site
- Abnormal heart rhythms
- New or worsening valve regurgitation (leakage)
- Rupture of the valve, requiring open-heart surgery
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your situation. It is a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray exams and/or treatments over a long period.
If you are pregnant or suspect that you may be pregnant, tell your healthcare provider due to risk of injury to the fetus from a valvuloplasty. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should tell your health care provider.
There is a risk of allergic reaction to the dye. If you are allergic or sensitive to medications, contrast dyes, iodine, or latex should, tell your doctor. If you have kidney failure or other kidney problems, tell your doctor.
Some people may find lying still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
How do I get ready for a valvuloplasty?
- Your doctor will explain the procedure to you and ask if you have any questions.
- You will 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 not clear.
- Tell your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
- Tell your doctor if you are sensitive to or are allergic to any medications, latex, tape, or anesthetic agents (local and general).
- You will need to fast for a certain period prior to the procedure. Your doctor will tell you how long to fast, usually overnight.
- If you are pregnant or suspect that you may be pregnant, tell your doctor.
- Tell your doctor if you have any body piercings on your chest and/or abdomen.
- Tell your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
- Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
- Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.
- Tell your doctor if you have a pacemaker.
- You may receive a sedative prior to the procedure to help you relax.
- Based on your medical condition, your doctor may request other specific preparation.
What happens during a valvuloplasty?
A valvuloplasty may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a valvuloplasty follows this process:
- You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aids if you use either of these.
- You will be asked to remove clothing and will be given a gown to wear.
- You will be asked to empty your bladder prior to the procedure.
- An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
- You will lie on the procedure table.
- If there is excessive hair at the catheter insertion site (groin area), the hair may be shaved off.
- You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
- There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.
- You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure
- Your pulses below the injection site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.
- 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 local anesthetic is injected.
- Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted 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.
- The valvuloplasty catheter will be inserted through the sheath into the blood vessel. The doctor will advance the catheter through the vein or artery across the heart valve. Fluoroscopy (a special type of X-ray that will be displayed on a TV monitor) may be used to assist in advancing the catheter to the heart.
- Once the catheter is in place, contrast dye will be injected through the catheter into the valve in order 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.
- You should tell the doctor if you feel any breathing difficulties, sweating, numbness, itching, chills, nausea and/or vomiting, or heart palpitations.
- The doctor will watch the contrast dye injection on a monitor. The doctor may ask you to take a deep breath and hold it for a few seconds.
- Once the balloon is in place and has been inflated, you may notice some dizziness or even brief chest discomfort. This should subside when the balloon is deflated. However, if you notice any severe discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, tell your doctor.
- The balloon may be inflated and deflated several times in order open the valve.
- Once it has been determined that the valve is opened sufficiently, the catheter will be removed. The catheter insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your doctor will determine which method is appropriate for your condition.
- If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the doctor (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. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.
- Your doctor may decide not to remove the sheath, or introducer, from the insertion site for approximately 4 to 6 hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off. You will need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medication to make you more comfortable.
- You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several 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 will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as 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 doctor placed a closure device, your bed rest may be of shorter duration.
In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bed rest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may be given medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bed rest so that your affected leg or arm will not be bent.
You may resume your usual diet after the procedure, unless your doctor decides otherwise.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bed rest.
You will 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 will receive detailed instructions for your discharge and recovery period.
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal 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 cannot be contained with a small dressing, notify your doctor.
If your doctor used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin at the injection site. This is normal. The knot should gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.
Tell your doctor to report any of the following:
- Fever and/or chills
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Coolness, numbness and/or tingling, or other changes in the affected extremity
- Chest pain or pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- The risks and benefits of the test or procedure
- When and where you are to have the test or procedure and who will do it
- When and how will you get the results
- How much will you have to pay for the test or procedure