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:

  • Heart murmur

  • Shortness of breath

  • Chest pain

  • Fatigue

  • Loss of consciousness

  • Dizziness

  • Palpitations

  • 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

  • Infection

  • 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

  • Blood loss

  • Kidney failure

  • Stroke

  • Valve rupture

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.

References:

  • 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

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