Definition & Overview
The human heart has several valves that play important roles in keeping the blood flowing in and out of its four chambers. These are the tricuspid, pulmonary, mitral, and aortic valves. Sometimes, these valves become narrow and impair blood flow - a condition called valvular stenosis, which could lead to a variety of heart conditions such as heart failure, angina or chest pain, arrhythmia or irregular heartbeat, and heart murmur.
Valvuloplasty or stiff heart valve repair surgery is used to correct this condition. It is performed by inserting a narrow catheter into the affected valve, enlarging it and improving blood flood in the process.
This procedure is typically recommended if alternative treatments, including medications and lifestyle changes, have failed to improve the patient's condition.
Who Should Undergo & Expected Results
Valvular stenosis, which can be congenital or acquired, can affect both children and adults. If it is congenital, it can impair the development and growth of the affected child. In this case, valvuloplasty is recommended to repair and improve blood circulation.
Stiff heart valve repair surgery is also recommended for adults with stenotic heart valve caused by bacterial infection leading to rheumatic fever and those who developed calcium obstructions in one of their heart valves.
In rare instances, pregnancy could also lead to the development of aortic valve stenosis. To alleviate the associated symptoms, valvuloplasty may be recommended though care is taken to ensure the safety of the foetus.
Valvuloplasty could also be a part of treatment for patients with advanced stenotic valve who are scheduled to undergo aortic valve replacement procedure later on. This scenario is very common among older patients who might not get the full benefit of valvuloplasty.
Stiff heart valve surgery is considered an effective treatment for stenotic valve condition, especially among children, teens, and young adults. Several days of hospitalization is required following this surgery. The patient would then be administered with anticoagulants to keep the blood flowing and might be required to take pain medication.
There are generally positive outcomes from this procedure, especially in younger patients. Among adults, there is a possible recurrence of stenotic valve condition that would necessitate another stiff heart valve surgery after a few years.
Patients can resume normal daily activities after a couple of weeks following the procedure, but would require periodic check-ups to monitor the effectiveness of the operation and prevent recurrence.
How Does the Procedure Work?
This procedure is usually done in a specialised laboratory with special equipment and X-ray monitors that will aid the surgeon in inserting and guiding the catheter. Valvuloplasty starts with the insertion of the catheter in the groin area of the patient, who is sedated and awake during the entire process. The catheter is inserted into the vein or artery and advanced to the heart. A contrast dye is then injected to evaluate the affected area using several monitors. Once the catheter reaches the affected valve, a balloon located at the tip of the catheter will be inflated to widen the narrowed valve. The balloon could be inflated several times to achieve the desired opening. After widening the valve, the balloon is deflated and the catheter removed. The insertion site in the groin is then closed and the patient is asked not to bend the leg for several hours after surgery.
Valvuloplasty usually takes about four hours to complete.
Possible Complications and Risks
Though generally considered a safe procedure, there are still several risks and complications associated with valvuloplasty. The affected heart valve could be damaged or become misshapen. The valve leaflets could also be completely damaged, which can further worsen the patient’s condition. In some cases, the valve might need to be replaced immediately.
Bleeding could also occur at the insertion site and in some cases, patients may require a blood transfusion if there is a significant loss of blood. The catheter could also cause damage to the vein or artery where it is inserted, leading to internal bleeding that would require emergency care.
Several medical conditions could also develop such as stroke, abnormal heart beat, or even valve rupture, which would require an open heart surgery.
There are also reported allergic reactions to the dye used during the procedure, as well as adverse conditions following exposure to radiation.
Coeytaux RR, Williams JW Jr., Gray RN, Wang A. Percutaneous heart valve replacement for aortic stenosis: state of the evidence. Ann Intern Med. 2010;153:314-324. PMID: 20679543
Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.