Procedure Details for Valvuloplasty
The heart, a vital organ, has four valves: the aortic, mitral, pulmonary, and tricuspid. When these valves become stiff and narrow due to a condition called valve stenosis, blood flow is restricted, leading to a range of symptoms.
Valve stenosis can occur in any of the heart's valves, such as the aortic, mitral, or pulmonary valves. For instance, aortic valve stenosis restricts blood flow from the lower left side of the heart to the main artery that transports blood to the rest of the body, while mitral valve stenosis restricts the flow of blood from the upper to lower chambers on the left side of the heart. Similarly, pulmonary valve stenosis restricts blood flow from the lower right chamber in the heart to the arteries that supply blood to the lungs.
A person may want to make any necessary lifestyle changes, such as following a heart-healthy diet and exercise regimen, to manage their symptoms and improve heart health. However, in some cases, medical intervention may be required.
Valvuloplasty, a minimally invasive procedure, is one such intervention. This procedure uses a catheter with a small balloon to open narrow heart valves, restoring proper blood flow and relieving symptoms of stenosis. A valvuloplasty can help restore proper blood flow in the heart when valve stenosis occurs.
The choice of treatment depends on the type of stenosis and the patient's individual circumstances. For example, a valvuloplasty is less invasive than valve replacement surgery.
For aortic valve stenosis, balloon aortic valvuloplasty (BAV) is often used as a bridge or in patients who are not candidates for valve replacement. While it can reduce valve gradient and improve symptoms temporarily, restenosis and symptom recurrence are common within months to a few years. Therefore, its long-term effectiveness is limited.
In contrast, Transcatheter Aortic Valve Implantation (TAVI) or replacement (TAVR), which is increasingly used especially in high-risk or inoperable patients, shows favorable short- to mid-term outcomes with good survival and functional improvement. Though technically different from valvuloplasty, early intervention with TAVI has shown improved mid-term survival versus BAV alone, particularly in unstable or critically ill patients.
For surgical valve replacement options, bioprosthetic valves (either porcine or bovine pericardial) show durable long-term survival (up to 20 years), although about 20-25% of patients require reintervention within that period. Some evidence favors porcine valves over pericardial ones in terms of lower reintervention rates.
Valve-in-valve TAVR procedures have emerged as effective mid-term solutions for patients with failing prosthetic valves, with good technical success and survival outcomes, supplementing long-term management options post initial valvuloplasty or valve replacement.
For mitral valve stenosis, balloon mitral valvuloplasty has demonstrated more durable long-term benefits than BAV in the aortic position, often improving blood flow and heart function effectively over years.
Following a valvuloplasty, a person may need to lie flat for several hours and refrain from lifting heavy objects or strenuous activity for a few days. They may also need to take medication following the procedure. A doctor may perform some follow-up tests, such as an electrocardiogram, to check how the heart is beating.
In most cases, a person will typically go home the day after the procedure. However, the recovery timeline can vary depending on the individual's health and the type of valve stenosis treated.
In conclusion, while balloon valvuloplasty can be useful in acute or high-risk settings, its long-term outcomes for aortic valve stenosis are generally inferior to valve replacement strategies such as TAVI or surgical AVR, which offer better durability, survival, and freedom from reintervention over years. The choice depends on patient factors, valve anatomy, and risk profiles.
