Balloon Pulmonary Valvotomy
What is Pulmonary Balloon Valvotomy?
It is a minimally invasive process that aims at the widening of narrowed pulmonary valve.
Out of the 4 valves in the heart which helps blood to move from one chamber to the other preventing the backflow of blood, the pulmonary valve allows blood to enter into the lungs from the right heart.
It is located between a big artery carrying blood to the lungs called the pulmonary artery and the right ventricle. This process is essential for the oxygenation of blood to supply oxygenated blood to vital body organs.
Why do a Valvotomy?
Sometimes pulmonary valve can get affected by diseases that make the valve leaflets thickened or calcified, making it hard for them to move apart or open and allow a proper flow through them. This is called pulmonary stenosis .As a consequence of this, the right ventricle will not empty, causing excess strain on the heart leading to heart failure, and also the amount of blood entering the lungs will be low causing hypoxia, a condition where the blood oxygen concentration is low
Pulmonary stenosis can be mild, moderate, or severe. The mild disease mostly is uneventful but when the disease is severe dire symptoms like,
- difficulty in breathing
- ankle swelling
- hard or fast breathing
- chest pain
- cyanosis or bluish discoloration of lips and fingertips
What Causes Pulmonary Stenosis?
Pulmonary stenosis is most commonly seen in children who get it congenitally, in other words, are born with the defect.
Adults may acquire this condition later in life due to ,
- Rheumatic heart disease
- Non-thrombotic bacterial endocarditis
- chest radiotherapy
- carcinoid syndrome, a form of cancer of the GUT
Who needs Balloon Valvotomy?
Children born with congenital pulmonary stenosis with severe symptoms and adults with moderate to severe disease can undergo the procedure.
Though this is a fairly safe and easier method people who have infective endocarditis, vegetations in the heart, and pulmonary regurgitation, where blood flows back to the heart from the pulmonary artery are not suitable to undergo this process. These patients have to undergo the alternative to balloon valvotomy being, an open-heart surgery to replace the narrowed pulmonary valve. This is done by a cardiothoracic surgeon.
How to Prepare?
You have to admit one day before the procedure to the hospital. You have to stay fasting for about 6-8 hours prior. A few basic tests will be performed like ECG, cardiac echo, chest X-ray, full blood count, and serum creatinine levels to assess renal function . If previous allergic reactions to contrast dye are present you may be given some prednisolone tablets to prevent allergy this time.
How is it Done?
After assessing your suitability and preparedness for the procedure doctor may inject a local anesthetic into your groin area to reduce pain. Some need sedation. Then the femoral artery a large artery in your groin area will be punctured. Through the artery, a catheter with a deflated balloon at the tip will be inserted and slowly directed towards your heart. Then the contrast will be injected to detect the exact place of the catheter and the valve .
At the pulmonary valve site, any calcifications will be broken and the balloon will be inflated by pumping air. This balloon will expand the valve leaflets and relieve the narrowing. Then the balloon will be deflated and the catheter will be retracted.
Possible Risks After
- Bleeding from the puncture site and later a hematoma will be formed.
- Infection of the puncture site.
- Damage to pulmonary valve causing.
- Allergy to contrast may cause a life-threatening emergency
- Damage to kidneys due to contrast
What to Expect?
Pulmonary valvotomy has shown an immediate to a five-year success rate of 94%. Pulmonary balloon valvotomy has multiple benefits in contrast to other treatment modalities as it is a minimally invasive process. The duration of hospital stay is short and the cost is much less. Healing is quicker and complications of general anesthesia will not be there. Other risks involved with serious open-heart surgery such as organ failure, heart attacks, strokes, and death will be negated. But there is evidence that restenosis of the valve in about 3.8%  of the patients in the long run but the procedure is easily repeated on them.
- Stanford Children’s Health. Stanfordchildrens.org. https://www.stanfordchildrens.org/en/topic/default?id=pulmonary-stenosis-90-P01815. Published 2021. Accessed November 28, 2021.
- Pulmonary Stenosis | Heart and Vascular | Penn Medicine. Pennmedicine.org. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/pulmonary-valve-stenosis. Published 2021. Accessed November 28, 2021.
- Congenital Pulmonary Stenosis Balloon Valvuloplasty. Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/congenital-pulmonary-stenosis-balloon-valvuloplasty. Published 2021. Accessed November 28, 2021.
- Ananthkrishnan A, VR Balasubramonium, HK T et al. Balloon pulmonary valvuloplasty in adults: immediate and long-term outcomes. PubMed. https://pubmed.ncbi.nlm.nih.gov/25803978/. Published 2021. Accessed November 28, 2021.
- Maostafa Behjati-Ardakani S. Long-term Results of Balloon Pulmonary Valvuloplasty in Children with Congenital Pulmonary Valve Stenosis. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574989/. Published 2021. Accessed November 28, 2021.