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Valvuloplasty for Aortic Valve Stenosis

Treatment Overview

Valvuloplasty is a procedure that widens a heart valve that is narrow. When you have a condition called aortic valve stenosis, the valve between your heart and the large blood vessel that carries blood to the body (aorta) is narrow. That forces the heart to pump harder to get enough blood through the valve.

The procedure to widen the valve is also called valvulotomy or valvotomy. It can help improve blood flow through the valve. If you are having symptoms such as chest pain, shortness of breath, or passing out (syncope), this procedure may help you feel better. The procedure may be done before a valve replacement procedure or surgery.

You may get medicine that relaxes you or puts you in a light sleep. You won't feel pain when the catheter is put in the blood vessel. The doctor puts a thin, flexible tube called a catheter into a blood vessel in your upper leg (groin). The doctor moves the catheter through that blood vessel and into your heart. The doctor puts a dye into the tube. This dye makes your heart show up on a screen so that the doctor can see the aortic valve.

The catheter has a small balloon at the tip. When the tube reaches the narrow heart valve, the balloon is inflated and deflated. Your doctor might do this a few times. The balloon widens the valve opening. Then your doctor removes the balloon and tube from your body.

You likely will stay overnight in the hospital after this procedure.

Your groin may have a bruise and feel sore for a few days. You can do light activities around the house. But don't do anything strenuous for several days.

Why It Is Done

Valvuloplasty is done to help the valve work better and improve blood flow through the valve. It may be done to relieve symptoms such as chest pain, shortness of breath, or passing out (syncope).

Valvuloplasty is not an option for most people who have aortic valve stenosis.

Children, teens, and young adults

Valvuloplasty might be used in some children, teens, and young adults in their 20s who have aortic valve stenosis.footnote 1 This group typically has aortic valve stenosis because of a congenital heart defect such as a bicuspid aortic valve.

Pregnant women

Valvuloplasty may be used for pregnant women who get aortic valve stenosis symptoms during their pregnancy.footnote 2 After the baby is born, the aortic valve may be replaced.

Older adults

Valvuloplasty is not appropriate for most older people who have stenosis. These people typically need an aortic valve replacement procedure. But valvuloplasty might be done to relieve severe symptoms if a person has to wait before having the valve replaced.footnote 3

How Well It Works

Balloon valvuloplasty is generally an effective treatment for aortic valve stenosis in children, teens, and young adults. But it doesn't work as well for older adults. In most older adults, the valve becomes narrowed again (restenosis) within 6 to 12 months after this procedure.footnote 3

Balloon valvuloplasty works better in younger people because of the difference in the causes of aortic valve stenosis in younger and older people. Young people typically have the condition because they were born with a bicuspid valve. This is an aortic valve that has two leaflets instead of three. But older people typically get stenosis over many years through a gradual hardening and buildup of calcium on their valves. This is a process called aortic sclerosis. It's similar to atherosclerosis, the buildup of hard plaque inside the arteries.

After the procedure in a young person, the aortic valve is wider, but it's still not normal. Over time, the valve can get narrow again, so another procedure or valve replacement might be done.footnote 1

Risks

A valvuloplasty procedure includes risks. For children, teens, and young adults, problems include bleeding and heart rhythm changes. The chance of having a problem from the procedure varies based on how severe the disease is.footnote 4

For older adults, serious complications happen in 1 or 2 out of 10 people who have this procedure. These problems include stroke, blood vessel problems that need surgery, and death.footnote 5

Complications related to the catheter include:

  • Pain, swelling, and tenderness at the catheter insertion site.
  • Irritation of the blood vessel by the catheter (superficial thrombophlebitis). This can usually be treated with warm compresses.
  • Bleeding at the catheter site.
  • A bruise where the catheter was inserted. This usually goes away in a few days.

References

Citations

  1. Feltes TF, et al. (2011). Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 123(22): 2607–2652.
  2. Cannobio MM, et al. (2017). Management of pregnancy in patients with complex congenital heart disease: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 135(8): e50–e87. DOI: 10.1161/CIR.0000000000000458. Accessed March 2, 2017.
  3. Otto CM, et al. (2020). 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Circulation, published online December 17, 2020. DOI: 10.1161/CIR.0000000000000923. Accessed December 17, 2020.
  4. Boe BA, et al. (2017). Acute success of balloon aortic valvuloplasty in the current era: A National Cardiovascular Data Registry study. Journal of the American College of Cardiology: Cardiovascular Interventions, 10(17): 1717–1726. DOI: 10.1016/j.jcin.2017.08.001. Accessed April 4, 2018.
  5. Alkhouli M, et al. (2017). Morbidity and mortality associated with balloon valvuloplasty: A nationwide perspective. Circulation: Cardiovascular Interventions, 10: e004481. DOI: 10.1161/CIRCINTERVENTIONS.116.004481. Accessed April 5, 2018.

Credits

Current as of: December 2, 2020

Author: Healthwise Staff
Medical Review:
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Martin J. Gabica MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Michael P. Pignone MD, MPH, FACP - Internal Medicine

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