What is cardiological valvuloplasty?

Valvuloplasty is a procedure in which a doctor stretches a heart valve or breaks the adhesions in a valve that may be scarred. Heart valves need to function properly. They direct the flow of blood through the chambers of the heart and to the rest of the body.

When is it used?

The doctor may perform this procedure if you have a scarred valve that leaks or doesn't close or open all the way, thus blocking the flow of blood to the lungs, chambers of the heart, or to the body.

Examples of alternatives are:

• trying or continuing to take drugs for the problem

• having the valve replaced

• having the valve repaired surgically

• choosing not to have treatment while recognizing the risks of your condition.

You should ask your doctor about these choices.

How do I prepare for cardiological valvuloplasty?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Tell the doctor before the procedure of any kidney problem you have had or any reaction to iodine-containing chemicals such as seafood and/or kidney contrast dye.

Follow instructions provided by your doctor. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

No particular preparation is needed for local anesthesia.

What happens during the procedure?

The doctor will give you a sedative and either a general or local anesthetic. A general anesthetic will relax your muscles and make you feel like you are in a deep sleep. It will prevent you from feeling pain during the operation. A local anesthetic is a drug that should keep you from feeling pain during the operation. If you have a local anesthetic, the doctor will put it into your groin, which may burn at first.

Then the doctor will put a needle into your vein or artery, depending on which valve has the problem, and guide a small catheter into the vessel. A catheter is a long tube the doctor can use to inject fluid, introduce other catheters and instruments, and measure blood pressure. The doctor will direct the catheter to the problem area of your heart.

The doctor will guide a wire within the small catheter into your heart and through the problem valve. The doctor will remove that catheter and slide a larger, balloon catheter through the blood vessel, over the wire. The doctor will inject a contrast dye into the balloon so he or she can watch it with motion picture x-rays. The doctor will guide the balloon into the problem valve, then inflate the balloon a bit to check, with the x-ray, if it is in the right place. Then the doctor will inflate the balloon so it makes the valve opening larger.

When the balloon is inflated, you may feel some temporary pain. This is not uncommon, but you should tell the doctor. The doctor may repeat this process several times until she or he feels the valve opening is the right size. Then the doctor may replace the large catheter with the smaller one and inject contrast media through the catheter. The doctor may use the smaller catheter to remeasure the pressure in your blood vessels and take a second x-ray.

The doctor will then remove the catheter and the wire and apply pressure over your groin to control any bleeding and to help healing.

What happens after the procedure?

You will be transferred to the coronary care unit or the intensive care unit to a monitored bed where you will remain overnight. The nursing staff will monitor your heart for at least 24 hours. They will also check your blood pressure and groin sites frequently for several hours.

While recovering from the valvuloplasty, don't bend your legs where the catheters were inserted and don't sit upright in bed or try to get out of bed. If you need to move, the nurse will help you. By cooperating, you will help prevent bleeding from the catheter sites.

The following morning the intravenous drips (lines into the vein) may be stopped. After the laboratory checks how well your blood is clotting, the catheter may be removed. The nurse will apply firm pressure for about 20 minutes to the site. Then he or she will place an ice pack and a ten- pound sandbag over the puncture site for about 6 hours to help the artery heal.

After the nurse removes the ice pack and sandbag, he or she will help you walk around the room. Sometime after this, you will be transferred from the coronary care unit or intensive care unit to a regular nursing station. You will be encouraged to walk around the station to prepare for discharge. The entire stay in the hospital may last from 1 to 3 days, based on your condition.

Ask your doctor what other guidelines you should follow and when you could come back for a checkup.

What are the benefits of this procedure?

Your heart may work normally again. You may avoid having a surgical procedure.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.

• There is a risk of infection or bleeding from this procedure.

• Your heart may beat in an unusual way. You may need medicine, electric cardioversion, or a temporary pacemaker.

• You could have an allergic reaction to the dye. You could become nauseated or flushed. If your kidneys are not working well, the dye can make them worse.

• If too much dye is injected into your system, it may cause damage. Blood may form a clot around the catheter. This could block the artery through which the doctor is inserting the catheter and may require surgery to reopen it.

• You may form a clot and lose your pulse in your groin, which may or may not be a threat to the circulation in the leg. The doctor may give you medicine to dissolve the clot. Rarely, surgery would be needed to clear the clot.

• With inflation of the balloon, the valve could break, which means you would have to have valve replacement surgery. The catheter may puncture the vein or artery and cause internal bleeding. This problem might require surgical repair.

• When the doctor inserts the catheter, debris on the wall of the artery may become dislodged and pass down your artery, causing a clog at some point. This may require surgical correction.

• There could be some bruising or bleeding at the site where the catheter was inserted.

• During the procedure, your blood pressure could drop, causing dizziness or heart rhythm disturbances.

• There is a rare chance you could have a seizure during the procedure.

• There is a chance the procedure might not work.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call your doctor immediately if:

• You develop a fever

• You become short of breath

• You have a lot of pain.

Call your doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.