Valvuloplasty is performed, in certain circumstances, to open a stenotic
(stiff) heart valve. In valvuloplasty, a very small, narrow, hollow
tube, or catheter, is advanced from a blood vessel in the groin through
the aorta into the heart. Once the catheter is placed in the valve to be
opened, a large balloon at the tip of the catheter is inflated until the
leaflets (flaps) of the valve are opened. Once the valve has been
opened, the balloon is deflated and the catheter is removed.
Other related procedures that may be used to assess and treat the heart
include resting and exercise electrocardiogram (ECG or EKG), Holter
monitor, signal-averaged ECG, cardiac catheterization, chest x-ray,
computed tomography (CT scan) of the chest, coronary artery bypass graft
surgery, valve repair/replacement surgery, echocardiography,
electrophysiological studies, magnetic resonance imaging (MRI) of the
heart, myocardial perfusion scans, radionuclide angiography, and
ultrafast CT scan. Please see these procedures for additional
Valves of the heart
better understand how valvular heart disease affects the heart, a review
of basic heart anatomy and valve function follows.
The heart is a pump made of muscle tissue. The heart has four pumping
chambers: two upper chambers, called atria, and two lower chambers,
called ventricles. The right atrium pumps blood into the right
ventricle, which then pumps the blood into the lungs where wastes such
as carbon dioxide are given off and oxygen and other nutrients are taken
into the blood.
From the lungs, the blood flows back into the left atrium, is pumped
into the left ventricle, and then is pumped through the aorta out to the
rest of the body and the coronary arteries. When the atria are pumping,
the ventricles are relaxed in order to receive the blood from the atria.
Once the atria have pumped their entire blood load into the ventricles,
they relax while the ventricles pump the blood out to the lungs and to
the rest of the body.
In order to keep the blood flowing forward during its journey through
the heart, there are valves between each of the heart's pumping
tricuspid valve – located between the right
atrium and the right ventricle
pulmonary (or pulmonic) valve – located between
the right ventricle and the pulmonary artery
mitral valve – located between the left atrium
and the left ventricle
aortic valve – located between the left
ventricle and the aorta
If the heart valves become damaged or diseased, they may not function
properly. Conditions that may cause dysfunction of heart valves are
valvular stenosis and valvular insufficiency (regurgitation). When one
(or more) valve(s) becomes stenotic (stiff), the heart muscle must work
harder to pump the blood through the valve. Some reasons why heart
valves become stenotic include infection (such as rheumatic fever or
staphylococcus infections) and aging. If one or more valves become
insufficient (leaky), blood leaks backwards, which means that less blood
is pumped in the proper direction.
Valvular heart disease may cause the following symptoms:
edema (swelling) of the feet, ankles, or abdomen
rapid weight gain due to fluid retention
Reasons for the Procedure
Valvuloplasty is performed in certain situations in order to open a
heart valve that has become stiff as a result of disease or the aging
process. Not all conditions in which a heart valve becomes stiff are
treatable with valvuloplasty.
There may be other reasons for your physician to recommend a
Risks of the Procedure
Possible risks associated with valvuloplasty include, but are not
limited to, the following:
bleeding at the catheter insertion site
blood clot or damage to the blood vessel at the insertion site
rupture of the valve, requiring open-heart surgery
You may want to ask your physician about the amount of radiation used
during the procedure and the risks related to your particular situation.
It is a good idea to keep a record of your past history of radiation
exposure, such as previous scans and other types of x-rays, so that you
can inform your physician. Risks associated with radiation exposure may
be related to the cumulative number of x-ray examinations and/or
treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should
notify your physician due to risk of injury to the fetus from a
valvuloplasty. Radiation exposure during pregnancy may lead to birth
defects. If you are lactating, or breastfeeding, you should notify your
There is a risk for allergic reaction to the dye. Patients who are
allergic to or sensitive to medications, contrast dyes, iodine, or latex
should notify their physician. Also, patients with kidney failure or
other kidney problems should notify their physician.
For some patients, having to lie still on the procedure table for the
length of the procedure may cause some discomfort or pain.
There may be other risks depending upon your specific medical condition.
Be sure to discuss any concerns with your physician prior to the
Before the Procedure
Your physician will explain the procedure to you and offer you
the opportunity to ask any questions that you might have about
You will be asked to sign a consent form that gives your
permission to do the test. Read the form carefully and ask
questions if something is not clear.
Notify your physician if you have ever had a reaction to any
contrast dye, or if you are allergic to iodine.
Notify your physician if you are sensitive to or are allergic to
any medications, latex, tape, or anesthetic agents (local and
You will need to fast for a certain period of time prior to the
procedure. Your physician will notify you how long to fast,
If you are pregnant or suspect that you may be pregnant, you
should notify your physician.
Notify your physician if you have any body piercings on your
chest and/or abdomen.
Notify your physician of all medications (prescription and
over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have heart valve disease, as you
may need to receive an antibiotic prior to the procedure.
Notify your physician if you have a history of bleeding
disorders or if you are taking any anticoagulant
(blood-thinning) medications, aspirin, or other medications that
affect blood clotting. It may be necessary for you to stop some
of these medications prior to the procedure.
Your physician may request a blood test prior to the procedure
to determine how long it takes your blood to clot. Other blood
tests may be done as well.
Notify your physician if you have a pacemaker.
You may receive a sedative prior to the procedure to help you
The area around the catheter insertion (groin area) may be
Based upon your medical condition, your physician may request
other specific preparation.
During the Procedure
A valvuloplasty may be performed as part of your stay in a hospital.
Procedures may vary depending on your condition and your physician's
Generally, a valvuloplasty follows this process:
You will be asked to remove any jewelry or other objects that
may interfere with the procedure. You may wear your dentures or
hearing aids if you use either of these.
You will be asked to remove clothing and will be given a gown to
You will be asked to empty your bladder prior to the procedure.
An intravenous (IV) line will be started in your hand or arm
prior to the procedure for injection of medication and to
administer IV fluids, if needed.
You will be placed in a supine (on your back) position on the
You will be connected to an ECG monitor that records the
electrical activity of the heart and monitors the heart during
the procedure using small, adhesive electrodes. Your vital signs
(heart rate, blood pressure, breathing rate, and oxygenation
level) will be monitored during the procedure.
There will be several monitor screens in the room, showing your
vital signs, the images of the catheter being moved through the
body into the heart, and the structures of the heart as the dye
You will receive a sedative medication in your IV before the
procedure to help you relax. However, you will likely remain
awake during the procedure
Your pulses below the injection site will be checked and marked
so that the circulation to the limb below the site can be
checked after the procedure.
A local anesthetic will be injected into the skin at the
insertion site. You may feel some stinging at the site for a few
seconds after the local anesthetic is injected.
Once the local anesthetic has taken effect, a sheath, or
introducer, will be inserted into the blood vessel. This is a
plastic tube through which the catheter will be inserted into
the blood vessel and advanced into the heart.
The valvuloplasty catheter will be inserted through the sheath
into the blood vessel. The physician will advance the catheter
through the aorta into the heart valve. Fluoroscopy (a special
type of x-ray that will be displayed on a TV monitor) may be
used to assist in advancing the catheter to the heart.
Once the catheter is in place, contrast dye will be injected
through the catheter into the valve in order to look at the
area. You may feel some effects when the contrast dye is
injected into the IV line. These effects include a flushing
sensation, a salty or metallic taste in the mouth, or a brief
headache. These effects usually last for a few moments.
You should notify the physician if you feel any breathing
difficulties, sweating, numbness, itching, chills, nausea and/or
vomiting, or heart palpitations.
The physician will watch the contrast dye injection on a
monitor. The physician may ask you to take a deep breath and
hold it for a few seconds.
Once the balloon is in place and has been inflated, you may
notice some dizziness or even brief chest discomfort. This
should subside when the balloon is deflated. However, if you
notice any severe discomfort or pain, such as chest pain, neck
or jaw pain, back pain, arm pain, shortness of breath, or
breathing difficulty, tell your physician.
The balloon may be inflated and deflated several times in order
open the valve.
Once it has been determined that the valve is opened
sufficiently, the catheter will be removed. The catheter
insertion site may be closed with a closure device that uses
collagen to seal the opening in the artery, by the use of
sutures, or by applying manual pressure over the area to keep
the blood vessel from bleeding. Your physician will determine
which method is appropriate for your condition.
If a closure device is used, a sterile dressing will be applied
to the site. If manual pressure is used, the physician (or an
assistant) will hold pressure on the insertion site so that a
clot will form. Once the bleeding has stopped, a very tight
bandage will be placed on the site. A small sandbag or other
type of weight may be placed on top of the bandage for
additional pressure on the site, especially if the site is in
Your physician may decide not to remove the sheath, or
introducer, from the insertion site for approximately four to
six hours, in order to allow the effects of blood-thinning
medication given during the procedure to wear off. You will need
to lie flat during this time. If you become uncomfortable in
this position, your nurse may give you medication to make you
You will be assisted to slide from the table onto a stretcher so
that you can be taken to the recovery area. NOTE: If the
insertion was in the groin, you will not be allowed to bend your
leg for several hours. To help you remember to keep your leg
straight, the knee of the affected leg may be covered with a
sheet and the ends tucked under the mattress on both sides of
the bed to form a type of loose restraint.
After the Procedure
In the hospital
After the procedure, you may be taken to the recovery room for
observation or returned to your hospital room. You will remain flat in
bed for several hours after the procedure. A nurse will monitor your
vital signs, the insertion site, and circulation/sensation in the
affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or
tightness, or any other pain, as well as any feelings of warmth,
bleeding, or pain at the insertion site in your leg or arm.
Bed rest may vary from two to six hours depending on your specific
condition. If your physician placed a closure device, your bed rest may
be of shorter duration.
In some cases, the sheath or introducer may be left in the insertion
site. If so, the period of bed rest will be prolonged until the sheath
is removed. After the sheath is removed, you may be given a light meal.
You may be given pain medication for pain or discomfort related to the
insertion site or having to lie flat and still for a prolonged period.
You will be encouraged to drink water and other fluids to help flush the
contrast dye from your body.
You may feel the urge to urinate frequently because of the effects of
the contrast dye and increased fluids. You will need to use a bedpan or
urinal while on bed rest so that your affected leg or arm will not be
You may resume your usual diet after the procedure, unless your
physician decides otherwise.
After the specified period of bed rest has been completed, you may get
out of bed. The nurse will assist you the first time you get up, and
will check your blood pressure while you are lying in bed, sitting, and
standing. You should move slowly when getting up from the bed to avoid
any dizziness from the long period of bed rest.
You will most likely spend the night in the hospital after your
procedure. Depending on your condition and the results of your
procedure, your stay may be longer. You will receive detailed
instructions for your discharge and recovery period.
Once at home, you should monitor the insertion site for bleeding,
unusual pain, swelling, and abnormal discoloration or temperature change
at or near the injection site. A small bruise is normal. If you notice a
constant or large amount of blood at the site that cannot be contained
with a small dressing, notify your physician.
If your physician used a closure device for your insertion site, you
will be given specific information regarding the type of closure device
that was used and how to take care of the insertion site. There will be
a small knot, or lump, under the skin at the injection site. This is
normal. The knot should gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your
physician will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your
physician will instruct you about when you can return to work and resume
Notify your physician to report any of the following:
fever and/or chills
increased pain, redness, swelling, or bleeding or other drainage
from the insertion site
coolness, numbness and/or tingling, or other changes in the
Your physician may give you additional or alternate instructions after
the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was
not designed to diagnose or treat a health problem or disease, or
replace the professional medical advice you receive from your physician.
Please consult your physician with any questions or concerns you may
have regarding your condition.
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