Heart Center: Aortic Balloon Valvuloplasty
Aortic valve stenosis is a narrowing of the valve that lets blood out of the left ventricle, the chamber of the heart that pumps blood to the body. It occurs in slightly less than 0.7 pecent of the population. This condition obstructs blood flow, causing the left ventricle to work harder. The severity of the stenosis is based on the pressure difference, or gradient, between the left ventricle and the aorta. The higher the difference, the more severe the stenosis and the harder the ventricle must work. If the gradient is severe, intervention is necessary.
In the past, surgeons were asked to operate and open the valve using a scalpel. Today there is a nonsurgical option for opening up the aortic valve called aortic balloon valvuloplasty. During this procedure a catheter with a balloon on the end is advanced under fluoroscopy (X-ray) from an artery in the leg into the narrowed valve. Once the catheter is in place, the balloon is rapidly inflated and deflated to dilate, or open, the valve. This technique can be performed successfully on patients who have, and patients who have not, had prior surgery. After the procedure the patient is admitted to the hospital for overnight observation and released the next day.
Results from an aortic balloon valvuloplasty vary with the age of the patient and the severity of the valve stenosis. In babies less than one week of age, the success rate approaches 70 percent. In older children the success rate is 90-95 percent. After more than 800 valvuloplasties, a few deaths have been reported in small, critically ill babies, and deaths are rare in older children.
The majority of patients continue to have a good result up to eight years after the valvuloplasty. Up to 50 percent may require repeat dilation or surgery after eight to 10 years to treat any narrowing of the valve or valve leakage (regurgitation). A small percentage of patients (3-4 percent) will progress to severe valve regurgitation and will require an aortic valve replacement within five to 11 years. This is not significantly different from the results of a surgical procedure for aortic valve stenosis.
A few complications can occur with this procedure: femoral artery damage, abnormal heart rhythm, aortic valve damage/prolapse, bleeding, and increased X-ray exposure time. To combat these complications, the balloon size is carefully matched to the aortic valve size, and heparin, a blood thinner, is given to prevent blood clot formation. Blood is ordered and is available for immediate use in case of bleeding.
Your cardiologist and Dr. Zellers will inform you more fully about this procedure on the morning of your child's catheterization. You will be able to ask questions and will be asked to sign a consent form. Your cardiologist will determine the need for further follow-up, which may include an echocardiogram the day after the procedure.
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