Balloon valvuloplasty (also called valvulotomy or valvotomy) is a procedure that widens a heart valve that is narrowed. The cause of this narrowing in the aortic valve is aortic valve stenosis.
During this procedure, a thin flexible tube called a catheter
is inserted through an artery in the groin or arm and threaded into the heart.
When the tube reaches the narrowed heart valve, a balloon at the end of the
tube is inflated. The balloon presses against the hardened (calcified) tissue
and enlarges the valve opening.
During the procedure, you will be awake. But you will
receive local anesthesia where the catheter is inserted as well as intravenous
(IV) pain medicine along with a sedative to help you relax.
You will likely stay overnight in the hospital after a valvuloplasty. You will be checked for any problems after the procedure, such as bleeding from the site where the catheter was inserted.
Balloon valvuloplasty is not an option for most people who have aortic valve stenosis.
Children, teens, and young adults
Balloon valvuloplasty might be used in some children, teens, and young adults in their 20s who
aortic valve stenosis. This group typically has aortic valve stenosis because of a congenital heart defect such as a bicuspid aortic valve.
Valvuloplasty may be used for pregnant women who get aortic
valve stenosis symptoms during their pregnancy. After the woman delivers, she
may then have aortic valve replacement surgery.
Valvuloplasty is not appropriate for most
older people who have stenosis.
But this procedure might be done in older people who
cannot have valve replacement surgery. A person might not be able to have their heart valve replaced if their valve is
severely calcified (very hard), they are very ill, or when open-heart
surgery would be too great a risk.
Also, valvuloplasty can be used as a "bridge" until surgery can be done
for a person who is too sick to have open-heart surgery right away.
Balloon valvuloplasty is generally an effective treatment for aortic
valve stenosis in children, teens, and young adults but has very limited effectiveness in
older adults. In most older adults, the valve becomes narrowed again
(restenosis) within 6 to 12 months after this procedure.1
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, which 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, which is similar to atherosclerosis, the
buildup of hard plaque inside the arteries.
After a valvotomy procedure in a young person, the aortic valve is wider, but it is still not normal. After 10 to 20 years, the valve might get narrow again, and he or she might need a valve replacement surgery.2
A valvotomy procedure for children, teens, and adults has low risk for serious complications.1
But for older adults, serious complications happen in 1 or 2 out of 10 people who have this procedure. These problems include stroke, heart attack, and aortic valve regurgitation.3
Complications related to the catheter include:
For information about valve replacement surgery, see Aortic Valve Replacement Surgery.
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CitationsBonow RO, et al. (2008). 2008 Focused update
incorporated into the ACC/AHA 2006 Guidelines for the management of patients
with valvular heart disease: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing committee to revise the 1998 Guidelines for the management of patients
with valvular heart disease). Circulation, 118(15):
e523–e661.Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.Freeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1692–1720. New York: McGraw-Hill.
November 2, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John A. McPherson, MD, FACC, FSCAI - Cardiology
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