Heart Center: Pulmonary Balloon Valvuloplasty
Pulmonary valve stenosis is a narrowing of the valve that lets blood out of the right ventricle of the heart. From here, the blood goes directly to the lungs to receive oxygen before circulating throughout the body. Stenosis occurs in 7.5-9 percent of patients with congenital heart defects. The obstruction of blood flow causes the right ventricle to work harder. The severity of the stenosis is based on the pressure difference, or gradient, between the right ventricle and the pulmonary artery. The higher the difference, the more severe the stenosis and the harder the right 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. The standard technique now used is pulmonary balloon valvuloplasty. During this procedure a catheter with a balloon on the end is advanced under fluoroscopy (X-ray) from a blood vessel in the leg into the narrowed valve. Once the catheter is in place, the balloon at the tip 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 a pulmonary balloon valvuloplasty vary with the age of the patient and the severity of the valve stenosis. In babies less than 2 years old, the success rate approaches 80 percent. In children over 2 years of age, the success rate is 90-95 percent with a residual gradient of less than 25mmHg.
The majority of patients continue to have a good result. Within five to 12 years, 15 percent of patients under 2 years of age may require re-dilation for re-narrowing of the valve.
A few complications can occur with this procedure, all are less than 2 percent. They are femoral vein damage, abnormal heart rhythm, pulmonary valve damage/prolapse, bleeding, and increased X-ray exposure time. To combat these complications, the balloon size is carefully matched to the pulmonic 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 child will have an echocardiogram the day after the valvuloplasty. Another one will be scheduled at six weeks and one year to check on the pulmonary valve.
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