Mitral Valvuloplasty also known as percutaneous balloon valvuloplasty is the surgical process adopted to repair a damaged mitral valve. This technique is used in case of a narrowed mitral valve, a condition known better as Mitral Stenosis and it involves dilating the narrowed valve by using a balloon.
Mitral Stenosis is a condition in which the mitral valve doesn’t open fully as a result of the thickening of the valve leaflets. The orifice of the valve is narrowed and this restricts blood flow from the left atrium to the left ventricle. Mitral valvuloplasty is done in such a situation where the valve fails to open fully and leads to inefficient pumping of blood.
Patients with the following conditions are subjected to mitral valvuloplasty:
- Patients showing symptoms of mitral stenosis
- Pulmonary oedema or fluid accumulation in the lungs
- Pulmonary hypertension following abnormal functioning of the left ventricle.
Certain conditions such as a thrombus or a blood clot within the left atrium, moderate or severe mitral regurgitation or any form of structural deformities to the tricuspid valve serve as a contraindication to performing mitral valvuloplasty i.e. it is inadvisable in the above cases.
Patients are selected for Mitral valvuloplasty following a brief review of the patients’ anatomy and medical history. Echocardiogram tests are conducted to monitor the condition of the valve and the patient is checked for symptoms of mitral stenosis. Once confirmed for the procedure the patient is advised not to eat or drink anything for at least 6 hours before the surgery. An intravenous line is inserted in the patients body so that medications such as anticoagulants and radioactive dyes for X rays can be administered. The patient’s groin area is shaved and cleaned with an antiseptic. The patient is then given an oral sedative such as diazepam about an hour before the procedure.
Mitral valvuloplasty starts with the insertion of a thin tube called a catheter with a small deflated balloon at its tip into a blood vessel through the skin in the groin area. And is then moved up to the opening of the stenotic heart valve. The balloon is then inflated to stretch the valve and dilate it. The procedure normally takes up to 4 hours and is performed in a cardiac catheterization laboratory. The setup for the mitral valvuloplasty contains an X ray machine and an X ray monitor which looks like a typical TV screen. The patient is made to lie on an X ray table and anesthetic is administered. The patient remains awake during the whole procedure and can watch the progress of the operation on the screen.
After the procedure the patient is kept under observation and the vital signs are monitored. The site of catheter insertion is dressed and the leg where insertion took place is kept as immobile as possible. Intravenous fluids are given to remove the radioactive dyes and anticoagulants are also administered to improve the blood flow.
Mitral Valvuloplasty may lead to some serious complications sometimes. The valve may not acquire the required shape and may get structurally modified into a condition worse than before. Another risk involved is embolism, i.e. the pieces of valve tissue may break of and get carried to some other part of the body like the brain or lungs and causing blockage. Sometimes the valve leaflets may get damaged during the procedure and in the occurrence of any such event valve replacement is the only option. Other complication which occurs less frequently are bleeding and accumulation of clotted blood at the puncture site, reduced blood flow, heart attack, infection and circulatory problems.
Mitral Valvuloplasty gives temporary relief and improves heart function in adults undergoing the procedure. But sometimes, in case the patient has other conditions like an underlying coronary artery disease etc mitral valvuloplasty will be insufficient and valve replacement will be eventually necessary. In case of children with congenital stenosis, mitral valvuloplasty is considered to be a safe and effective treatment.
Certain restrictions are put on the patients activities following mitral valvuloplasty. These include:
- No lifting of heavy loads, pushing or pulling weights greater than 10 pounds for 5 days.
- No strenuous activities which cause deep breathing for 6-8 weeks
- No driving for 5 days
- No swimming for 7 days