Balloon valvotomy for mitral valve stenosis

A balloon valvotomy is the preferred treatment for mitral valve stenosis, because it does not require open-heart surgery.

A balloon valvotomy uses a thin flexible tube (catheter) that is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon device located on the tip of the catheter is quickly inflated. The narrowed or fused mitral valve leaflets are separated and stretched open as the balloon presses against them. This process increases the size of the mitral valve opening and allows more blood to flow from the left atrium into the left ventricle.

An important consideration when having a balloon valvotomy is the experience of the doctor. As a general rule, balloon valvotomies done by a doctor skilled in the procedure usually have better results.

A balloon valvotomy does not cure the condition or make the valve normal. It is useful for improving valve function and thereby reducing the symptoms associated with mitral valve stenosis.

A balloon valvotomy may also be used to treat people who have mitral valve stenosis but do not yet have symptoms (asymptomatic) if they have:

  • A higher risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation as well as those who have had a blood clot before.
  • High blood pressure in the lungs (pulmonary hypertension).
  • Mitral valves that are still in fairly good condition.

Your doctor may recommend a balloon valvotomy if you are planning to have another surgery (not on your heart), if you are pregnant, or if you are planning a pregnancy.

People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy. Balloon valvotomy is not usually used if the mitral valve is severely narrowed.

Overall, 80% to 95% of people who are treated with a balloon valvotomy have a successful outcome.1 The opening of the mitral valve usually increases to at least 2.0 cm2. Also, blood pressure inside the left atrium decreases, which helps relieve symptoms of lung congestion.

Symptoms may recur after a balloon valvotomy. Sometimes these symptoms are due to the mitral valve narrowing again (restenosis). But more often they develop as a result of other heart conditions, such as problems related to the heart's main pumping chamber (left ventricular dysfunction), mitral valve regurgitation, or an opening in the wall that separates the upper chambers of the heart (atrial septal defect). People who develop symptoms shortly after balloon valvotomy (1 to 2 years) are usually those who had badly damaged valves (calcified, stiff) before the procedure. Also, the more time that passes before symptoms come back, the more likely it is that they are due to conditions other than restenosis of the mitral valve.

Treatment for any recurrence of symptoms will depend on their cause. For symptoms caused by restenosis of the mitral valve, a repeat balloon valvotomy or surgery to repair or replace the valve may be needed.

Citations

  1. Bonow RO, et al. (2006) 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, 114(5): e84–e231.

Last Updated: February 10, 2010

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