What is a valvuloplasty?
A valvuloplasty (also called valvotomy) is a procedure to open a stiff (stenotic)
heart valve. It's done by a cardiologist. This is a healthcare provider who specializes
in treating the heart and blood vessels. In valvuloplasty, your provider inserts a
very small, narrow, hollow tube (catheter) into a blood vessel in the groin and advances
it into the heart through either an artery or a vein. Once the catheter reaches the
stiff valve, your provider inflates a large balloon at the tip of the catheter until
the flaps (leaflets) of the valve are pushed opened. Once the valve has been opened,
the provider deflates the balloon and removes the catheter.
To keep the blood flowing forward through the heart, there are valves between each
of the heart's pumping chambers:
Tricuspid valve. Located between the right atrium, which receives blood from the body, and the right
Pulmonary, or pulmonic, valve. Located between the right ventricle and the pulmonary artery, which takes blood to
the lungs to get oxygen.
Mitral valve. Located between the left atrium, which receives blood from the lungs, and the left
Aortic valve. Located between the left ventricle and the aorta, which takes blood to the rest of
Why might I need a valvuloplasty?
Valvuloplasty may be done to open a heart valve that has become narrow and stiff.
But, not all conditions in which a heart valve becomes stiff are treatable with valvuloplasty.
If the heart valves become damaged or diseased, they may not work properly. Conditions
that may cause problems with the heart valves are stiffened valve (valvular stenosis)
and leaky valve (valvular regurgitation). When one or more valves become stiff, the
heart muscle must work harder to pump the blood through the valve. Stiff valves may
be caused by birth defects, scarring from radiation therapy to treat cancer, aging,
and infections, such as rheumatic fever or staph (staphylococcus) infections. If one
or more valves become leaky, blood leaks backward and less blood is pumped in the
Heart valve disease may cause the following symptoms:
Palpitations (fast, hard, or irregular heartbeats)
Swelling (edema) of the feet, ankles, or abdomen
Rapid weight gain due to fluid retention
Severe tiredness (fatigue)
Less energy when doing regular activity
There may be other reasons for your provider to advise a valvuloplasty.
What are the risks of a valvuloplasty?
Possible risks of valvuloplasty include:
Bleeding at the catheter insertion site
Blood clot or damage to the blood vessel at the insertion site
Infection at the catheter insertion site
Significant blood loss that may require blood transfusion
Abnormal heart rhythms
New or worsening valve regurgitation (leakage)
Rupture of the valve or the soft tissue around the valve. This requires open-heart
Slowed heartbeat that may need a pacemaker
If you're pregnant or think you could be, tell your provider. Valvuloplasty could
injure you're unborn baby. Radiation exposure during pregnancy may lead to birth defects.
Also tell your provider if you're lactating or breastfeeding.
There's a risk of allergic reaction to the dye that may be used to better see the
parts of the heart. If you're allergic or sensitive to medicines, contrast dyes, iodine, or
latex , tell your healthcare team. If you have kidney failure or other kidney problems,
tell your provider.
Some people may have discomfort or pain caused by lying still on the procedure table
for the length of the procedure.
There may be other risks depending on your specific medical condition. Be sure to
talk with your provider about any concerns before the procedure.
How do I get ready for a valvuloplasty?
Your provider will explain the procedure to you and ask if you have any questions.
You'll be asked to sign a consent form that gives your permission to do the test.
Read the form carefully and ask questions if something is unclear.
Tell your provider if you've ever had a reaction to any contrast dye or if you're
allergic to iodine.
Tell your provider if you're sensitive or allergic to any medicines, latex, tape,
antibiotics, skin products, or anesthesia medicines (local and general).
You'll need to stop eating and drinking (fast) for a certain period before the procedure.
Your provider will tell you how long to fast. It's usually overnight.
Tell your provider if you're pregnant or think you could be.
Tell your provider if you have any body piercings on your chest or abdomen.
Tell your provider about all prescription and over-the-counter medicines and herbal
supplements that you take.
Tell your provider if you have a history of bleeding disorders or are taking any anticoagulant
(blood-thinning) medicines, aspirin, or other medicines that affect blood clotting.
You may need to stop some of these medicines before the procedure.
Your provider may request a blood test before the procedure to determine how long
it takes your blood to clot. Other blood tests may be done as well.
Tell your provider if you have a pacemaker.
You may receive a sedative before the procedure to help you relax.
Your provider may request other specific preparation based on your medical condition.
What happens during a valvuloplasty?
A valvuloplasty may be done as part of your stay in a hospital. Procedures may vary
depending on your condition and your provider's practices.
Generally, a valvuloplasty follows this process:
Remove any jewelry or other objects that may interfere with the procedure. Check with
your provider as to whether you may wear your dentures or hearing aids.
Change into a hospital gown and empty your bladder before the procedure.
A healthcare professional will start an IV (intravenous) line in your hand or arm
to inject medicine or give IV fluids, if needed.
If there's excessive hair at the catheter insertion site (groin area), it may be shaved
A healthcare professional will connect you to an electrocardiogram (ECG) to monitor
and records the electrical activity of the heart. Your vital signs (heart rate, blood
pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
There will be several monitor screens in the room, showing your vital signs, the images
of the catheter being moved through the body into the heart, and the structures of
the heart as your provider injects the dye.
You'll get a sedative medicine in your IV before the procedure to help you relax.
However, you'll likely remain awake during the procedure
A healthcare professional will check and mark your pulses below the injection site
and compare them to pulses after the procedure.
A local anesthetic will be injected into the skin at the insertion site. You may feel
some stinging at the site for a few seconds after the local anesthetic is injected.
Once the local anesthetic has taken effect, your provider will insert a sheath (introducer)
into the blood vessel. This is a plastic tube through which the catheter will be inserted
into the blood vessel and advanced into the heart.
Your provider will insert the valvuloplasty catheter through the sheath into the blood
vessel and to the heart.
Once the catheter is in place, your provider will inject contrast dye through the
catheter into the valve to look at the area. You may feel some effects when the contrast
dye is injected into the IV line. These effects include a flushing sensation, a salty
or metallic taste in the mouth, or a brief headache. These effects usually last for
a few moments.
Heart ultrasound pictures will also be used to help guide the location of the catheter
and see how well it's working.
Tell your provider if you have any difficulty breathing, sweating, numbness, itching,
chills, nausea or vomiting, or heart palpitations.
The provider will watch the contrast dye injection on a monitor. They may ask you
to take a deep breath and hold it for a few seconds. If the valvuloplasty procedure
is being done on the aortic valve, your provider may use a temporary pacemaker to
make your heart beat faster and lower your blood pressure. You can feel dizzy and
confused after the pacemaker has been turned on and off.
Once the balloon is in place and has been inflated, you may notice some dizziness
or brief chest discomfort. This should decrease or go away when the balloon is deflated.
But tell your provider if you have any severe discomfort or pain, such as chest pain,
neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty.
Your provider may inflate and deflate the balloon several times to open the valve.
Once the valve is opened sufficiently, your provider will remove the catheter. They
may close the catheter insertion site with a closure device that uses collagen to
seal the opening in the artery, by the use of sutures, or by applying manual pressure
over the area to keep the blood vessel from bleeding. Your provider will decide which
method is appropriate for your condition.
If your provider uses a closure device, they'll apply a sterile dressing to the site.
If manual pressure is used, the provider or an assistant will hold pressure on the
insertion site so that a clot will form. Once the bleeding has stopped, a very tight
bandage will be placed on the site.
Your provider may decide not to remove the introducer from the insertion site for
about 4 to 6 hours. This allows the effects of blood-thinning medicine to wear off.
You'll need to lie flat during this time. If you become uncomfortable in this position,
your nurse may give you medicine to make you more comfortable. Your provider might
also give a reversal medicine for the blood thinner to reduce the risk of bleeding
and allow for the sheath to be removed from the artery site.
Next, you'll be taken to the recovery area. NOTE: If the insertion was in the groin,
you won't be allowed to bend your leg for several hours. To help you remember to keep
your leg straight, the knee of the affected leg may be covered with a sheet and the
ends tucked under the mattress on both sides of the bed to form a type of loose restraint.
What happens after a valvuloplasty?
In the hospital
After the procedure, you may be taken to the recovery room for observation or returned
to your hospital room. You'll remain flat in bed for several hours after the procedure.
A nurse will monitor your vital signs, the insertion site, and circulation and sensation
in the affected leg or arm.
Tell your nurse right away if you feel any chest pain or tightness, any other pain,
or any feelings of warmth, bleeding, or pain at the insertion site in your leg or
Bed rest may vary from 2 to 6 hours depending on your specific condition. If your provider
placed a closure device, you may spend less time on bed rest.
In some cases, the introducer may be left in the insertion site. If so, the time you
spend in bed rest will be longer. After the sheath is removed, you may be given a
You may be given medicine for pain or discomfort related to the insertion site or
having to lie flat and still for a prolonged period.
You'll be encouraged to drink water and other fluids to help flush the contrast dye
from your body.
You may feel the urge to urinate often because of the effects of the contrast dye
and increased fluids. You'll need to use a bedpan or urinal while on bed rest so that
you don't bend your affected leg or arm.
You may resume your usual diet after the procedure, unless your provider tells you
After the specified period of bed rest, you may get out of bed. The nurse will help you
the first time you get up and may check your blood pressure while you're lying in
bed, sitting, and standing. Move slowly when getting up from the bed to avoid any
You'll most likely spend the night in the hospital after your procedure. Depending
on your condition and the results of your procedure, your stay may be longer. You'll
receive detailed instructions for your discharge and recovery period.
Once at home, watch the insertion site for bleeding, unusual pain, swelling, and discoloration
or temperature change at or near the injection site. A small bruise is normal. If
you notice a constant or large amount of blood at the site that can't be contained
with a small dressing, call your provider.
If your provider used a closure device for your insertion site, you'll be given specific
information about how to take care of the insertion site. There will be a small lump
under the skin at the injection site. This is normal. It should gradually disappear
over a few weeks.
It'll be important to keep the insertion site clean and dry. Your provider will give
you specific bathing instructions. Don't soak in a bathtub or hot tub, or go swimming,
until the skin has healed. This helps prevent infection.
Your provider may advise you not to participate in any strenuous activities. Your provider
will tell you when you can return to work and resume normal activities.
Tell your provider if you have any of the following:
Fever or chills
Increased pain, redness, swelling, or bleeding or other drainage from the insertion
Coolness, numbness, tingling, or other changes in the affected leg or arm
Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting
Swelling of the arms, legs, or abdomen
Weight gain of more than 3 pounds in 1 day
Your provider may give you other instructions after the procedure, depending on your
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you're having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you're to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you didn't have the test or procedure
Any alternative tests or procedures to think about
When and how you'll get the results
Who to call after the test or procedure if you have questions or problems
How much you'll have to pay for the test or procedure