Balloon Valvuloplasty, Antalya | Prof. Dr. Umuttan Doğan

Balloon valvuloplasty is the widening of a narrowed heart valve by inflating a balloon brought to it on a catheter. It goes in through a vessel in the groin; the chest is not opened and the heart is not stopped. The method is used on three valves, and it means something different on each: on the mitral valve it is accepted as the main treatment in suitable patients, while on the aortic valve it is usually a temporary step. Knowing that distinction makes it easier to understand what is being suggested to you.

What Does a Narrowed Valve Mean?

Heart valves are one-way doors. They open to let blood through, then close to stop it coming back.

When a valve narrows, it cannot open far enough. The blood has to pass through a small opening. To move the same amount of blood, the heart produces a higher pressure; the pressure rises in the chamber behind the valve and structural changes begin over time.

Narrowing is a different problem from leaking. In a leaking valve the leaflets do not close fully; in a narrowed one they do not open fully. The treatments differ too.

What Is Balloon Valvuloplasty?

A catheter with an inflatable balloon at its tip is taken through the blood vessels to the narrowed valve. The balloon is inflated inside the valve itself.

As it inflates, it separates the points where the leaflets have fused together. The opening of the valve widens and blood passes more easily. The balloon is then let down and withdrawn.

The procedure is done under local anaesthetic, in the catheter laboratory.

Which Valves Is It Used On?

The Mitral Valve

This is where the method is most established. In rheumatic mitral stenosis, where the anatomy of the valve is suitable, balloon valvuloplasty is accepted as the main treatment in suitable patients. The results can last for years.

The Aortic Valve

Here the situation is different. Narrowing of the aortic valve is usually due to calcification: the leaflets have stiffened rather than fused. A balloon opens the valve somewhat, but the calcium stays where it is and the valve narrows again in time.

Aortic balloon valvuloplasty is therefore not a lasting treatment. It is generally used as a step along the way.

The Pulmonary Valve

In narrowing of the pulmonary valve present from birth, balloon valvuloplasty is an established method and its results are long-lasting.

Mitral Stenosis and Rheumatic Fever

The main cause of mitral stenosis is acute rheumatic fever in childhood or adolescence.

It works like this: after an untreated throat infection, the body’s immune response also damages the heart valves. The leaflets thicken and their edges fuse together. The problem usually shows itself years later, once the patient is an adult.

Many people diagnosed with mitral stenosis therefore have no memory of the illness in their childhood.

What Symptoms Appear?

Breathlessness on exertion, appearing with less and less effort as the narrowing progresses
Breathlessness lying down at night, needing more pillows
Tiring easily
Palpitations; atrial fibrillation often goes with mitral stenosis
A cough, sometimes with blood in the phlegm
A marked increase in symptoms during pregnancy

That last point matters: because the volume of blood rises in pregnancy, mitral stenosis that had gone unnoticed can come to light for the first time then.

Diagnosis and the Assessment Beforehand

Examination: mitral stenosis has a murmur of its own.
Echocardiography: it shows the opening of the valve, the difference in pressure across it and the structure of the leaflets. Whether a balloon is suitable is decided largely on this test.
An echo from the gullet: this is required before the procedure. Its purpose is to see whether there is a clot in the left atrium.
ECG and rhythm assessment: whether atrial fibrillation is present as well.

Mitral Balloon Valvuloplasty: Is Your Valve Suitable?

What decides a mitral balloon valvuloplasty is not only how severe the narrowing is but how the valve is built. Four things are scored separately on the echocardiogram. Most patient pages leave this out, yet it is what settles the decision.

How mobile are the leaflets? Leaflets that have kept their flexibility are more suited to being separated by a balloon. On a valve as stiff as stone, a balloon achieves nothing.
How much have the leaflets thickened? The more thickening there is, the less predictable the result.
Is there calcium, and where? Calcium at the points where the leaflets join makes the balloon’s work harder in particular.
What are the structures beneath the valve like? The cords that tie the leaflets to the heart muscle may have thickened and shortened, which limits movement even if the valve is opened.

Where the total score across these four is low — that is, where the valve has largely kept its flexibility — mitral balloon valvuloplasty comes to the fore. As the score rises, the surgical option gains weight.

This is why the question “I have mitral stenosis, can a balloon be done?” cannot be answered without seeing the echocardiogram.

How Is Balloon Valvuloplasty Carried Out?

During the Procedure

For the mitral valve the procedure goes in through the vein in the groin. The catheter first reaches the right atrium; because the mitral valve is on the left side, a controlled crossing is made through the wall that separates the two atria.

The balloon is placed inside the narrowed valve and inflated in stages. After each inflation the valve is measured again: how much has the opening increased, and has any leak appeared? If the measurements are not yet enough, the balloon is enlarged a little and the step repeated.

That stepped approach is the heart of the matter. The aim is not to open the valve as far as possible but to reach a sufficient opening without creating a leak.

For the aortic and pulmonary valves the procedure goes in through the artery or the vein in the groin, following the same principle.

After the Procedure

You stay under close observation for a period, with the access site and your rhythm watched. People are usually up the following day. How long you stay in hospital is planned around your own situation.

Who Is It For?

Patients with moderate or severe mitral stenosis who have symptoms
Those whose valve leaflets have largely kept their flexibility
Particular situations where open surgery carries a high risk, such as pregnancy
People with narrowing of the pulmonary valve present from birth
Patients with aortic stenosis who need to be stabilised before a lasting solution

When It Is Not Suitable

Suitability depends not only on general condition but on how the valve is built:

If there is a clot in the left atrium, the procedure is postponed. Blood-thinning treatment is continued and the situation reassessed once the clot has cleared.
If the valve is also leaking noticeably, a balloon may increase the leak; surgery is considered in that case.
Where the leaflets are heavily calcified and stiff
Where the cords beneath the valve have thickened and shortened severely
Where there are other heart problems to be dealt with in the same session

Whether it suits you is decided by weighing the echocardiogram findings and your symptoms together.

Balloon or Surgery? How Is the Decision Made?

There are two routes in the treatment of mitral stenosis, and the choice does not rest on one measure.

Balloon valvuloplasty: comes to the fore where the valve has kept its flexibility, there is no clot and no marked leak. The chest is not opened and recovery is short.
Open heart surgery: considered where the valve is heavily calcified, where there is a leak as well, or where another heart problem has to be dealt with in the same session. The valve can be repaired or replaced.

The structure of the valve, the severity of the narrowing, your symptoms, your rhythm, your age and any other conditions are taken together. In particular situations such as pregnancy, the balance can shift towards the balloon.

In complicated cases this assessment is not made by one doctor but through a process in which cardiology and cardiac surgery give their views together. Your own preference is part of that process.

One point is worth adding: a balloon procedure does not rule surgery out. If the valve narrows again over the years, surgery may come onto the table.

Why Is Aortic Balloon Valvuloplasty a Step Along the Way?

This section explains what is most often misunderstood on this page.

In aortic stenosis the problem is calcification, not fusion. A balloon cannot break the calcium; it only opens the valve a little, and temporarily. The valve returns to its earlier state within a short time.

Aortic balloon valvuloplasty is therefore not planned as a treatment in its own right. It is generally used in these situations:

Where the patient needs stabilising before TAVI or surgery
Where temporary relief is needed in an emergency
Where the risk has to be reduced before urgent non-cardiac surgery
Where suitability for a lasting treatment is not yet clear

If an aortic balloon is being suggested to you, it is worth asking which lasting option is planned to follow it.

How Do You Prepare?

An echo from the gullet: done shortly before the procedure. Confirming that there is no clot in the left atrium is required.
Your list of medicines: bring everything you take in writing, with the doses. Your doctor decides how blood thinners are managed around the procedure; do not stop them on your own.
Dental check: untreated dental infections matter in people with valve disease. It is sensible to have this assessed beforehand.
Your kidney results: contrast dye is used during the procedure and your kidney function is assessed in advance.
Your earlier records: bring any previous echocardiography reports. Seeing how the narrowing has progressed over the years makes planning easier.
Pregnancy: always say if you are pregnant or might be. X-rays are used during the procedure, so the planning takes account of it.

At the consultation beforehand the expected benefit, the possible risks and the alternatives are explained, and your written consent is taken. If there is anything you do not follow, do ask.

What Are the Possible Risks?

Bruising, bleeding or injury to the vessel at the access site
A leak developing at the valve; this is why the balloon is inflated in stages, with a measurement at each step
A small opening left in the wall that was crossed; usually of no consequence, and it is monitored
Fluid collecting in the sac around the heart; rare, and drained if needed
Events caused by clot; this is the reason for the check beforehand
Temporary changes in rhythm during the procedure

The risks are weighed against the benefit expected from the procedure and discussed in detail for your own situation at the consultation beforehand.

Afterwards

Cardiology review and echocardiography are carried out at set intervals. This is how it is checked that the valve opening has held.
If you have atrial fibrillation, blood-thinning treatment continues independently of the procedure.
Say that you have valve disease before any dental work or surgery.
In rheumatic valve disease, the preventive treatment recommended against throat infections should be followed.
Activity is increased in stages.

If you notice worsening breathlessness, palpitations or fainting, see your doctor without waiting.

Balloon Valvuloplasty in Antalya

Prof. Dr. Umuttan Doğan is a cardiologist working in the interventional treatment of heart valve disease. Balloon valvuloplasty procedures are carried out in the catheter laboratory at Antalya American Hospital.

If your echocardiogram has shown a narrowed valve, you can be seen at the clinic in Konyaaltı with the results you already have. For severe narrowing of the aortic valve see TAVI, for leaking valves TEER, and for the other procedures the heart valve treatments page. You will find his background and contact details on their own pages.

Frequently Asked Questions

Is balloon valvuloplasty an operation?

No. The procedure goes in through a vessel in the groin; the breastbone is not opened, the heart is not stopped and no heart-lung machine is used. Local anaesthetic is usually enough. It is still an interventional procedure, with risks of its own.

Does a mitral balloon last, or will the valve narrow again?

In carefully selected patients the results can last for years. The rheumatic process can carry on affecting the valve, though, and it may narrow again in time. Regular echocardiography is therefore needed. The procedure can be repeated if necessary, or surgery considered.

Why is it not a lasting solution on the aortic valve?

In aortic stenosis the problem is calcification of the leaflets rather than fusion. A balloon does not remove the calcium; it opens the valve a little, temporarily, and the narrowing returns within a short time. It is therefore generally used as a step on the way to TAVI or surgery.

Why is an echo from the gullet done before the procedure?

To see whether there is a clot in the left atrium. If there is, it could be dislodged during the balloon procedure; the procedure is therefore postponed, blood-thinning treatment continued and the situation reassessed later.

Might surgery still be needed after a balloon procedure?

It might. Surgery comes onto the table if the valve narrows again over time, if a marked leak develops during the procedure, or if the structure of the valve later stops being suitable for a balloon. This possibility is discussed with you beforehand.

The information on this page is for general guidance and does not replace a consultation. Decisions about diagnosis and treatment are made by your doctor after assessing your own situation.