Percutaneous Mitral Balloon Valvuloplasty

Mitral stenosis is a heart valve disease developed associated with acute rheumatic fever suffered in the childhood. Mitral valve is located between the left atrium and the left ventricle. It has two leaflets. Mitral stenosis occurs when two leaflets of the valve thicken and attach to each other, and is characterized by narrowed valve as a result of thickened and shrunk muscles and fibers holding the mitral valve. Diagnosis of mitral stenosis is established by an echocardiogram after listening to patient complaints, and following an examination. Auscultation rarely does not reveal any symptoms. Final diagnosis is made by echo.

Mitral stenosis prevents oxygenated blood coming from the lungs from passing from the left atrium to the left ventricle. Therefore, the left atrium is the first to enlarge then the blood begins accumulating in the lungs. Intrapulmonic pressure is increased by accumulated blood in the lungs, and the patients will have complaints of shortness of breath, cough, heart-throb, and in the advanced stages hemoptysis (pulmonary edema or pulmonary congestion) may occur. Mitral valve normally covers an area of 2-3 cm². If the mitral valve is smaller than 1,5 cm², a treatment is required because this time the right side of the heart is affected as a result of accumulated blood in the lungs and increased intrapulmonic pressure because of narrowed valve (smaller than 1,5 cm²). The right heart failure and tricuspid valve disease occur in an advanced stage.

Treatment of mitral stenosis varies depending on the severity of stenosis. Pharmacotherapy should be enough for mild stenosis. Diuretics will be helpful to prevent accumulation in the lungs and beta blockers will be useful for heart-throb. With progressed stenosis, percutaneous mitral balloon valvuloplasty (PMBV) or open heart surgery (surgical repair or replacement of mitral valve) is performed.

Mitral balloon valvuloplasty is used to enlarge narrowed mitral valve by a balloon. When performed on appropriate patients, mitral balloon valvuloplasty has many advantages over open heart surgery. The most important advantage is that the patient does not receive general anesthesia, and the rib cage is not opened. Thus, the patient is conscious during the procedure and does not require intensive care after the procedure. In addition, patients are able to recover in short time and mostly discharged the following day. Another important advantage is that a large number of patients, who has received a mitral balloon valvuloplasty, does not need to use anticoagulant drugs if no arrhythmia occurs while the patients, who have undergone an open heart surgery and implanted an artificial (prosthesis) valve, need to use anticoagulant drugs (Coumadin-Warfarin) for a lifetime.

Mitral balloon valvuloplasty procedure is performed by interventional cardiologists at angiography laboratory. Inguinal region is cleaned with an antiseptic solution to apply a local anesthetic prior to procedure. A cannule is placed in the inguinal artery and vein and guided to the heart’s right atrium by a catheter then the wall between the heart’s right and left atria is perforated by a specific needle to get to the left atrium. The balloon catheter is guided from the left atrium to left ventricle by a specific wire then inflated at the mitral valve to enlarge the valve as much as possible.

This figure demonstrates how the balloon passes along the mitral valve then is inflated on the mitral valve.

The wire and balloon catheter is removed after the procedure and a bandage is applied on the inguinal region. The patient is advised a bed rest and discharged the following day if no problem occurs during follow-up. The success rate of mitral balloon valvuloplasty is higher than 90%. Most patients will have a well-being for about 20 years. Mitral balloon valvuloplasty procedure may be repeated, if necessary, when mitral valve becomes narrowed again. Mitral balloon valvuloplasty procedure has been performed for long years at our hospital. We are the leading hospital with a serious of 1200 cases in the world and in the country. We perform mitral balloon valvuloplasty safely.

Percutaneous mitral balloon valvuloplasty has risks as with any invasive procedure. Such risks become affected by some factors, e.g. the age of the patient and the presence of other diseases.

Although these events are monitored less at experienced centers, the following adverse events might occur during the procedure or within the first 12-24 hours.

  1. A serious rupture may occur on the valve (2-10%) and a heart surgery may be needed to repair the rupture.
  2. A serious defect may occur between the small heart chambers (atria)
  3. During septostomy, a pericardial tamponade may develop from accumulated blood in the pericardial leaflets because of the perforated heart wall, which may result in death (possibility is 1-2%).
  4. Inguinal hemorrhage may occur which may result in inguinal bruising or pseudoaneurysm and require a surgical intervention.
  5. Stroke may occur (0%, 5-5) which may result in loss of function in one half of the body and permanent disablement.

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