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What is a mitral valvuloplasty procedure?
The heart's mitral valve is subject to hardening or stenosis as a symptom of heart disease. Mitral valvuloplasty uses a catheter to inflate a balloon inside the valve, stretching it and ideally improving its function.
Mitral valvuloplasty, also known as mitral valvotomy, is a minimally invasive procedure to treat narrowing (stenosis) of the heart’s mitral valve. The procedure dilates the mitral valve opening by inflating a tiny balloon inserted into the mitral valve. The balloon is advanced into the heart’s chambers through a thin flexible tube (catheter) inserted into the femoral vein in the groin.
Before the advent of mitral valvuloplasty, an open-heart surgery known as surgical commissurotomy was the treatment for mitral valve stenosis. The first of these percutaneous mitral balloon valvuloplasty surgeries was performed in 1984, and now the procedure is the preferred mode of treatment for mitral valve stenosis.
Why is mitral valvuloplasty performed?
Mitral valvuloplasty is performed to improve blood flow into the heart’s left ventricle and reduce the pressure in the pulmonary artery and lungs. Left untreated, these conditions can lead to heart failure and death.
The mitral valve is located between the left atrium and left ventricle of the heart. The mitral valve is made up of leaflets that open to let the blood flow from the left atrium into the left ventricle, and close to prevent the blood from flowing back into the atrium (mitral regurgitation). When the mitral valve leaflets thicken or become stiff due to disease, they fail to function normally.
Mitral valve stenosis obstructs the free flow of blood, causing blood to back up in the lungs and increase the pressure in the pulmonary artery (pulmonary hypertension). Because the function of the pulmonary artery to bring oxygenated blood to the left atrium is compromised, the left ventricle gets insufficient blood to pump to the organs of the body.
What causes mitral valve stenosis?
- Rheumatic fever, a complication of strep throat, is the most common cause of mitral stenosis, due to inflammation of the mitral valve. Rheumatic mitral stenosis usually occurs decades after the illness.
- Calcium deposits in the mitral valve building up over time, particularly in dialysis patients.
- Carcinoid syndrome caused by carcinoid tumors.
- Congenital defect in the mitral valve or inherited disorder.
What are the symptoms of mitral valve stenosis?
- Shortness of breath, especially with exertion
- Irregular heartbeat (arrhythmia)
- Chest pain or discomfort
- Fatigue
- Swollen feet and legs
- Dizziness or fainting
When is a mitral valvuloplasty performed?
Mitral valvuloplasty may be performed in patients with severe or mild mitral valve stenosis who
- Are asymptomatic
- Do not improve after treatment with medication
- Develop symptoms during pregnancy
- Do not require mitral valve repair or replacement surgery
- Are at high risk for commissurotomy
- Are critically ill, as a palliative measure
Mitral valvuloplasty is not usually performed in the following situations:
- Presence of blood clot in the left atrium. The patient may have to undergo treatment for a few months to dissolve the blood clot, before testing for the procedure again.
- Presence of moderate to severe mitral regurgitation.
- Stenosis of tricuspid valve that is between the right atrium and right ventricle.
- Malfunctioning tricuspid valve causing regurgitation of blood from the right ventricle into the right atrium.
- Aortic valve disease.
- Patients requiring surgery for any coexisting (comorbid) heart diseases such as coronary artery disease.