January, 2021 | Dr Raghu

Mitral stenosis is the narrowing of the valve present between the left chambers of the heart (mitral valves), thereby blocking the blood flow. This condition usually develops several years after a person had a rheumatic fever. Mitral stenosis is treated with balloon valvotomy, when the medications do not reduce the symptoms. If left untreated, mitral stenosis can result in various heart complications.

Mitral valvotomy (or valvuloplasty), also known as percutaneous balloon dilation, is a minimally invasive procedure that involves widening a mitral valve using a balloon catheter, a thin, flexible tube with a balloon at the tip. This procedure improves the overall function of the heart.

What are the risks of mitral valvuloplasty?

The risks associated with percutaneous balloon dilation include:

Blood clot formation or tears in the heart
Backward flow of the blood (mitral valve regurgitation) due to damaged valve
Restenosis of the mitral valve

What happens before the procedure?

Your doctor will explain the procedure in detail and provide you the opportunity to ask any questions; do not hesitate to ask any questions related to the procedure.

Your healthcare team will give you certain instructions to prepare for the procedure:

You will be asked not to eat or drink anything after midnight, on the previous night of the procedure; you can drink water up to 4 hours of the procedure.
A blood test may be done to evaluate the time required for the blood to clot; other blood tests may also be performed.
You may be asked to stop taking certain medicines that may involve with the blood clotting process.

Notify your doctor if you:

Had an allergic reaction to any contrast dye, iodine or seafood.
Are sensitive to any medications, tape, latex, or anaesthetic agents.
Have a pacemaker.
Have any body piercings on the abdomen or chest.
All the medications you are taking, including over-the-counter drugs, herbal supplements, blood thinners, etc.
Have heart valve disease, as antibiotic drugs may be given before this procedure.
Have a history of bleeding disorders
Are or may be pregnant

Before the procedure, the area near the catheter insertion site (the groin area) may be shaved. Your physician may order other preparations for the procedure based on your medical condition.

How is mitral valvuloplasty performed?

On the day of the procedure, you should remove your jewellery and other objects that may interfere with the procedure. You will be asked to change into a hospital gown and empty your bladder before the procedure.

An intravenous (IV) line will be attached to your arm or hand to inject medications and administer IV fluids, if needed. You may receive a sedative to help you relax.

The following are the steps generally involved in a balloon valvuloplasty:

A local anaesthetic is injected at the insertion site.
Once the anaesthesia sets in, a sheath or an introducer (a plastic tube) will be inserted into the blood vessel.
A valvuloplasty catheter is inserted through the sheath into the blood vessel. The catheter is advanced through the aorta into the heart valve. The catheter may be guided by a fluoroscopy (a special x-ray).
Once the catheter reaches the precise location, a contrast dye is injected into the valve to get a clear image of the area.
The balloon is then inflated and deflated several times.
The catheter is then removed.
The catheter insertion site is closed using a sterile bandage.

What happens after the procedure?

After the procedure, you will be moved to the recovery room. You should remain flat on bed for several hours after the procedure. Your vital signs, and circulation and sensation in the affected arm or leg, the insertion site will be monitored regularly.

Medicines may be given for pain or discomfort near the insertion site. You will be asked to drink water and other fluids to eliminate the contrast dye from your body. You can return to your regular diet after the procedure.

Mostly, you may have to spend the might in the hospital, based on your medical condition and recovery.

Your healthcare team will give you instructions to be followed after leaving the hospital:

Keep a check on the insertion site for unusual pain, bleeding, swelling, or discoloration.
Keep the insertion site clean and dry.
Do not participate in any strenuous activities. Your doctor will inform you when you can resume normal activities and return to work.

Call your doctor immediately if you have any of the following:

Fever or chills
Severe pain, swelling, redness, bleeding or other leakage from the insertion site
Numbness, coolness or tingling sensations in the affected extremity
Pain or pressure in the chest, nausea or vomiting, sweating, or dizziness
Reduced urination
Swelling of the abdomen or extremities
Over 3 pounds weight gained in a day

Carotid artery disease is a condition that arises when the fat deposits accumulate and block the blood vessels that deliver blood to the brain.

Hemodialysis is a preferred treatment option for patients with chronic kidney disease. In this t procedure, the blood is filtered outside the body by a dialyzer or “artificial kidney”. For hemodialysis, a vascular access is created to insert the needles that connect the dialyzer, thereby allowing the blood to move out and return to the body at a high rate. An arteriovenous fistula is the preferred vascular access for hemodialysis.

An arteriovenous (AV) fistula is created by connecting an artery to a vein, usually in the wrist or upper arm. But sometimes, the fistula can become infected, blocked or narrowed. The blocked fistula can be treated by a balloon fistuloplasty.

arteriovenous (AV) fistula

What is balloon fistuloplasty?

Balloon fistuloplasty is a procedure in which any blockage or narrowing in the fistula is located by using a dye, and the blockage is relieved by stretching the blood vessels with a special balloon.

In this procedure, a small balloon is inflated for several times at the narrowed regions of a fistula; if required a stent may also be placed. This technique widens the lumen and facilitates the process of dialysis.

Why perform fistuloplasty?

A fistula can age and cause problems like clotting and scarring, thereby decreasing its function and effectiveness of dialysis. Clots can decrease the rate of blood flow or block the fistula completely. If these problems are left untreated, it may lead to the failure of fistula.

Thus, it is important to treat the narrowing or blockage at an early stage, so that the fistula works well, and dialysis occurs without any complications.

What are the risks of dialysis fistuloplasty?

Fistuloplasty is usually a safe procedure, but some complications may occur rarely. The common risks and complications associated with fistuloplasty include:

Bruising around the site of insertion of the needle, which may become large and uncomfortable (rarely).
Infection of large bruises, which may need antibiotic treatment or surgical intervention.
Allergic reaction to the dye, which may present as a skin rash
Circulatory problems due to the damage to the artery or fistula caused by catheter or balloon
Treatment failure, which will require surgical intervention

How to prepare for the procedure?

Your healthcare provider will give you instructions to prepare for the procedure, which may include:

You may be asked not to eat or drink anything for six hours before the procedure; you can drink water up to two hours before.
Some blood tests may be performed before the procedure to evaluate the risk of bleeding.
If you are diabetic, ask your doctor to alter the treatment regimen.
Ask your doctor which medicines you can continue to take, and which ones you should stop.
If you are taking any antiplatelets or anticoagulants, you may have to stop taking these medicines a few days before.
Ensure that you have an adult to drive you home and accompany you overnight.

Inform your healthcare provider if you:

Are allergic to iodine, or have any other allergies
Have a history of reaction to the dye used for CT scan or X-rays
May be or are pregnant
Are a diabetic

What happens during the procedure?

The following are the steps usually performed in a fistuloplasty:

You will be asked to lie on your back on an x-ray table. Some monitoring equipment will be attached to measure your heart rate and blood pressure.
The interventional radiologist will observe the fistula by using an ultrasound, which provides a clear picture of the fistula.
A small needle is inserted in the fistula, and a contrast dye is injected. This provides an image of the blood vessels, which helps to locate the narrowing or blockage.
A catheter (a small, flexible tube) with a balloon at the tip is then inserted in the blood vessel to reach the precise location.
Once the catheter reaches the site of the blockage or narrowing, the balloon is inflated and deflated several times from outside the body.
Sometimes, if the balloon does not improve the fistula, a permanent stent may be used to widen the narrowing.
Then the catheter is removed from the blood vessel, and the puncture site is stitched to prevent bleeding.

Usually, fistuloplasty takes about one hour, but the duration may vary in different patients.