Balloon Mitral Valvotomy

What is Balloon Mitral Valvotomy?

  • Narrowing or restricting blood flow across the mitral valve located between the left atrium and left ventricle is known as mitral stenosis.
  • The function of the mitral valve is to direct blood flow in one direction i.e; from the left atrium to the left ventricle.
  • When the mitral valve is narrowed it leads to stagnation of blood in left atrium causing breathlessness, palpitations, chest pain etc.
  • Balloon Mitral Valvotomy best does treatment of Mitral stenosis.
  • In this procedure, the narrowed mitral valve is widened using a balloon so that blood flows more easily through the heart.
  • This minimally invasive procedure is commonly called Percutaneous Balloon Mitral Valvuloplasty (PBMV) or Percutaneous Transvenous Mitral Commissurotomy (PTMC).
  • A thin flexible tube (catheter) is inserted through the femoral vein in the groin and passed into the heart. When the catheter reaches the narrowed mitral valve, the balloon located on the tip is quickly inflated. This opens up the narrowed or fused mitral valve leaflets and increases the size of the mitral valve opening and allows more blood to flow from the left atrium into the left ventricle.
Balloon Mitral Valvotomy

What is balloon mitral valvotomy needed to be done?

  • When the mitral valve is narrowed to less than 1.5 square cm.
  • Brain stroke in the presence of mitral stenosis
  • In case a person is planning for pregnancy in the presence of pre-existing mitral stenosis
  • When the patient develops symptoms of breathlessness due to valve narrowing
  • High BP in the lungs (pulmonary hypertension) that has been identified by the echo.

What are the risks of the Balloon Mitral Valvotomy?

  • Balloon mitral valvotomy is catheter-based, not surgical, and has a lower risk of further complications and death than an open-heart surgery such as a commissurotomy or valve replacement.

What are the complications of the Balloon Mitral Valvotomy?

  • Mitral Valve Regurgitation:

    This might happen in 1 people out of 10. Valve might be damaged; it does not close normally and allows blood to leak backwards in the heart.

  • Restenosis:

    Mitral valve usually narrows again after 10 to 20 years of balloon mitral valvotomy. If restenosis occurs, treatment depends on the condition of the valve and might require another balloon valvotomy or mitral valve replacement surgery.

Why valve replacement surgery is not preferred for Restenosis after Balloon Mitral Valvotomy?

Balloon Mitral Valvotomy Surgical Mitral Valve Replacement
Surgery Minimally invasive Needs opening of the chest
Hospital stay 1 day 8-10 days
Effect on heart structure Preserves the natural valve present from birth The natural valve is replaced by an artificial metallic valve
Blood thinners (Anti-coagulants) Not needed Life long blood thinners needed
The dose of anticoagulants modification Not needed Essential – as any modification of drug effect can have catastrophic complications
Monitoring of anticoagulant effect Not needed Needs periodic testing of PT/INR
Dysfunction of the valve after the procedure Repeat Balloon Valvotomy or surgical valve replacement and is a normal risk procedure Repeat Surgical valve replacement only and is a high-risk procedure

What are the outcomes of Balloon Mitral Valvotomy?

Short-term outcomes:

  • Relief of symptoms is immediate and dramatic after balloon mitral valvotomy
  • Early(immediate) results of Balloon Mitral Valvotomy are excellent
  • Approximately, 1.0 to 2.0cm2 increase in valve area resulting in a reduction of left atrial pressure further increases cardiac output.
  • Increase in left atrial pump function in patients with sinus rhythm
  • Increase in left atrial reservoir function in patients with atrial fibrillation.

Long-term outcomes:

  • Hemodynamic factors improvement
  • Pulmonary vascular resistance declines and may normalize.

What is the survival rate for Balloon Mitral Valvotomy?

  • The actuarial survival rate is more than 90% over 4 years

Event-free rate is 70 % over 4 years

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