Q. Can you explain Balloon Valvuloplasty?

Whenever feasible valvuloplasty is the treatment modality of choice. One has to make sure that the valve is suitable and expertise to do the procedure is available. Surgical stand by is desirable. Immediate and long term results are directly related to pliability of the valve. With a pliable valve better valve area can be achieved and chance of immediate severe mitral regurgitation is less. A thorough trans thoracic echocardiography is mandatory prior to performing the procedure. Similarly in those with atrial fibrillation and in those with left atrial diameter more than 4 cm. trans esophageal examination (TEE) should be done to rule out the presence of any left atrial thrombi. TEE is also helpful in assessing the degree of associated mitral regurgitation if any. Patient with left atrial appendage clot may be given oral anticoagulants and followed closely over next few months till the clot dissolves and then go for balloon valvuloplasty. Such a strategy may
or may not be useful for left atrial clots as they may or may not dissolve with oral anti coagulants.

Higher valve scores and presence of commissural fibrosis and calcification may lead to sub optimal result and acute complications during the procedure. Mitral restenosis is a possibility after balloon valvuloplasty and the time taken for restenosis is dependent upon the initial pliability of the valve and the valve area achieved. Calcific valves tend to restenose early. Patients should continue with penicillin prophylaxis and have a periodic echocardiographic evaluation after balloon valvuloplasty. If symptoms recur repeat balloon valvuloplasty or valve replacement may be done. Complications of the procedure include local vascular complications, vasovagal episodes, cardiac perforation and tamponade, acute mitral regurgitation, embolic complication due to missed left atrial thrombi and very rarely infective endocarditis. In terms of simplicity and costs balloon valvuloplasty is superior to surgical commissurotomy and all patients should be first considered for balloon valvuloplasty.