Aortic and Mitral Valvuloplasty
Heart valves that don't open fully (stenosis) can be repaired either with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy.
During the procedure, a balloon-tipped tube is threaded through your blood vessels and into the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.
You're awake during the procedure, which usually requires an overnight stay in the hospital.
Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can still worsen over time. You may need medicines to help with symptoms or surgery to repair or replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery. For some patients who have mitral valve stenosis, it may work as well as surgical repair or replacement. For these reasons, balloon valvuloplasty usually is preferred over surgical repair or replacement for these people.
Closure of Holes in the Heart (ASD and PFO)
The septum is the wall that separates the chambers on the left side of the heart from those on the right. The wall prevents mixing of blood between the two sides of the heart.
An atrial septal defect (ASD) is a hole in the part of the septum that separates the atria—the upper chambers of the heart. This heart defect allows oxygen-rich blood from the left atrium to flow into the right atrium instead of flowing to the left ventricle as it should. At the time of the procedure, a transesophageal echo (TEE) or intracardiac echo (ICE) may be performed to direct the physician.
Normal Heart and Heart with Atrial Septal Defect
An ASD can be small or large. Small ASDs allow only a little blood to leak from one atrium to the other. Very small ASDs don't affect the way the heart works and don't require any treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium to large ASDs allow more blood to leak from one atrium to the other, and they're less likely to close on their own.
Half of all ASDs close on their own or are so small that no treatment is needed. Medium to large ASDs that need treatment can be repaired using a catheter procedure or open-heart surgery.
Figure A shows the structure and blood flow in the interior of a normal heart. Figure B shows a heart with an atrial septal defect, which allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood from the right atrium.
Normal Heart & Heart with Ventricular Septal Defect (VSD)
A VSD is a hole in the part of the septum that separates the ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle into the right ventricle instead of flowing into the aorta and out to the body as it should.
A VSD can be small or large. A small VSD doesn't cause problems and may close on its own. Large VSDs cause the left side of the heart to work too hard. This increases blood pressure in the right side of the heart and the lungs because of the extra blood flow.
The increased work of the heart can cause heart failure and poor growth. If the hole isn't closed, high blood pressure can scar the delicate arteries in the lungs. Open-heart surgery is used to repair VSDs.
Figure A shows the structure and blood flow in the interior of a normal heart. Figure B shows two common locations for a ventricular septal defect. The defect allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle.
Simple congenital heart defects also can involve the heart's valves. These valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart (the aorta and the pulmonary artery). Valves can have the following types of defects:
- Stenosis. This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the valve from fully opening. The heart has to work harder to pump blood through the valve.
- Atresia. This defect occurs if a valve doesn't form correctly and lacks a hole for blood to pass through. Atresia of a valve generally results in more complex congenital heart disease.
- Regurgitation. This is when the valve doesn't close completely, so blood leaks back through the valve.
The most common valve defect is called pulmonary valve stenosis, which is a narrowing of the pulmonary valve. This valve allows blood to flow from the right ventricle into the pulmonary artery. From there it flows to the lungs to pick up oxygen.
Pulmonary valve stenosis can range from mild to severe. Most children who have this defect have no signs or symptoms other than a heart murmur. (A heart murmur is an extra or unusual sound heard during a heartbeat.) Treatment isn't needed if the stenosis is mild.
In babies who have severe pulmonary valve stenosis, the right ventricle can get very overworked trying to pump blood to the pulmonary artery. These infants may have symptoms such as rapid or heavy breathing, fatigue (tiredness), or poor feeding.
If a baby also has an ASD or patent ductus arteriosus (PDA), oxygen-poor blood can flow from the right side of the heart to the left side. This can cause cyanosis (si-a-NO-sis). Cyanosis is a bluish tint to the skin, lips, and fingernails. It occurs because the oxygen level in the blood leaving the heart is below normal.
Older children who have severe pulmonary valve stenosis may have symptoms such as fatigue while exercising. Severe pulmonary valve stenosis is treated with a catheter procedure.