Balloon Valvuplasty

Balloon valvuplasty also called balloon valvutomy is an alternative management to valve replacement procedure. It is a less invasive procedure that opens or dilates a stenosed (narrowed) valve of the heart due to a congenital defect, rheumatic fever, calcification and aging. It uses a balloon-tipped catheter to dilate a narrowed area.

There are four valves in the heart namely: tricuspid, pulmonic, mitral and aortic valves. These valves are essential for efficient blood flow in the heart. In some cases, a valve narrows causing an obstruction to blood flow. Balloon valvuplasty is used in the treatment of these cardiac disorders that blocks the blood flow.

The procedure is done through a cardiac catheterization with an x-ray machine that has a special TV monitor or screen. Then a needle is inserted into the blood vessel and a contrast medium is injected. The dye is used to pinpoint the exact location of the blocked area as viewed on the screen. Once the narrowed valve has been identified, a thin wire is inserted into the catheter and guided to the blocked area. The wire serves as a guide for the balloon catheter by allowing the physician to position the deflated balloon precisely at the midpoint of the affected area. The balloon is then inflated and as it expands it increases the size of the orifice, improving the valve function and cardiac circulation.

Pre-procedure

1. Emphasize the doctor’s explanation of the procedure including the risks involved and other treatment alternatives.
2. Inform the patient that he will be awake throughout the procedure and be given a sedative and/or local anesthetic before the procedure.
3. Describe the expected sensation during local anesthesia administration and catheter insertion. With the injection of the contrast medium, a warm, flushed feeling will likely occur.
4. Instruct the patient to abstain from eating and drinking 6 hours before the procedure or as prescribed. (Usually NPO post midnight)
5. Tell the client that the procedure may last up to 4 hours.
6. Assess for any allergy to shellfish, iodine or contrast medium.
7. Check the informed consent for the client’s signature, if over 18 years old or the parents if the patient is underage.
8. Baseline vital signs must be taken including peripheral pulses in all extremities.
9. Insert an intravenous line to provide entry for medications to be administered (Heparin).
10. Shave insertion sites and cleanse it using an antiseptic.
11. Check and collect the standard laboratory test results required by the doctor before the procedure such as ECG, chest x-rays and routine blood tests.
12. Place ECG electrodes precisely upon patient’s arrival in the cardiac catheterization laboratory and check the I.V. lines for patency.

During the procedure

1. Administer oxygen via nasal cannula.
2. Under a local anesthesia the doctor will make a small cut in the femoral blood vessel in the upper part of the leg.
3. A guide wire is carefully passed through the needle and is gently pushed into the vessel towards the chest. A catheter tube is threaded along the wire until it reaches the heart.
4. The doctor then uses the catheter to inject the contrast medium to visualize the heart valves and assess the degree of the narrowed part.
5. Heparin is also injected into the catheter to prevent it from clotting.
6. The physician positions the deflated balloon precisely at the midpoint of the affected area. The balloon is then inflated using a low pressure for about 12-30 seconds. Time and pressure gradually increases and if desired outcome is not seen, a larger balloon may be used.
7. A series of angiograms is obtained to evaluate the effectiveness of the treatment.
8. The doctor then sutures the guide catheter in place and removes it after the effect of heparin wears off.

Post-procedure

1. Monitor insertion site frequently. Be alert for signs of hemorrhage.
2. Keep the affected leg straight and instruct the patient to avoid prevent excessive hip flexion.
3. Monitor vital signs with following order:

Every 15 minutes x 1hour

Every 30 minutes x 2 hours

Every hour x 5 hours

Unstable vital signs: every 5 minutes

1. Assess the peripheral pulses, color, sensation, temperature and capillary refill of the affected leg.
2. Closely observe the catheter site for bruising, hematoma and bleeding. If hematoma expands, mark the site for later evaluation and notify the physician immediately.
3. Assess for signs of fluid overload (due to contrast medium injection) such as distended neck veins, dyspnea, pulmonary congestion, tachycardia, hypertension, hypoxemia, atrial and ventricular gallop.
4. Monitor intake and output.
5. Increase IV fluid rate for at least 100 ml/hour to aid kidneys in excreting the contrast medium.
6. Encourage patient to do deep breathing exercises to prevent atelectasis.
7. Frequent heart function evaluation should be done by auscultation. Murmurs indicate a worsening valve insufficiency.
8. Be alert for signs and symptoms of cardiac tamponade such hypotension, decreased or absent peripheral pulses and pale or cyanotic skin. This condition requires immediate surgery.
9. Removal of guide catheter is usually 6-12 hours after the procedure. Direct pressure should be applied for at least 10 minutes to prevent bleeding.

Images from my.clevelandclinic.org, familydoctor.co.uk

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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