How do heart valves work?
Blood passes through a valve before leaving each chamber of the heart. There are four valves in your heart (see figure 1). Valves make sure blood flows in only one direction through your heart.
The mitral valve is located between the left upper and lower chambers of the heart. It has two leaflets that open and close, similar to a double door.
What is mitral stenosis?
The right and left sides of the heart work together. Oxygen-depleted blood first enters the right side of the heart. From the right side of the heart, the blood flows to the lungs where oxygen is added.
Oxygen-rich blood then returns to the left side of the heart. The blood flows from the left upper chamber (left atrium) to the lower chamber (left ventricle) through the open mitral valve. The blood is then pumped out to the body from the left ventricle. (see figure 2)
Stenosis literally means narrowing of an opening, such as a heart valve. Stenosis of the mitral valve limits the forward flow of blood from the left atrium to the left ventricle. This may cause a backup of blood and fluid in the lungs.
What are the symptoms of mitral stenosis?
Many of the symptoms of mitral stenosis, such as shortness of breath and fatigue, result from a backup of blood in the lungs. Other symptoms of mitral stenosis may include:
- Quick weight gain
- Swelling in the ankles, feet, and/or abdomen (edema)
- Heart palpitations (irregular heartbeat)
What causes mitral stenosis?
Mitral stenosis most commonly develops many years after a person has had rheumatic fever, although many patients diagnosed with mitral stenosis don't recall ever having the illness.
During rheumatic fever, the valve becomes inflamed. Over time, the leaflets of the inflamed valve stick together and become scarred, rigid and thickened, limiting its ability to open completely (see figure 3).
How is mitral valve stenosis treated?
If the symptoms are mild, mitral valve stenosis can sometimes be treated with medications. When medications do not work to control symptoms, balloon mitral valvotomy or surgical valve repair or replacement is performed.
Balloon valvotomy (see figure 4) successfully opens the narrowed valve and improves the overall function of the heart.
If balloon valvotomy cannot be performed, surgical valve repair or replacement may be options. Valve repair may be performed to separate fused valve leaflets, sew torn leaflets, or reshape parts of the valve. Valve replacement (removing the old valve and replacing it with a mechanical or biological valve) is reserved for valves that are damaged beyond repair.
How is a balloon valvotomy performed?
Balloon valvotomy is a non-surgical procedure performed in the cardiac catheterization laboratory by a cardiologist and a specialized team of nurses and technicians.
Long, slender tubes called catheters are first placed into blood vessels in the groin and guided into the chambers of the heart. The cardiologist then creates a tiny hole in the wall between the upper two chambers of the heart. This hole provides an opening for the cardiologist to access the left atrium with a special catheter that has a balloon at the tip.
The catheter is positioned so the balloon tip is directly inside the narrowed valve (see figure 4). The balloon is inflated and deflated several times to widen the valve opening. Once the cardiologist has determined that the opening of the valve has been widened enough, the balloon is deflated and removed.
During the procedure, the cardiologist may perform an echocardiogram (ultrasound of the heart) to get a better picture of the mitral valve.
What should I expect before the procedure?
- Most patients will need to have blood tests, a chest x-ray, electrocardiogram and an echocardiogram before the procedure. These tests are usually scheduled the day before the procedure.
- Tell your doctor or nurse if you are taking any blood thinning medications such as Coumadin (warfarin). An alternate method for thinning your blood may be prescribed a few days before the procedure.
- You will not be able to eat or drink after midnight the evening before the procedure.
- If you normally wear glasses or a hearing aid, plan to wear them during the procedure to help with communication.
- You will remain awake during the procedure, but you will be given medication to relax.
How long does the procedure last?
The procedure lasts about 1 hour, but the preparation and recovery time add several hours. Patients usually go home the day after the balloon valvotomy procedure.
What should I expect during the recovery?
- You will need to lay flat for about 6 hours after the catheter has been removed from your groin to prevent bleeding. You will have a tight, bulky dressing on your groin area while you are resting in bed. Do not bend your legs during this time to prevent bleeding. A sheet may be placed across your legs to remind you to keep them straight. Your nurse will tell you when you may sit up and get out of bed.
- You should not eat anything until the catheter has been removed from your groin.
- Notify your nurse immediately if you have a fever, chest pain, swelling, or pain in your groin or leg, or bleeding at your groin site.
- You will have an echocardiogram the morning after the procedure.
- Medications may be prescribed.
- Ask your doctor if it is safe to continue taking the medications you took prior to the procedure.
- Once you have recovered from the procedure and have talked with your doctor about your follow-up care, you will be able to go home.
- You will be able to return to most of your normal activities the day after the procedure. Ask your doctor when it is safe to drive, return to work, or begin or continue an exercise program.
- Once your cardiologist has successfully opened the narrowed mitral valve, your symptoms of valve disease should decrease or disappear completely.
When should I call my doctor?
Once you go home after the procedure, call your doctor or nurse immediately if you have:
- Fever of 100°F (38°C) or higher
- Chest pain
- Shortness of breath
- Unusual swelling or weight gain
- Bleeding, swelling, pain, or changes in skin color at the groin site
- A return of previous symptoms (symptoms you had before the procedure was performed)
Does balloon valvotomy cure mitral valve disease?
Balloon valvotomy is a procedure that may relieve many of the symptoms of valve disease, but it will not cure valve disease. Some patients may continue to need medications, even after a successful procedure.
After the procedure, you will need to continue seeing your doctor regularly to make sure your heart valves are working properly. Lifestyle factors that can worsen valve disease may also need to be changed. An exercise program may be prescribed to improve your heart health after the procedure.
To protect your heart valves from further damage, tell your doctors, dentist and other health care providers that you have valve disease so antibiotics can be prescribed before you undergo any procedure that may cause bleeding. Also, take good care of your teeth and gums.
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