By Craig M. Walker, M.D.
Medical Director,
Cardiocascular Institute of the South

The use of a nonsurgical technique first developed to reopen blocked arteries is being used increasingly to reopen heart valves narrowed by the aftereffects of rheumatic fever.

Balloon valvuloplasty has become a practical and significantly less traumatic option to open heart surgery for a number of patients suffering mitral valve stenosis -- narrowing of the valve that connect the upper and lower left pumping chambers of the heart.

The interference with normal blood flow resulting from this condition causes an increase in pressure in the lungs, leading, ultimately, to congestive heart failure, in which patients suffer severe shortness of breath, the inability to lie down without breathlessness, dizziness and fainting spells, and retention of water and sodium..

The most common cause for mitral valve narrowing is scarring of the valve following the inflammation accompanying rheumatic fever. This process is a slow one, usually producing its first symptoms ten to 15 years after the rheumatic fever episode.

The treatment of choice for many years has been open heart surgery to permit the valve to be mechanically stretched, or, in the most advanced cases, replaced.

Over the past several years, however, it has been demonstrated that a similar effect can be obtained by using a balloon-tipped catheter. The inflation of the balloon, in many instances, can stretch the valve sufficiently to restore normal function, especially if the valve has not become too calcified or thickened.

Balloon catheters were initially developed to unblock arteries in the heart and elsewhere, and the mitral valve procedure differs only in scale and routing of the balloon. A large vein in the groin is used as the introduction point for the catheter, and the balloon is many times larger, when inflated, since the valve is about an inch in diameter.

The principal advantage of mitral valvuloplasty is that it is much less invasive, requiring only a local anesthetic and a brief hospital stay. That is a particular benefit to patients who would be poor candidates for major surgery -- pregnant women or patients with a complicating illness, for instance.

While the restoration of effectiveness accomplished by valvuloplasty may permit the mitral valve to function adequately for years, most mitral valve stenosis patients, will, at some point in their lives, face the prospect of replacement of the damaged valve with a natural or artificial prosthetic valve -- a situation which is also true of valves restored to function by stretching during open heart surgery.

&copy 1995 Cardiocascular Institute of the South

For further information, call Jane Arnette, Cardiocascular Institute of the South/Houma, 1-800-425-2565, or Jim Keyser at 1-800-848-2715. E-mail questions or comments to: jakeyser@cardio.com.

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