Ballonvalvuloplastie

Ballonvalvuloplastie, or balloon valvuloplasty, is a percutaneous procedure that dilates a narrowed heart valve by inflating a balloon catheter across it. The goal is to increase the valve area and reduce transvalvular gradients, improving blood flow while preserving the native valve.

Indications include stenosis of the mitral valve (most often rheumatic mitral stenosis), pulmonary valve stenosis, and selected cases of aortic stenosis, particularly in younger patients or when surgery carries high risk or as a bridge to valve replacement. It is most effective with pliant valves and favorable anatomy.

Technique varies by valve. Mitral valvuloplasty uses venous access with a transseptal puncture to reach the left atrium, then crosses the mitral valve with a balloon and inflates to separate fused commissures. Aortic valvuloplasty employs arterial access to cross the aortic valve. Balloon size is chosen from imaging, and the procedure is guided by fluoroscopy and echocardiography.

Outcomes: The procedure typically lowers gradients and increases valve area, with rapid symptom improvement in many patients. Durability depends on valve type and patient age; rheumatic and congenital stenoses may remain improved longer than calcific degenerative aortic stenosis, which often recurs or progresses.

Risks and alternatives: Complications include vascular injury, bleeding, contrast nephropathy, embolism, arrhythmias, new or worsened regurgitation, perforation, tamponade, or infection. Restenosis can occur. Balloon valvuloplasty is usually considered when surgery is high risk or as a bridge to valve replacement or repair.