Valvuloplasty

Valvuloplasty repairs a diseased heart valve to improve opening or reduce leakage, avoiding valve replacement when feasible. It includes percutaneous balloon valvoplasty and surgical valvoplasty (commissurotomy or valvotomy).

Percutaneous balloon valvuloplasty (PBV) dilates a stenotic valve by advancing a balloon catheter across the orifice and inflating it to separate fused leaflets at the commissures. It is most successful for mitral stenosis with pliable leaflets and limited subvalvular disease, and is also used for selected aortic, pulmonary, and congenital stenoses. Relief of gradients and symptomatic improvement are common, but restenosis or new or worsened regurgitation may occur.

Surgical valvuloplasty repairs the valve via an operative approach, usually with cardiopulmonary bypass. Examples include mitral commissurotomy, aortic valvotomy, and tricuspid valvuloplasty. Techniques may be closed (without bypass) or open (with bypass) and aim to preserve native valve tissue when feasible. Repair decisions depend on valve anatomy and concomitant procedures.

Valvuloplasty is indicated for symptomatic stenosis when valve leaflets and supporting structures permit durable repair, notably rheumatic mitral stenosis with commissural fusion, certain congenital stenoses, and select tricuspid or aortic lesions. In some patients it delays or avoids valve replacement.

Risks include embolism, leaflet or chordal injury, acute or worsening regurgitation, bleeding, vascular complications, and infection. Long-term results depend on valve morphology and disease; PBV has higher restenosis rates in rheumatic disease, while surgical repair offers durable outcomes in well-selected cases, with valve replacement required if repair is not feasible.