Valvulotomie

Valvulotomy, also spelled valvulotomie in French, is a surgical procedure that involves incising or destroying a valve to relieve obstruction or abnormal flow. The goal is to disrupt valvular tissue so that blood can flow more freely in the desired direction. The term applies to both cardiac and venous valves, depending on the context.

Cardiac valvulotomy: Historically, valvulotomy was used to treat stenotic or obstructed heart valves, particularly in congenital or rheumatic disease. Techniques included open surgical valvulotomy, where an incision is made in the valve leaflets, and closed or catheter-based approaches using a valvulotome to cut or perforate leaflets. Pulmonary valve stenosis was a common indication, with procedures performed before modern balloon valvuloplasty and valve repair became standard.

Venous valvulotomy: In vascular surgery, valvulotomy describes destroying or incising valves within a vein to create a continuous flow, for example in preparation for arterial bypass grafts or to treat chronic venous insufficiency. A valvulotome or similar cutter is advanced through the vein to disrupt the cusps, often in segments intended to serve as low-resistance conduits for arterial flow.

Outcomes and risks: Valvulotomy can relieve obstruction and improve flow, but carries risks such as bleeding, infection, thrombosis, venous or valvular injury, and residual incompetence. In many settings, especially for venous indications, its use has declined with the advent of newer endovascular and grafting techniques.

History and context: The procedure dates to the early era of cardiac and vascular surgery and remains largely historical in some applications, having been superseded by balloon valvotomy, valvuloplasty, and contemporary bypass methods.