valvotomy

Valvotomy is a surgical procedure to relieve stenosis of a heart valve by incising the stenotic leaflets or commissures to widen the orifice. It is used for stenotic lesions of the mitral, aortic, or, less commonly, tricuspid valves. The term is often distinguished from valvuloplasty, which widens the valve primarily by dilation without cutting.

Historically, valvotomy was a mainstay treatment for rheumatic mitral stenosis, notably as closed commissurotomy and later as open mitral commissurotomy. It is also employed in selected cases of congenital or acquired aortic stenosis and, rarely, tricuspid stenosis. The advent of balloon valvotomy and valve replacement has reduced its use in some settings.

Techniques include open valvotomy, performed with cardiopulmonary bypass to directly incise fused commissures under vision; and closed valvotomy, done without bypass through limited thoracic access. Percutaneous balloon valvotomy (balloon valvuloplasty) is a less invasive alternative for suitable mitral or aortic lesions, using a catheter-mounted balloon to separate fused leaflets.

Indications and outcomes: Candidates typically have stenosis with favorable valve morphology and high surgical risk for replacement. Immediate hemodynamic improvement is common, but restenosis or new regurgitation can occur, sometimes necessitating replacement or reintervention. Complications include leaflet or chordal injury, embolism, bleeding, arrhythmias, and infection.