92986 Percutaneous balloon valvuloplasty; aortic valve

Name of the Procedure:

Percutaneous Balloon Valvuloplasty; Aortic Valve
Common name(s): Balloon Aortic Valvuloplasty (BAV), Balloon Valvotomy

Summary

Percutaneous Balloon Valvuloplasty is a minimally invasive procedure used to widen a narrowed aortic valve. It involves inserting a catheter with a balloon at its tip into the blood vessels and guiding it to the aortic valve. Once in place, the balloon is inflated to enlarge the valve opening, improving blood flow.

Purpose

The procedure addresses the condition of aortic stenosis, where the aortic valve becomes narrowed and restricts blood flow from the heart to the rest of the body.

• Goals: To improve heart function and reduce symptoms such as shortness of breath, chest pain, and fainting.

Indications

• Symptoms: Severe aortic stenosis with symptoms like breathlessness, chest pain, fainting, or heart failure.
• Patient criteria: Typically performed on patients who are not suitable candidates for surgical aortic valve replacement due to high surgical risk.

Preparation

• Pre-procedure instructions: Patients may need to fast for several hours before the procedure. Medication adjustments, such as stopping blood thinners, may be necessary.
• Diagnostic tests: Echocardiogram, chest X-ray, and possibly cardiac catheterization to assess the severity of aortic stenosis and overall heart function.

Procedure Description

• A catheter with a deflated balloon is inserted into a blood vessel, usually in the groin, and guided to the heart.
• Using fluoroscopy (X-ray guidance), the catheter is positioned across the narrowed aortic valve.
• The balloon is then inflated to stretch and widen the valve opening.
• After achieving sufficient dilation, the balloon is deflated and the catheter is removed.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Percutaneous Balloon Valvuloplasty is usually performed in a hospital's cardiac catheterization lab.

Personnel

• Interventional cardiologist
• Cardiac nurses
• Anesthesiologist or sedation nurse
• Radiologic technologists

Risks and Complications

• Common risks: Minor bleeding or bruising at the catheter insertion site.
• Rare risks: Valve damage, blood vessel injury, stroke, heart attack, arrhythmias, infection.

Benefits

• Expected benefits: Relief of symptoms associated with aortic stenosis, improved heart function, and a better quality of life.
• Realization time: Patients often notice symptom improvement shortly after the procedure.

Recovery

• Post-procedure care: Monitoring in a recovery area for several hours, with instructions to avoid strenuous activities for a few days.
• Recovery time: Most patients can resume normal activities within a week, but a follow-up appointment is usually scheduled to monitor progress.

Alternatives

• Surgical aortic valve replacement: More invasive, but may offer a more durable solution.
• Transcatheter aortic valve replacement (TAVR): Another minimally invasive option, suitable for certain patients.
• Pros and cons: BAV is less invasive with a quicker recovery, but the effects may be temporary. Surgery or TAVR may provide longer-lasting results but come with higher risks and a longer recovery.

Patient Experience

• During the procedure: Most patients receive local anesthesia with sedation, so they may feel slight pressure but no significant pain.
• After the procedure: Some discomfort at the insertion site, mild bruising, and general fatigue. Pain is usually managed with over-the-counter medications.