Aortic Balloon Valvuloplasty

WHAT YOU SHOULD KNOW:

What is aortic balloon valvuloplasty?

Aortic balloon valvuloplasty (VAL-vu-loh-plas-tee) is a procedure that is done on the aortic valve. It helps open up the valve so that blood can flow more easily through the heart. This procedure may be done if you do not want or cannot have surgery to treat your aortic stenosis.

Where is the aortic valve?

• Your heart has four chambers or rooms. The two upper chambers are called atria (A-tree-uh). The two lower chambers are called ventricles (VEN-trik-ulls). When the heart "beats," the atria pump blood into the ventricles. The ventricles then pump blood out of your heart. The right ventricle pumps blood into the pulmonary artery, and then into the lungs to get oxygen. The left ventricle pumps blood with oxygen into the aorta and out to the body.
  
  
• There are valves (doors) between the chambers that open and close to direct blood flow through the heart. The aortic valve is the door between the left ventricle and the aorta. The aortic valve is made up of three smaller "cusps" attached to the aortic ring. The cusps come from the sides and top of the valve and meet in the middle to "close the door." When the ventricle squeezes to push the blood out, the valve opens and allows blood into the aorta. The valve closes after the blood goes through to prevent it from flowing back into the ventricles.

What is aortic stenosis?

"Stenosis" means narrow or tight. Because your aortic valve is stenosed, it is unable to open all the way. There are several ways the aortic valve may become stenosed. Most people with aortic stenosis were born with a problem in their aortic valve. The valve may have two cusps instead of three, or the cusps may be deformed and only partly open. As people get older, calcium can build up on the cusps. Calcium build-up may cause the cusps to get thicker and stiffer. Having had rheumatic fever may also cause aortic stenosis.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks during aortic balloon valvuloplasty. You may bleed more than usual, get an infection, or have trouble breathing. The artery where the catheter was put may be damaged. The procedure may cause air bubbles, or pieces of calcium from the valve to be in your blood. These could cause a stroke or a heart attack. The other valves or muscles in your heart could be damaged. Your kidneys may stop working. You could have problems with your heartbeat.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Even after this procedure, your aortic valve may grow narrow again over time. If this happens, you may need to have this procedure done again or have heart surgery. Your shortness of breath, dizziness, passing out, and chest pain could get worse if you do not have the procedure. Your heart could get larger until it has problems pumping. Fluid could build up in your lungs, and your heart could begin to fail. In heart failure, you will not be able to send the right amount of blood to your body. You could have problems with your heartbeat or you could have a heart attack and die. Call your caregiver if you are worried or have questions about your procedure, medicine or care.

WHILE YOU ARE HERE:

Before the procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers may take one to see how your lungs and heart look before or after the procedure. Caregivers may also use the x-ray to look for signs of infection like pneumonia.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

Pre-op care:

• A special dye made from iodine may be injected (put) into the heart catheter during your procedure. The dye helps to make arteries, heart chambers and the valve easier for caregivers to see. Tell caregivers if you have any allergies, especially to iodine or shellfish. If you have allergies, caregivers may give you special medicines before the procedure to prevent an allergic reaction.
  
  
• You may be given medicine to make you feel sleepy and more relaxed. You may also be given antibiotics to help fight infection. Caregivers will help you lie on your back on a padded table in the room where the procedure is done. Caregivers will help you get comfortable on the table. A belt may be put over you for safety. This is done because the table is tilted in different directions during the procedure. If you get cold, ask for more blankets. Caregivers may remove hair from your groin area if needed.

During the procedure:

• A caregiver will clean the skin on your groin with soap. Your groin is the area where the top of your leg meets your abdomen. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the procedure area clean. You will be given a shot of local anesthesia in the area where the catheter is inserted. The local anesthesia numbs the area so you do not feel it when the catheter is inserted. You may still feel pressure or pushing during the procedure.
  
  
• A sheath (long hollow tube) is put through the skin and into the artery (blood vessel) of your groin. The sheath allows your caregivers to insert different catheters (tubes) into the artery during the procedure. A catheter with a balloon on the tip is threaded through the sheath and into your heart. You may have a fluttering feeling in your chest. This is caused by extra heartbeats once the catheter is in your heart. When the end of the catheter is in the aortic valve, the balloon is filled with liquid. The filled balloon forces the valve cusps open so blood can flow more freely through the valve.

After the procedure:

• Artery (blood vessel) care: The catheter will be taken out of the artery. Caregivers will hold pressure on the area for at least 20 minutes and will apply (put on) a pressure bandage. Your vital signs will be checked often for the first few hours after the procedure. Caregivers will watch the dressing to make sure you are not bleeding or bruising too badly. The skin temperature and pulse of your leg where the catheter went in will also be checked often. Tell caregivers if you feel warmth or wetness in the area. This may mean the artery is still bleeding.
  
  
• Bedrest: You must stay in bed 6 to 8 hours after the procedure. While in bed you must not move around. Keep the leg with the groin incision (where the catheter was inserted) straight for 4 to 8 hours. Use your call button to call for your caregivers. Tell your caregiver if you are having pain and need pain medicine, or if you have any other problems.
  
  
• Blood sugar tests: Caregivers will monitor your blood sugar closely after the procedure. This may help decrease your chance of getting an infection.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after the procedure. Deep breathing opens the tubes going to your lungs. You should deep breathe and do a number of small coughs every hour while you are awake. Also do this if you wake up during the night. When you cough, reach down and put pressure on your groin dressing. This may help to prevent bleeding from the groin incision after you cough.
  
  
  • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with small coughs. Put any sputum (spit) you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake.
    
    
  • You may be given an incentive spirometer. An incentive spirometer helps you take deeper breaths. Put the plastic piece in your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Ice: Ice causes blood vessels to constrict (get smaller). When vessels are smaller you will have less pain, swelling and redness. Ice is best started after the procedure and for 24 to 48 hours afterwards. Caregivers put crushed ice in a plastic bag and cover it with a towel. Place the ice pack over the area for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.
  
  
• Medicines: After the procedure, caregivers may give you the medicine you were taking before coming to the hospital. You may also be given one or more of the following medicines.
  
  
  • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Temporary pacemaker: This is a machine that helps your heart beat at a normal speed. There are two types of temporary pacemakers.
  
  
  • If you have a transcutaneous (on the skin) pacemaker, large patches are placed on your chest and back. These are connected to a special monitor that watches the heart rate. If your heart beats too slow, the pacemaker will send small electrical signals through the skin patches to the heart muscle. The signals should help the heart beat faster. Some people feel discomfort or pain when this happens. Ask your caregiver if there are medicines that you can take if your pacemaker causes pain or discomfort.
    
    
  • If you have a transvenous (through the vein) pacemaker, you will have a pacing lead (wire). Caregivers insert the pacing lead into a groin or neck vein. They thread it through the vein until it reaches the right ventricle of the heart. The pacing lead is connected to a pacer box (monitor) outside your body. The pacer box watches your heart rate. If your heart beats too slow, the pacemaker will turn on and cause your heart to beat faster.
    
    
  • You may need a pacemaker just for a short time. In some cases, you may need it for the rest of your life. If so, your caregiver may replace your temporary pacemaker with a permanent (long-term) one.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.