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balloon mitral valvotomy for severe mitral stenosis (MS)

Balloon Mitral Valvotomy For Mitral Stenosis

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Balloon mitral valvotomy is a minimally invasive procedure done by a cardiologist for severe mitral stenosis. Once upon a time, the only option available to patients with mitral stenosis was heart surgery. Fortunately, physicians now have another treatment option that has proven to be less invasive than surgery and just as effective: balloon mitral valvotomy (BMV).

Balloon mitral valvotomy or balloon mitral valvuloplasty was first developed in the late 1960s. Still, it’s grown in popularity over the past two decades as doctors have come to realize how minimally invasive and successful this treatment option can be for mitral valve stenosis (MS).

Other names for Balloon mitral valvotomy

 

  1. BMV
  2. PBMV or percutaneous balloon mitral valvotomy
  3. Percutaneous Mitral Balloon valvuloplasty

 

Mitral stenosis or MS: Introduction

 

Mitral stenosis is a condition in which the mitral valve can’t open properly, leaving blood to flow back into the lungs instead of circulating out to the rest of the body. This happens when your mitral valve develops scar tissue, making it harder to open until it’s virtually impossible to do so. If left untreated, this can be fatal, but thanks to a new procedure called balloon mitral valvotomy, it can now be treated successfully and safely in some cases—all without surgery!

Severe mitral stenosis - caused by rheumatic fever, needs BMV or MVR
Mitral stenosis

 

Causes of mitral stenosis:

 

The most common cause of mitral valve stenosis is rheumatic heart fever. An infection of Streptococcus bacteria causes rheumatic heart fever. Signs include fever, chills, joint pain, headache, and loss of appetite. This commonly affects school-going children. If untreated, it can lead to permanent heart damage during adulthood.  The immune system attacks the mitral valve and other heart valves while fighting against an untreated Streptococcus bacterial infection. This gradually damages the mitral valve.

Other causes are age and congenital heart problems.

 

Balloon mitral valvotomy cost in India

 

The cost of percutaneous balloon mitral valvotomy or PBMV varies from hospital to a hospital. It is a complex procedure and has to be done in a dedicated heart hospital. The cost of BMV typically ranges from one lakh to two lakh Indian Rupees.

 

Percutaneous mitral balloon valvuloplasty: Introduction

 

Mitral stenosis, or MS, is the most common form of heart valve disease in adults. Patients with MS often suffer from tiredness and shortness of breath. Balloon mitral valvotomy has emerged as a viable treatment option for mitral stenosis because it can be performed through small incisions in the groin with very little downtime. Read on to learn more about this breakthrough procedure for mitral stenosis, its risks and benefits, and how you can learn if it’s right for you.

 

What is balloon mitral valvotomy or balloon mitral valvuloplasty?

 

If you suffer from mitral stenosis (MS), a condition in which your heart valve’s opening is smaller than normal, balloon mitral valvotomy (BMV) can be a breakthrough. During BMV, a doctor inserts a catheter through your groin and into your heart. He then inflates a small balloon inside your valve. Then he widens it by pressing the balloon against its walls. This relieves MS symptoms like shortness of breath and fatigue, allowing you to return to daily activities.

 

How will my doctor prepare me for percutaneous balloon mitral valvuloplasty?

 

-Your doctor will advise admission one day prior. He requested some blood tests, ECG, 2d echo, and TEE tests.

-If you have diabetes, inform your doctor. Before surgery, the doctor brings blood sugars under control. 2d echo and TEE tests tell you whether you are the right candidate for BMV. If you are taking any blood thinner (warfarin), your doctor may suggest you stop it and advise an injection for a few days in that place.

-You will be asked not to eat or drink the night before the surgery.

-All valuables should be left at home. Bring these with you to the treatment to aid communication if you regularly wear dentures, glasses, or a hearing aid.

Tell your doctor and/or nurses if you have any allergies, especially to dye and antibiotics. Tell your doctor and/or nurses.

-You will be given anesthesia or sedation to keep you calm.

 How is balloon mitral valvuloplasty done?

 

-The doctor gives local anesthetics to the groin, then he punctures the leg vein and inserts a short, slender sheath inside.

-Special Catheters are long, slender tubes inserted into blood veins in the groin and guided into the heart chambers. The cardiologist then makes a small hole in the wall between the heart’s upper two chambers. Then the cardiologist passes a specific catheter with a balloon at the tip  through this hole into the left atrium.

-The catheter’s balloon tip is positioned directly inside the constricted mitral valve. The balloon is inflated and deflated multiple times to widen the mitral valve opening. The balloon is deflated and removed once the cardiologist determines that the valve opening has been sufficiently expanded.

Balloon mitral valvotomy for severe mitral stenosis (MS)
Balloon mitral valvotomy for severe mitral stenosis (MS)
Percutaneous balloon mitral valvuloplasty for mitral stenosis
percutaneous balloon mitral valvuloplasty

– Before you go into surgery, your doctor will likely ask you to take antibiotics (such as cephalosporins) to reduce your infection risk. You’ll also be asked to quit several weeks before and after surgery if you smoke. Hospital staff will shave both the groin before the surgery.

Video balloon mitral valvuloplasty

How long will it take to recover from the surgery?

 

Recovery after BMV is very quick compared to open surgery. After surgery, you’ll be sent to a recovery room and stay there until your heart rate and blood pressure are back to normal. You may need to stay in a hospital overnight. We will discharge the patient the next day.

It usually takes about a week or two to recover, but your doctor can give you an exact recovery time frame based on how much scarring is present in your heart. You must get plenty of rest and limit physical activity during that time.

Is coronary angiography needed before balloon surgery for mitral stenosis?

 

A coronary angiogram or CAG is done routinely during or before balloon surgery in all patients above the age of 40 years. The purpose to do coronary angiography is to rule out associated coronary artery disease. The cost of an angiogram is extra apart from balloon surgery cost and hospital stay cost. The cost of CAG is about 15000 to 30000 Indian rupees.

 

Will I need any particular medicines before BMV?

 

It is common to use medicines for mitral stenosis even after BMV.  Beta-blockers, like atenolol, are often used to reduce symptoms and prevent complications caused by high blood pressure. Diuretics such as Lasix help remove excess fluid from your body to alleviate symptoms. If you have heart failure due to mitral stenosis, diuretics can also be used as a form of treatment. the doctor prescribes antibiotics to prevent rheumatic fever that needs to be taken for a prolonged period

Will I need any particular medicines after PBMV?

 

It would help if you continued the antibiotics to prevent rheumatic fever as usual. need for other medications like beta-blockers and diuretics are decided case by case by the treating doctor.

Will I be able to get back to my normal activities after the surgery?

 

Following balloon mitral valvotomy, you’ll need to avoid exercise that puts stress on your heart and groin. You’ll be able to resume most normal activities after a few weeks, with specific activities being avoided for a few months. If you have any questions about what activities you can and cannot do, speak with your doctor about it.

 

How do doctors know whether balloon mitral valvotomy works for me?

 

The balloon mitral valvotomy procedure is an effective way to deal with mitral stenosis. However, it’s only appropriate for a particular type of patient—and there are specific pre-procedure tests your doctor will want to perform before recommending it to you. To make sure you can benefit from balloon mitral valvotomy and that you can avoid any complications during or after surgery, discuss your particular situation with your doctor first.

Your doctor performs a 2d echo test and TEE test (transesophageal echo test) to know if BMV works for you.

The following candidates with mitral stenosis are unfit for balloon mitral valvotomy

  1. A clot in the heart
  2. Severely thickened(calcified) mitral valve
  3. Have other associated valve diseases that need open heart surgery
  4. Mitral valve leaking or mitral regurgitation

 

 

Are there risks associated with the procedure?

 

The balloon mitral valvotomy procedure is widely considered to be a safe and effective treatment for patients with mitral stenosis. There are only rare incidences of infection, stroke, and death associated with it. As long as your doctor and their team are skilled at performing mitral valvotomy, there’s little reason to worry about complications or adverse side effects.

  1. Brain stroke
  2. Bleeding
  3. Infection
  4. Perforation of the heart leading to pericardial effusion (fluid around the heart) and cardiac tamponade
  5. Injury to blood vessels
  6. Mitral regurgitation
Complications of balloon mitral valvuloplasty such as brain stroke, bleeding, pericardial effusion
Complications of balloon mitral valvuloplasty

What happens if I decline balloon mitral valvotomy or am not a candidate?

 

If you don’t want BMV or are not a candidate, you’ll be prescribed medications to help reduce your symptoms and control your heart rate. Suppose that doesn’t work and your symptoms are severe. In that case, doctors might recommend open-heart surgery, and untreated severe mitral stenosis can lead to severe complications such as atrial fibrillation, brain stroke, and heart failure. It ultimately leads to sudden death.

Who should consider balloon mitral valvotomy?

 

If you suffer from mitral stenosis and are looking for a procedure to relieve your symptoms, balloon mitral valvotomy is an excellent option. Although a catheter-based surgery may sound scary, patients who undergo BMV (balloon mitral valvotomy) say it’s far less invasive than they expected.

 

Will Medicare or insurance cover balloon mitral valvotomy in Hyderabad?

 

Fortunately, Insurance will cover balloon mitral valvotomy as a treatment method for mitral stenosis.

Is there any chance of recurrence after BMV?

 

BMV is a palliative surgery and is not a permanent solution for mitral stenosis. Mitral stenosis invariably recurs after BMV, but this happens after 5 to 10 years. Still, you should consider bmv than open heart surgery if your doctor chooses balloon valvotomy.

 

Open heart surgery vs. balloon mitral valvotomy

 

The damaged mitral valve is replaced with a new valve with open-heart surgery. The new valves can be either tissue valves or mechanical valves. Open heart surgery is major surgery and needs to open the chest. It requires a prolonged hospital stay and takes more time to recover. One advantage of open surgery is that it is a permanent treatment for MS.

However, maintaining a mechanical valve is very difficult. Poor maintenance can lead to catastrophic complications. Therefore, doctors choose bmv over open-heart surgery.

 

BMV is a minimally invasive surgery with a short hospital stay and fewer complications. The downside is that BMV is a temporary treatment for mitral stenosis. Recurrence is expected after 5 to 10 years.

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