Valvuloplasty

Valvuloplasty in Turkey: what it is and how it works

Valvuloplasty, more fully balloon valvuloplasty or balloon valvotomy, is a catheter procedure that widens a narrowed heart valve without open-heart surgery. A thin tube (catheter) is guided through a blood vessel, usually in the groin, to the stiff valve. A balloon at its tip is placed across the valve and inflated for a few seconds, which stretches the valve opening and splits fused edges so that blood can pass more freely. The balloon is then deflated and removed. No valve is replaced and no chest incision is made.

The technique is used for stenosis (narrowing) of three valves: the mitral valve, most often narrowed by rheumatic fever; the pulmonary valve, usually a condition present from birth; and, in selected cases, the aortic valve. This guide explains how it works, which valve and patient suit it, what the evidence says, what it costs in Turkey compared with other countries, how recovery goes and what the risks are. For the wider specialty see our cardiac surgery treatments in Turkey.

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Which valves can be treated with a balloon?

The result depends heavily on which valve is narrowed and why.

• Mitral valve (percutaneous mitral balloon valvuloplasty). This is the most firmly established use. In rheumatic mitral stenosis the leaflets fuse at the edges and the balloon can split them apart. The catheter reaches the left atrium by passing through the thin wall between the two upper chambers (a transseptal puncture).
• Pulmonary valve. Balloon valvuloplasty is the standard first treatment for pulmonary valve stenosis in children and many adults, with durable results.
• Aortic valve. The valve in older adults is often stiff with calcium, so the benefit is usually short-lived. It is mostly used as a temporary measure or as a bridge to a valve replacement, particularly in very ill patients.
• Tricuspid valve. Rarely treated this way.

A balloon cannot fix a valve that leaks; for regurgitation the options are repair or replacement.

Does valvuloplasty work? What the evidence says

For the right patients it works very well. In suitable rheumatic mitral stenosis, balloon valvuloplasty enlarges the valve area, relieves breathlessness and gives results comparable to surgical widening in the first years, with a much smaller procedure; many patients stay free of further intervention for ten to fifteen years. In pulmonary stenosis the long-term results are excellent. In calcific aortic stenosis the evidence is clear that the valve tends to narrow again within months, and balloon treatment does not improve long-term survival, so it is not an alternative to replacement for most people. Suitability is judged using an echocardiogram score of leaflet stiffness, thickness, calcium and the structures below the valve (the Wilkins score), and by excluding clots in the left atrium.

Valvuloplasty cost in Turkey compared with the UK, US and Germany

The figures below are approximate ranges, not hospital quotes. They assume an uncomplicated adult mitral or pulmonary procedure with a short stay.

What changes the price: the valve involved, whether an oesophageal echo (a camera probe through the mouth) is used to guide the procedure, anaesthesia, the number of nights in hospital, any complication that needs a longer stay and the pre-procedure tests. A package normally includes the diagnostic tests, procedure, cardiologist and anaesthetist, ward or monitoring stay, medication and airport transfers. Ask for the list in writing.

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Balloon, repair or replacement: how do the options compare?

If your valve is not suitable for a balloon, surgery is the next step. Mitral valve repair keeps your own valve; mitral valve replacement and replacement of the aortic valve insert an artificial valve and are the standard treatments for calcified or leaking valves.

The cardiologist decides on the basis of the echo and sometimes a transoesophageal echo, so send recent reports before any quote is final.

Who is a good candidate for valvuloplasty, and who is not?

A good candidate has symptomatic or severe mitral stenosis with flexible valve leaflets, little calcium, no more than mild leakage of the valve and no clot in the left atrium. Pregnant women with severe mitral stenosis are sometimes treated this way when symptoms cannot be controlled with medicines, with shielding of the abdomen. The balloon is not advised if a left atrial clot is found, if there is moderate or severe regurgitation, if the valve is heavily calcified, or if another heart operation is needed anyway, such as a bypass. In that case a combined operation is usually planned instead of treating one problem at a time.

How is valvuloplasty done, step by step?

1. Preparation. Blood tests, ECG, chest X-ray and echocardiography; blood thinners are adjusted and you fast for several hours.
2. Anaesthesia. Local anaesthetic at the groin with light sedation; sometimes general anaesthesia when a camera probe is used.
3. Access. A catheter is introduced through the femoral vein (mitral and pulmonary) or artery (aortic) under X-ray guidance.
4. Crossing the valve. For the mitral valve the catheter crosses from the right to the left atrium through the septum, then across the valve.
5. Dilation. The balloon is inflated, usually two to four times, while pressures and echo are checked.
6. Finish. The catheter is removed and the groin is pressed or closed.

The procedure takes about one to two hours. Compared with a procedure such as coronary stenting, which opens arteries, valvuloplasty opens a valve, although both use a catheter through the groin.

Recovery after valvuloplasty: hospital stay and weeks at home

You lie flat for a few hours to protect the groin and usually stay in hospital for one to three nights, with an echocardiogram the next day to check the new valve opening and look for leakage. Most people walk the next day and fly home within about three to five days if the check is satisfactory. Expect a bruise at the groin, which can last two weeks. Breathlessness often improves within days to weeks. Light work can resume after about a week, heavy lifting and sport after two weeks, and a follow-up echo is advised at three to six months and then every year. A trip of four to six nights covers the procedure and the pre-travel check.

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What results can I expect, and how long do they last?

If the procedure succeeds, the valve area roughly doubles and symptoms improve soon afterwards. A successful mitral result is generally defined as a larger valve area without significant new leakage. Over years the valve can narrow again, particularly with continued rheumatic activity, and some patients later need a second balloon or surgery. In rheumatic disease, preventing further rheumatic fever with long-term penicillin, where advised, protects the result. In aortic disease expect temporary benefit unless a replacement follows. A realistic expectation is that valvuloplasty buys time and symptom relief and delays surgery, but not that the valve returns to normal.

What are the risks of valvuloplasty?

Complications are uncommon in experienced hands but include bleeding or bruising at the groin, a new or worse leak of the valve (the most important mitral risk, which occasionally needs urgent surgery), a tear in the heart wall causing fluid around the heart (tamponade), stroke from a clot or calcium fragment, rhythm disturbance and rarely death. For the aortic valve the risks are higher in older patients with calcified valves. Reliable information is available from the NHS, the British Heart Foundation and the American College of Cardiology. After going home, seek help for severe breathlessness, chest pain, fever, a swelling or bleeding in the groin, or signs of stroke.

How to choose a cardiology team, and questions to ask

Choose a cardiologist registered in Turkey who performs valve procedures regularly, in a licensed hospital with a catheter laboratory, echocardiography, cardiac anaesthesia and an on-site cardiac surgery team in case of emergency. Red flags include a fixed price without seeing your echo, no discussion of surgery as an alternative, no pre-procedure check for clot and unclear aftercare. Read how our process works and use the free quote page to send your reports. Useful questions:

• Is my valve suitable for a balloon, and what is my echo score?
• Will you check for a clot in the left atrium before the procedure?
• Is a cardiac surgeon on site if something goes wrong?
• How long should the benefit last, and what follow-up will I need?
• Who reviews my echo and symptoms after I return home?

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Hospitals with Cardiac Surgery in Turkey

Academic Hospital

Üsküdar, Istanbul

MoHHealth Tourism Licence+2

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Lokman Hekim Istanbul Hospital

Pendik, Istanbul

JCIMoH+2

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