BALLOONING OF TIGHT VALVES OF HEART

The heart has four valves. The function of these valves is to ensure that blood flows only in one direction i.e. forward and not backward. Diseases involving these valves are common and can be congenital (i.e. by birth) or acquired in origin. Commonly, diseases which involve heart valves lead to narrowing or tightening of these valves so that there is obstruction to smooth flow of blood across them. As a result pressure builds up in the heart chamber just before the affected valve which can lead to symptoms such as breathing difficulty, accumulation of flud (water) in different parts of the body such as lungs, abdomen and fact, blood in sputum, pain in abdomen, weakness, jaundice etc.
Till about 1980s, the only treatment of these tight valves was surgery wherein surgeon, at the time of open heart surgery, splits the narrow valve with a knife or, if the valve is too much distorted, replaces them with artificial valves. However, over last 15 years or so, these tight valves can be treated by heart specialists without surgery, a technique commonly called 'ballooning' of tight valves of heart. In this technique an appropriate sized balloon is positioned across the narrow valve. After making sure that the balloon is in adequate and correct position, it is inflated with the help of a syringe held in the hands of the operator. The balloon then inflated is kept across the tight valve for 5-10 seconds and is rapidly deflated followed by its removal. The inflated balloon causes splitting of the tight and narrow edges of affected valve thereby leading to its relaxation and opening; the latter then causes smoother blood flow across them with consequent fall in pressure in the chamber before the affected valve. For the ballooning procedure, the patient is admitted in the hospital for 2-3 days. A careful echocardiography (ultrasound) examination of the heart is mandatory before the procedure. Important point to be excluded is that there should be no significant leakage of the valve along with its narrowing, a common association with a tight valve; if more than moderate (or significant) leakage of the valve is associated with tightening, ballooning treatment is not advisable because in such situations leakage of valve may increase after ballooning. Other points to be looked for before taking a patient for ballooning are detail anatomy (or structure) of the affected valve including its movement, deposition of calcium, if any on the affected valve etc.
The ballooning technique, as described above, is performed in fully equipped catheterization laboratory which is a costly set-up and not readily available. In addition, equipments used for ballooning of tight valves are imported and hence costly. Unfortunately, diseases of these valve affect individuals belonging to lower and middle economic groups who can not afford these costly procedures easily. Efforts are being made to bring down the cost of the procedure without catheterization laboratory thus bringing down the cost of the procedure.