Balloon Pulmonary Valvuloplasty (BPV)

Background: 

The pulmonary valve is located between the right ventricle, the main pumping chamber on the right side of the heart, and the pulmonary artery that supplies blood to the lungs.  The valve becomes narrow in some individuals. It may be an isolated problem or may occur in association with certain congenital heart defects. A good example is Tetralogy of Fallot where there is also a defect between the two ventricles (VSD).  If the narrowing is severe it requires relief. 

 

What is BPV?

The balloon pulmonary valvotomy or BPV procedure involves placement of a balloon catheter across the narrow valve and inflating it to get rid of the narrowing.  The balloon is typically passed over a wire that is previously placed across the narrow valve.

 

When is it done?

The commonest reason to do a BPV is isolated pulmonary valve stenosis.  In these patients the pulmonary valve is narrow often because the three leaflets of the valve are fused at the margins.  The BPV procedure is often very effective in completely relieving the problem thereby effecting a ‘cure’. 

Increasingly, BPV is now being done for selected babies with other conditions such as Tetralogy of Fallot (TOF) to provide temporary relief until definitive surgery can be undertaken.  These patients are often newborns or at most a few months old. The BPV procedure increases blood flow to the lungs and improves oxygen level until definitive surgery can be undertaken.

 

What are the complications?

For isolated pulmonary stenosis, complications with BPV are generally exceptionally rare unless the procedure is done at a very young age such as in newborns.  These babies could develop severe spasm in the region of the balloon dilation and as a result there is marked reduction in blood supply to the lungs. With adequate precautions and use of general anesthesia the procedure is, by and large, quite safe.

 

What results can be expected over the long term period?

For the vast majority of patients with severe isolated narrowing of the pulmonary valve, there is permanent relief after BPV. These patients do very well. Later in  life the pulmonary valve may start to leak and this may need follow up visits every few years.  

Selected patients do not have a predictable result. Typically these are patients with Noonan syndrome where the relief after BPV is incomplete. These patients may eventually require surgery.