Balloon Pulmonary Valvotomy in India - Causes, Symptoms, Recovery and Treatment Cost

Balloon Pulmonary valvotomy is a minimally invasive surgical procedure that is used to treat a heart condition called pulmonic valve stenosis. Pulmonic valve stenosis is generally caused due to heart defects that develop before birth. Adults develop pulmonic valve stenosis as a result of any other illnesses. The pulmonic valve is one of the four valves of the heart. Each valve has different functions. The Pulmonic valve’s function is to flow the deoxygenated blood from the heart to the lungs where it gets oxygenated. The problem in this valve is called pulmonic valve stenosis.

Balloon Valvotomy is a minimally invasive surgical procedure that is used to treat valve defects. This procedure is believed to show good long-term results. It is also the safer alternative as compared to other highly invasive surgery that may have some major complications. In many cases, this condition can be treated with medicines. However, in severe cases, the doctor suggests you for the treatment called Balloon Valvotomy.

In Africa, the valvotomy procedure is used for the treatment of valve stenosis. However, due to lack of adequate training and regulation, the patients face complications after the procedure. which results in more spending and less benefit. In India because of proper hands-on training and regulations, the chances of complications after the treatment have been reduced. There are doctors with much experience who work with accuracy and precision. The cost of treatment in India is also affordable than other countries.

What Are The Causes Of Pulmonic Valve Stenosis In Newborns?

Pulmonic valve stenosis is generally caused by heart defects that develop before birth. Hence, it is a congenital condition, i.e. it is developed when the baby is in the womb. Many factors can lead to this condition. There are:

• Defects in the genes and chromosomes of the child, like the Down Syndrome
• Severe Medication, drug or alcohol abuse during pregnancy.
• Viral infection during the initial months of pregnancy.
• If the mother was having type 1 or type 2 diabetes, it might have interfered with the development of the child's heart.
• Pulmonic valve stenosis appears to run in families and is associated with many genetic syndromes
• Smoking during pregnancy increases the risk of having a child with Pulmonic valve stenosis.

Pulmonic Valve Stenosis In Newborn Children?

This condition arises when the pulmonic valve doesn’t grow properly in a baby during the initial eight weeks of the pregnancy. The pulmonic valve connects the heart with the lungs. It has three flaps/cusps, that act like a doorway that allows the blood to flow from the right ventricle of the heart to the pulmonary artery which leads to the lungs and prevents the blood from flowing backward, i.e. from the pulmonary artery to the right ventricle.

When the child has pulmonary stenosis, it is difficult for the flaps to open and the flaps may be stuck together. This can happen if the flaps have become thick. In some cases, the flaps become narrow.

What Are The Symptoms Of Pulmonic Valve Stenosis In A Newborn Child?

In most cases, the child with mild pulmonic valve stenosis does not show or show few symptoms. The child may develop the symptoms later in life. However, in severe cases of this condition, we can see some symptoms. The most common symptoms include:

• Fast breathing
• Difficulty in breathing
• Increased heart rate
• Fainting
• Pain in the chest
• Low oxygen due to which the fingers and lips becomes bluish colour
• Swelling in the feet, legs, abdomen, ankles, or face
• A murmur sound is heard under the stethoscope
• Prominent and enlarged jugular vein

Pulmonic valve stenosis can lead to sudden death in severe instances, therefore Balloon pulmonic valvotomy is recommended as soon as Pulmonic valve stenosis is diagnosed.

How Is Pulmonic Valve Stenosis Diagnosed In A Child?

Your healthcare provider will ask a few questions about the child’s symptoms and medical history. The doctor will conduct a physical exam. He may hear a murmur sound when examining using the stethoscope. If the doctor notices some symptoms of the valve stenosis, he may run the following tests on the child:

• X-ray: A chest X-ray will be taken which will show any changes in the heart.
• Electrocardiogram (ECG): The ECG shows the heartbeats of the child. The irregular heartbeats known as arrhythmia can be detected by this method.
• Echocardiogram: It is commonly known as an ultrasound test. It uses sound waves and shows the moving picture of the heart. This test is the most helpful diagnostic technique in case of valve stenosis.
• Cardiac Catheterization: In this procedure, first, a medication will be given to the child to make her/him relax. Then, a catheter which is a thin and flexible tube will be inserted into the artery either from the groin, leg, or arm and is moved towards the heart. A contrast dye is injected through the catheter so that the doctor can visualize the structures inside the heart. The doctor will examine all the valves of the heart.

NOTE: A child may not need to have a cardiac cath if the diagnosis is successfully made by the echocardiogram.

How is Pulmonary Artery Stenosis Treated in Newborns

Mostly, the mild pulmonary stenosis does not require major treatment, it can be treated with medication. However, in severe cases of the condition, the infant may need to be admitted to the ICU (Intensive Care Unit). The type of treatment a patient will get depends on the severity of the condition.

The doctor may give a medicine that keeps the valve open so that the blood can flow to the lungs. The doctor will proceed with the procedure once the child is stabilized. Based on the severity of the condition the doctor may proceed with one of these treatments:

• Balloon Valvuloplasty: This procedure is mainly used for the diagnostic test. A catheter having a balloon in its tip is incorporated into the artery from the legs or arms and it is moved towards the heart. Once the catheter reaches the heart, the doctor will make the balloon inflate for a short time so that it opens. NOTE: Children who have had balloon valvuloplasty treatment may need to consume antibiotics to prevent infection in the heart.
• Valvotomy: This procedure is used to remove the damaged or scar tissue from the pulmonic valve flaps. It helps the valve to open as it should normally open.
• Patch Enlargement: The patches are used to treat the narrow areas of the valve. It enlarges the narrowed area of the valve. The patch is either placed in the right ventricle or in the pulmonary artery.
• Valvectomy: This procedure’s name itself suggests removal. This procedure is performed to remove the damaged valve. The patch is used to help the blood flow from the heart towards the lungs. The valve is replaced when the child grows up and reaches the adult stage.
• Pulmonic Valve Replacement: Some children may need valve replacement surgery. The damaged valve is removed and replaced with a tissue valve taken either from a pig or a human.

NOTE: The children who have had the valve replacement surgery may need to take antibiotic medicines before any medical procedures in future.

How Is Balloon Valvuloplasty For Pulmonic Valve Stenosis Performed?

The balloon valvuloplasty also known as balloon valvotomy, is a procedure used to treat heart valve disease in the patient. If the procedure is done for mitral valve treatment, then it is called balloon mitral valvotomy, if it is used for aortic valve treatment, it is known as aortic balloon valvotomy. Similarly, here it is used for pulmonic valves. Hence, it is called Pulmonary Balloon valvotomy.

Your doctor will perform the balloon valvotomy procedure by following the steps mentioned below:

• First, you will be given anesthesia to make you comfortable and ease the pain during the procedure.
• Next, your doctor will sanitize the area at your groin and insert a catheter which is a thin and flexible tube in the blood vessel present at the groin. And then carefully moves it toward the heart. The X-ray or echocardiographic images will guide the doctor to move the catheter.
• Then, the doctor may inject a contrast agent/ dye through the catheter to make the narrowed area clearly visible.
• The doctor will then pass a balloon through the catheter up to the narrowed heart valve, and inflate the balloon once it is in the position. The doctor may need to inflate and deflate the balloon a few times to make the valve opening to expand.
• Once the heart valve is opened, the doctor will carefully remove the balloon and then the catheter.
• The pressure is applied at the site of catheter insertion to make the bleeding stop. And then the incision is closed with the required dressing.

Best Balloon Pulmonary Valvotomy Doctors in India

1. Dr. T S Kler

2. Dr. Ashok Seth

3. Dr. Naresh Trehan

4. Dr. Kewal Krishan

Recovery After Balloon Valvotomy Treatment

After a successful procedure, you will be put under observation for a few hours. Your heart rate, oxygen, site of the catheter insertion, etc. will be monitored. You will have to lie flat on the bed and avoid folding your leg for at least 3 to 6 hours. Your doctor will advise you to drink plenty of water so that the contrast agent/dye used during the procedure is eliminated from the body as soon as possible. You will need to use a urinal or a bedpan because of this reason.

Your healthcare provider will give you guidelines to follow after recovery such as maintaining a healthy lifestyle, what are the things that you should avoid and what should you include in your diet. He will also guide you about how and when to take the medicines if there are any. You will need not to perform heavy exercises after the procedure as it can cause exertion at the site which might give rise to certain complications.

What is the Cost of Valvuloplasty in India?

The average cost of valvuloplasty in India is 3900 to 6000 USD which is much cheaper than other countries. The cost of the same procedure in the US is 8,298 to 10,875 USD, in Turkey 15,200 to 22,800 USD, and in Malaysia 6400 to 9600 USD.

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