The aortic valve controls the flow of blood from the left ventricle into the aorta, which supplies oxygen-rich blood to the rest of the body. When the valve becomes narrowed, a condition known as aortic stenosis, the heart has to work harder to pump blood through the restricted opening. Aortic valvuloplasty uses a small balloon to widen the narrowed valve and improve blood flow.
During the procedure, a thin catheter with a balloon at its tip is guided through a blood vessel, usually from the groin, toward the aortic valve. Once correctly positioned, the balloon is briefly inflated to stretch the narrowed valve opening and then deflated and removed. Aortic valvuloplasty may provide improvement in blood flow and symptoms, although the valve can narrow again over time. It is therefore used selectively, particularly in certain patients who are not immediate candidates for definitive valve replacement or who require temporary improvement before another intervention.
Aortic stenosis can develop for several reasons. In older adults, the most common cause is progressive calcification and thickening of the aortic valve over time. Calcium deposits can make the valve leaflets stiff and prevent them from opening fully. Aortic stenosis can also occur because of a congenital bicuspid aortic valve, in which the valve has two leaflets instead of the usual three.
Other causes can include rheumatic heart disease and, less commonly, conditions that damage or alter the structure of the aortic valve. The underlying cause, severity of narrowing and overall health of the patient are important factors when determining whether aortic valvuloplasty or another treatment approach is appropriate.
Mild aortic stenosis may not cause noticeable symptoms for many years. As the narrowing becomes more severe, the heart may struggle to pump enough blood to meet the body’s demands. Patients may experience shortness of breath, particularly during physical activity, fatigue, reduced exercise tolerance, chest discomfort or dizziness.
In more advanced cases, aortic stenosis can cause fainting or symptoms of heart failure, such as breathlessness while lying down or swelling of the legs and ankles. Symptoms should not be ignored, particularly when they occur during exertion, because severe aortic stenosis can become a serious cardiovascular condition requiring timely treatment.
The evaluation of aortic stenosis begins with a detailed medical history and cardiovascular examination. A heart murmur may be detected during a physical examination and can lead to further testing. Echocardiography is the primary investigation used to assess the aortic valve, measure the severity of narrowing and evaluate the heart’s pumping function.
Additional investigations may be recommended when more detailed information is required. An electrocardiogram can assess the heart’s electrical activity, while chest imaging and cardiac CT may provide additional information about the heart, aorta and degree of valve calcification. In selected patients, cardiac catheterization may be performed to assess pressures within the heart and blood vessels and to help plan an appropriate intervention.
Treatment for aortic stenosis depends on the severity of the valve narrowing, the presence of symptoms, heart function, age, overall health and the patient’s suitability for different procedures. Patients with mild or moderate disease may be monitored regularly, while medications may be used to manage associated conditions and symptoms. However, medications cannot directly remove the narrowing of a severely stenotic aortic valve.
Aortic valvuloplasty may be considered in selected patients to temporarily improve blood flow through a severely narrowed valve. It may be used in certain younger patients with specific valve conditions, as a bridge to definitive treatment, or in patients who require stabilization before transcatheter or surgical aortic valve replacement. For many patients with severe symptomatic aortic stenosis, transcatheter aortic valve replacement or surgical aortic valve replacement may provide more definitive treatment. The most appropriate approach is determined after comprehensive evaluation by an experienced heart valve team.
After aortic valvuloplasty, patients are monitored to assess the heart, blood pressure, heart rhythm and the condition of the catheter access site. Because the procedure involves a blood vessel, patients are generally advised to avoid strenuous activity for a period recommended by their treating doctor while the access site heals.
Follow-up care is important because aortic valvuloplasty does not always provide a permanent solution to valve narrowing. The valve may gradually become narrowed again, particularly when significant calcification is present. Regular clinical assessments and echocardiograms help monitor valve function and determine whether additional treatment, such as transcatheter or surgical valve replacement, may eventually be required.
Aortic valvuloplasty is a minimally invasive procedure, but it carries potential risks. These may include bleeding or bruising at the catheter insertion site, damage to a blood vessel, abnormal heart rhythms, blood pressure changes or reactions related to medications or contrast material used during the procedure. In some cases, the aortic valve may develop or worsen leakage after balloon treatment.
More serious complications, although uncommon, can include blood clots, stroke, infection, significant damage to the aortic valve or surrounding structures and cardiovascular instability. The risk varies according to the patient’s age, general health, severity of aortic stenosis and other medical conditions. Careful assessment before the procedure and appropriate monitoring during and after treatment help minimize these risks.
Patients experiencing unexplained breathlessness, chest discomfort, dizziness, fainting, unusual fatigue or a significant reduction in exercise capacity should undergo a cardiovascular evaluation, particularly if a heart murmur or known aortic valve disease is present. Early diagnosis allows the severity of aortic stenosis to be assessed and appropriate treatment to be planned before significant complications develop.
Individuals already diagnosed with aortic stenosis should maintain regular follow-up with their cardiologist, even if symptoms are mild or absent. If symptoms suddenly become severe, especially chest pain, fainting or significant difficulty breathing, immediate medical attention is necessary. Timely evaluation can help determine whether continued monitoring, aortic valvuloplasty, transcatheter aortic valve replacement or surgical valve replacement is most appropriate.
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