Balloon use helps heart valves.

Balloon use helps heart valves

Balloons, first used in hearts to open up narrowed blood vessels, can also free up stiffened heat valves, according to several studies presented this week in Dallas at the American Heart Association meeting. The procedure, known as balloon valvuloplasty, was first done in 1979 in children with congenital valve disease; its more recent application to adults represents a significant broadening of its horizons.

In addition to congenital causes, rheumatic fever and the general aging process can cause valve disease. The four valves in the heart, each several leaves of delicate tissue that jointly open in only one direction, keep blood headed the right way. Calcification of the valves partially fuses the flaps together. Malfunctioning valves can ultimately be deadly.

At the meeting, researchers from Asia, South America, Europe and the United States described positive results in trials of balloon valvuloplasty in dozens of adults. While techniques vary, the basic procedure, first done in adults in 1984, is to thread a balloon through a catheter into a sticky valve while the heart is beating. The balloon is then inflated for up to 40 seconds using a saline/dye solution, at a pressure of 45 to 60 pounds per square inch. The inflation splits the flaps of the valve apart, allowing them to open and close more freely.

William Grossman and his co-workers at Harvard Medical School have done balloon valvuloplasty on 76 people since October 1985. "Results in general have been quite good," he says. Grossman says the two who died within a week succumbed to preexisting damage, not to the valvuloplasty itself.

The current treatment for people with diseased heart valves is either to replace or to surgically slice apart the valve flaps. Tens of thousands of such operations are done annually. But many people with diseased valves are too old or infirm to withstand the surgery. The balloon procedure can be done with painkillers and local, rather than general, anesthesia, and the patient can leave the hospital within a few days, Grossman says.

He does not expect the technique to replace valve surgery, however. "This is definitely new and must be regarded as experimental," he says. People with leaky rather than stiff valves will not be helped by balloon valvuloplasty, and the procedure does not keep the opened valve from stiffening up again.

And what if the balloon bursts? It has happened, says Charles McKay of Los Angeles County/University of Southern California Medical Center, where 22 operations - some using two balloons in the same valve - have been done "with very encouraging results." But bursting hasn't been a problem - the deflated balloon is pulled out through the catheter, and the saline/dye solution flows harmlessly through the patient's bloodstream.