Q. Explain the procedure of Balloon Pulmonary Valvuloplasty?
Right heart study is done to measure the transvalvular gradient and exclude supravalvular and subvalvular components. A 5F sheath is placed in the right femoral artery for pressure monitoring and an 8F sheath is placed in the right femoral vein for the BPV procedure. An RV angiogram is performed in AP and lateral views to assess location of PV and for sizing of the pulmonary annulus. It is often necessary to oversize the balloon 25 to 30 per cent larger than the valve annulus diameter. In general balloon pulmonary valvuloplasty procedure is indicated if the resting peak systolic pressure exceeds 40mmHg. Lateral projection is best suited for the procedure. An end hole catheter is positioned into the left pulmonary artery. An exchange length guide wire is anchored in distal LPA. A double balloon technique is recommended if pulmonary annulus exceeds 18-19mm, or if the single balloon catheter required for the procedure is too large for introduction into the patient's femoral vein. With double balloon technique, the balloon diameter sum is 60 per cent more than the annulus diameter. The balloon valvuloplasty catheter is advanced across the valve and positioned with the valve in the midportion of the balloon. The valvuloplasty balloon or balloons are then inflated with, a mixture of saline and contrast, by hand, until the waist disappears. The procedure can be repeated if necessary for adequate pulmonary valve dilatation. The valvuloplasty catheter is removed and a wedge catheter is used to record the RV outflow tract gradient and cardiac output to document efficacy of the procedure followed by an RV angiogram. The acute and long-term results of this procedure have been very satisfying.