After preparing and anesthetizing the catheter insertion site, the physician inserts a catheter into the femoral artery (for left heart valves) or femoral vein (for right heart valves). He then passes the balloon-tipped catheter through this catheter and, guided by fluoroscopy, slowly threads it into the heart.

Next, he positions the deflated balloon in the valve opening and repeatedly inflates it with a solution containing normal saline solution and a contrast medium. As the balloon inflates, the valve leaflets split free from one another, permitting them to open and close properly and increasing the valvular orifice.

Valvuloplasty is considered a success if hemodynamic pressure decreases across the valve after balloon inflation. If it does, the physician removes the balloon-tipped catheter. However, he may leave the femoral catheter in place in case the patient needs to return to the laboratory for a repeat procedure.

Balloon valvuloplasty can worsen valvular insufficiency by misshaping the valve so that it doesn’t close completely. Another serious complication is embolism caused by pieces of the calcified valve breaking off and traveling to the brain or lungs. In addition, valvuloplasty can cause severe damage to the delicate valve leaflets, requiring immediate surgery to replace the valve. Other complications include bleeding and hematoma at the arterial puncture site, arrhythmias, myocardial ischemia, myocardial infarction (MI), and circulatory insufficiency distal to the catheter entry site.

Elderly patients with aortic disease frequently experience restenosis 1 to 2 years after undergoing valvuloplasty. Fortunately, the most serious complications of valvuloplasty—valvular destruction, MI, and calcium emboli—rarely occur.

Anxiety related to valvuloplasty. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will: