Balloon Pulmonary Valvotomy (BPV)—also called Balloon Pulmonary Valvuloplasty—is a minimally invasive catheter-based procedure used to treat Pulmonary Valve Stenosis, a condition in which the valve between the right ventricle and pulmonary artery becomes narrowed, restricting blood flow to the lungs.
This procedure is especially common in children, infants, and even newborns, but can also be performed in older patients with congenital stenosis.
Balloon Pulmonary Valvotomy safely opens the narrowed pulmonary valve, improves blood flow to the lungs, and avoids open-heart surgery.
What Is Pulmonary Valve Stenosis?
Pulmonary stenosis is usually congenital (present at birth) and may range from mild to severe. If untreated, it may lead to:
- Breathlessness
- Fatigue
- Cyanosis (bluish skin) in newborns
- Poor feeding or poor weight gain in infants
- Chest pain or fainting in older children/adults
- Right-sided heart enlargement and failure
When Is BPV Recommended?
Balloon pulmonary valvotomy is the preferred first-line treatment when:
- Right ventricular pressure is >50% of systemic pressure
- Doppler gradient is moderate to severe (≥50–60 mmHg)
- Symptoms like breathlessness, cyanosis, or exercise limitation are present
It is effective in:
- ✔ Typical dome-shaped pulmonary valves
- ✔ Critical pulmonary stenosis in newborns
- ✔ Post-surgical restenosis
- ✔ Congenital isolated pulmonary valve narrowing
Not suitable in:
- ✘ Dysplastic valves in syndromes like Noonan Syndrome (may still benefit but results may vary)
- ✘ Severe pulmonary regurgitation
- ✘ Complex congenital heart diseases requiring surgery
How BPV Is Performed
- ✔ Performed under sedation or general anesthesia (varies with age)
- ✔ A catheter is inserted through the femoral vein
- ✔ A balloon is positioned across the pulmonary valve
- ✔ The balloon is inflated to stretch/open the valve
- ✔ Catheter is removed; no stitches required
Benefits of Balloon Pulmonary Valvotomy
Major global clinical studies (including CCHD registries, Mullins & McCrindle series) show:
- Excellent long-term results
- Low complication rate
- Reduced symptoms and normalization of right ventricular function
- Avoids open-heart surgery in most patients
Special Note: Newborns With Critical Pulmonary Stenosis
In newborns with severe narrowing and low oxygen levels, BPV is lifesaving.
- Performed urgently
- May require temporary prostaglandin infusion (PGE1) to keep the ductus open
- Rapid improvement in oxygen saturation after procedure
