Balloon aortic valvotomy (BAV)
Balloon aortic valvotomy is usually done as a palliative procedure for those at high risk for open aortic valvotomy or aortic valve replacement. A guide wire is introduced through the femoral artery into the aorta. The stenotic aortic valve is crossed, often requiring multiple attempts and a long time. A long sheath is introduced over the guide wire and through the sheath a Mansfield balloon is introduced and positioned across the aortic valve. The balloon is manually inflated using a large syringe filled with dilute contrast. Care is taken to avoid melon seeding of the balloon into the aorta during inflation. If there is difficulty in maintaining the balloon across the aortic valve during inflation, temporary ventricular pacing at high rate can reduce the cardiac output and give stability to the balloon. Balloon is deflated and the trans valvar gradient reassessed for success of the procedure. Repeated dilatations can be given if necessary. There is a small but significant risk of development of aortic regurgitation during the procedure, which if severe, can lead on to pulmonary edema. Certain types of balloons can rupture while attempting to dilate a calcified valve as a palliative procedure. The balloon should be de-aired and filled with dilute contrast to avoid the chance of air embolism in case of balloon rupture during dilatation.