Cardiovascular diseases remain a serious global health threat...
According to the Health Minister of Indonesia, there are about 651,481 deaths due to cardiovascular diseases per year. This has made cardiovascular disease the highest mortality scoring non-communicable disease in the last few years. One of the most common heart conditions is leaky valves. The heart has 4 valves, one of which is the mitral valve. This valve connects the left atrium and the left ventricle.
The mitral valve will open when blood flows from the left atrium and fills the left ventricle (diastolic phase) and will close when the left ventricle pumps blood for the whole body. Mitral valve leakage happens when this valve didn’t close completely, which led to some blood going back to the left atrium. This condition may cause the heart to be overworked, which also influences the cardiac output. So, this is what mitral valve regurgitation or mitral valve leakage is all about.
What is the Cause of Mitral Valve Regurgitation?
Some conditions or sickness that can cause mitral valve regurgitation:
Connective tissue disorders, affecting the heart valves
Degeneration of valvular tissue caused by the aging process
Cardiomyopathy
Congenital heart disease
Endocarditis
Heart damage caused by a heart attack
Cardiac tumors
Rheumatic heart disease
Trauma
It is important to know, lite mitral valve regurgitation oftentimes will not have any symptoms. On the other side, in the medium or heavy cases, symptoms are more likely to show:
Chest pain
Heavy coughing
Losing consciousness
Heart palpation
Shortness of breath
Feet swelling
How to Handle Mitral Valve Regurgitation?
Based on the information above, it can be concluded that when it comes to mitral valve regurgitation, there are 2 procedures that can be performed: valve replacement and valve repair. We’ll talk more about those 2 procedures, below:
1. Mitral Valve Replacement
This procedure will be recommended when your mitral valve already has so much damage. In this procedure, a cardiologist will swap the broken valve with a new valve that is made from metal (mechanical valve) or animal (bioprosthetic valve). Usually, the recovery time for this procedure is 1 month.
Side effects of mitral valve replacement:
Relatively high risk procedure (bleeding, stroke, infection, arrhythmia, etc.)
The usage of a mechanic valve will result in consuming strong blood thinning medicines to keep it functioning. Therefore, bleeding risk will increase in some of the population:
The elderly
Patients with blood clotting disorders
People who have gastric ulcer
Kidney failures
Multiple comorbidities
The bioprosthetic valve needs to be changed after ±10 years, and redoing the procedure may come with a higher risk.
2. Mitral Valve Repair
Another option for mitral valve regurgitation is mitral valve repair. In this procedure, your native mitral valve will be preserved and repaired so that it can close effectively. Your doctor may do one of the following procedures:
Surgical
Annuloplasty, attachment of a ring to minimize valve’s ring size.
Non-surgical
MitraClip, minimally invasive procedure to de-escalate mitral valve leakage.
Surgical and non-surgical procedures each has its own advantages and limitations. However, in this article, we will discuss in more detail about heart valve repair using the MitraClip procedure.
The MitraClip procedure is a minimally invasive technique used to reduce mitral valve regurgitation. It is performed without open-heart surgery by inserting a catheter through a blood vessel in the groin and advancing it to the heart, where a small clip is placed to grasp the mitral valve and allow it to close more tightly.
This procedure allows for faster recovery and is an option for high-risk patients who may not be suitable candidates for major surgery. Although it is a relatively new procedure, MitraClip offers significant benefits by reducing mitral valve regurgitation without the need for open-heart surgery.
The MitraClip device is made of nickel/titanium, cobalt, chromium, and polyester components. It is designed to grasp the two leaflets of the mitral valve at the site of leakage. One or more clips may be used to achieve optimal results.
Stages of the MitraClip Implantation Procedure
1. Pre-procedure Preparation
Before proceeding with the procedure, you will need to go through some tests. These tests are done to make sure you are in the optimal condition for the procedure. Here are some of the tests that you need to do:
Blood test
Electrocardiogram (ECG)
Dental check
Transesophageal echocardiography (TEE), which is a cardiac ultrasound performed by inserting a small probe through the mouth into the esophagus to obtain more detailed images of the heart.
Pre-anesthesia check
2. MitraClip Implantation Process
The following are some of the steps that your doctor and medical team will perform during the MitraClip implantation process:
The doctor makes a small incision in the groin (leg).
A catheter is inserted through a blood vessel and guided to the right atrium.
Guided by TEE and fluoroscopy, the doctor punctures the atrial septum to access the left atrium.
A steerable guide catheter is advanced into the left atrium.
The Clip Delivery System carrying the MitraClip is guided toward the mitral valve.
The position of the clip is adjusted with precision.
The clip is opened and used to grasp the two mitral valve leaflets at the site of leakage.
Evaluation is performed using TEE to assess the improvement in regurgitation.
Possible Complications
Even though implantation of MitraClip is a relatively safe procedure, it still comes with some complications:
Recovery Process After MitraClip Implantation
After MitraClip implantation, patients will undergo the following care and recovery process:
1. Hospital stay (2–3 days)
You will be admitted to the Intensive Care Unit (ICU) for further observation. During this time, nurses will monitor your blood pressure, heart rate, oxygen levels, and any signs of complications.
A follow-up echocardiogram will be performed to ensure that the clip is properly positioned.
In general, you will need to stay in the hospital for 2–3 days, depending on your condition.
2. Home Recovery (Long Term)
Physical activity restrictions are usually not required for a long period. Most patients are able to return to normal activities within 24–48 hours after the procedure. However, during the first week, you will be advised to avoid strenuous activities such as heavy lifting or intense exercise. You will also be advised to continue taking heart medications as prescribed, according to your individual needs.
Routine control schedule:
Make sure you do routine control 2–4 weeks after you get discharged from the hospital.
Reconfirm your schedule before leaving the hospital.
Benefits and Outcomes of MitraClip Implantation
MitraClip implantation has been proven to provide significant improvements in the quality of life of patients by treating mitral valve regurgitation. With the reduction of backward blood flow through the valve, major symptoms such as shortness of breath, fatigue, and swelling improve rapidly.
Altius Hospitals: Successful First MitraClip Implantation in West Java
The successful completion of the first MitraClip implantation at Altius Hospitals in West Java marks a significant milestone in the treatment of heart valve disease. The procedure was led by dr. Antono Sutandar, Sp.JP(K) together with a highly experienced team of cardiology specialists. Altius Hospitals continues to strengthen its reputation as a leading cardiovascular referral center, supported by:
State-of-the-art cardiac catheterization laboratory (Cathlab).
Strict safety protocols and quality control measures.
A team of experienced specialist doctors and nurses in structural heart procedures.
Reference
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