Mitral valve disease: Percutaneous interventions

Overview

Mitral valve disease is classified into two types.

• Mitral regurgitation (MR): This is when the mitral valve leaflets do not connect and form a seal that prevents blood from going back from the heart to the lungs.
• Mitral stenosis (MS): When a person has mitral stenosis, their mitral valve leaflets are scarred, impeding proper opening and resulting in the backup of blood into the lungs.

Both types of conditions can lead to breathing difficulties, increased fatigue, and swelling in the feet, legs, and abdomen. Surgery is often necessary to address these issues, but some individuals might benefit from less invasive options like percutaneous or catheter-based treatments.

The choice between surgical and percutaneous interventions depends on various factors. To assist healthcare providers in making the best treatment decision, a thorough examination and tests such as CT scans and echocardiograms are necessary. This is because many treatments require a specific understanding of the patient’s anatomy, which can only be obtained through specialized imaging. To minimize the need for repeat testing, it is crucial to ensure that healthcare providers have access to prior test results and images.

Procedure

Mitral regurgitation:

The types of MR are degenerative mitral regurgitation (DMR) and functional mitral regurgitation (FMR). To determine the type of MR the patient has, they will have an echocardiography in addition to other diagnostic tests. When determining the appropriate course of treatment for a patient, the healthcare provider will take into account the patient’s kind of MR in addition to other relevant considerations.

• Degenerative mitral regurgitation:
  In most cases, heart surgery will be the best option for a patient with DMR who does not have a significant risk of complications from the surgery.
  The best course of treatment can be a catheter-based operation if they are high-risk due to their age, health issues, or other factors. The FDA-approved MitraClip and the clinical trial-based transcatheter mitral valve replacement (TMVR) are two examples of the treatment.
• Functional mitral regurgitation:
  In addition to other health problems, many FMR patients have an enlarged and/or weak heart. These may raise the possibility of issues following heart surgery. Additionally, surgery could not be a permanent solution as it is for people with DMR. There is a chance that the patient would benefit more from a catheter-based treatment. A MitraClip might be a suitable choice, depending on the anatomy. If not, your healthcare provider might discuss the option of participating in a clinical trial involving alternative catheter-based mitral valve repair devices or TMVR.

Mitraclip: For patients with DMR or FMR who are at a high risk of complications from open heart surgery, the FDA has approved the MitraClip.

Mitraclip is place by:

• The patient will be put under general anesthesia and made asleep throughout the procedure. They are therefore going to have a breathing tube, which will most likely be removed before they leave the operation room.
• A catheter, which is a long, thin tube, is used to implant the MitraClip.
• Through an incision at the top of the thigh, the catheter is inserted into a vein. To guide the device to the mitral valve, the healthcare provider uses echocardiography and X-rays. The MitraClip is positioned at the valve’s margins to allow them to connect and prevent blood flow backward. For optimal results, the patient might require multiple MitraClips.

Percutaneous annuloplasty: The FDA has not yet given its approval to these procedure, but the healthcare provider may discuss them with the patient if their valve structure or other circumstances make them a better candidate for the treatment.

• The patient will be put under general anesthesia and made asleep throughout the procedure. They are therefore going to have a breathing tube, which will most likely be removed before they leave the operation room.
• A catheter is used to implant the device. Through an incision made in their neck or at the top of their thigh, the catheter is inserted into a vein.
• The device reduces the size of the heart at the location where the mitral valve is connected. This brings the valve leaflets into closer proximity, effectively preventing the backward flow of blood.

Transcatheter mitral valve replacement: Patients who are considered to be too high risk for conventional valve surgery and are unable to undergo a MitraClip treatment may be candidates for TMVR.

• The patient will be put under general anesthesia and remain unconscious throughout the surgery. They are therefore going to have a breathing tube, which will most likely be removed before they leave the operation room.
• Certain devices are positioned through a vein by making an incision at the top of your thigh. Others are inserted through an incision in the chest straight into the heart.

Mitral stenosis:

Many persons with mitral stenosis experienced rheumatic fever throughout their childhood. Others get it as a result of a combination of diseases and aging that lead to the formation of scar tissue and calcium on the mitral valve and its surrounding tissue.

Although percutaneous treatment is occasionally an option, cardiac surgery is frequently the best course of action for mitral stenosis.

Percutaneous mitral balloon valvuloplasty (PMBV): The mitral valve is opened using a small balloon attached to a catheter.

The majority of individuals who have mitral stenosis caused by rheumatic fever are candidates for this surgery. If this is the best course of action for the patient, the healthcare provider will assess it using an echocardiography.

• In order to perform the surgery, a conscious sedation with IV sedative and painkillers are used along with a local anesthetic.
• Through an incision at the top of the thigh, the balloon-catheter is inserted into a vein. To guide the catheter to the mitral valve, the healthcare provider will use echocardiography and X-rays.

Transcatheter mitral valve repair (TMVR): The healthcare provider may discuss TMVR if the patient has a significant risk of complications from cardiac surgery and cannot have PMBV. Patients with mitral stenosis are undergoing this treatment as a part of a clinical trial.

Prior mitral valve surgery

For individuals who have undergone mitral valve repair with a ring or band or have received a bioprosthetic mitral valve replacement, there is a potential for degeneration to occur as time passes. This degeneration can lead to conditions such as mitral regurgitation or stenosis. Both of these issues may be addressable through percutaneous procedures, specifically either a MitraClip or Transcatheter Mitral Valve Replacement (TMVR).

MitraClip for patients with a degenerated mitral valve

MitraClip may be considered as a treatment option for certain individuals experiencing the deterioration of a surgical mitral valve repair involving a ring or band. Your healthcare provider will assess your specific case and discuss the suitability of this procedure for your condition.

Mitral valve-in-valve or valve-in-ring replacement

Patients with a degenerated bioprosthetic mitral valve, originally placed during surgery, may be eligible for a catheter-based valve-in-valve/valve-in-ring replacement procedure. This FDA-approved treatment involves the insertion of an aortic valve within the existing mitral valve. To determine the suitability of this treatment for you, your doctor will assess your valve anatomy.

The procedure is performed using local anesthesia, along with conscious sedation involving IV sedatives and pain relief medication.

A catheter is introduced through an incision at the top of your thigh into a vein. Guided by X-ray imaging, your doctor navigates the catheter to reach your mitral valve, where the new valve is subsequently positioned within the existing mitral valve.