Mitral valve regurgitation is a heart condition and the most common form of heart valve disease where the mitral valve, which is located on the left side of the heart, does not close properly and causes a backflow of blood into the left atrium.
The mitral valve serves as a “door” that connects the top left chamber (atrium) and the bottom left chamber (ventricle) of the heart. When this door closes, blood is prevented from flowing back up into the top chamber so that it can go out of your heart to supply blood to your body. Damage to this door, or the walls or structure surrounding this door, leads to mitral valve regurgitation and the leakage of blood.
This can lead to an increase in pressure in the left atrium and may cause symptoms such as shortness of breath, fatigue, and palpitations.
Over time, if left untreated, can lead to severe mitral regurgitation that is a risk to more serious heart problems, including heart failure.
What are the symptoms?
Symptoms of severe mitral regurgitation include:
Shortness of breath during exercise, or even at rest in more advanced cases of severe mitral regurgitation
Swelling in the legs
Who is at a higher risk?
Elderly patients with heart conditions such as Atrial Fibrillation (AF) as it can cause the enlargement of the heart chambers, which leads to mitral regurgitation
Patients with prior heart attack with decreased heart function
Patients born with an abnormally-shaped mitral valve, most commonly known as a mitral valve prolapse
Elderly patients with degenerative mitral valve and calcification of the mitral valve annulus can also lead to mitral regurgitation
How is it diagnosed?
Patients with severe mitral regurgitation will typically have a specific heart murmur that can only be identified by a doctor. The most reliable method for diagnosing this condition is through a cardiac ultrasound or echocardiogram, which must be conducted by a heart specialist or cardiologist.
What are the tests?
Your healthcare provider will first ask about your symptoms and do a physical examination. If your healthcare provider suspects severe mitral regurgitation, they may recommend conducting some further tests. The tests may include Transthoracic Echocardiogram, blood test, Electrocardiogram (ECG) supporting test, and sometimes a Transoesophageal Echocardiogram (TEE) if further examination is required.
Transthoracic Echocardiogram (TTE): What is it? The most common type of echocardiogram that uses ultrasound to produce images of your heart. This test is non-invasive as no part of the instrument is inserted into the body. Why is it done? To view the structure and size of your heart’s chambers and assess for abnormalities. Does it hurt? This test is painless. Potential risks and complications? TTE is extremely safe. No clinically important adverse effects have been reported, even with repeated examinations. Pregnant women may also undergo TTE, without additional risk to themselves or the unborn child.
What are the treatments?
A damaged mitral valve can either by repaired or replaced, depending on the severity of the condition.
Mitral Valve Repair A mitral valve repair saves the patient’s existing valve to improve heart function. Treatment for the repair of mitral valve can include the following: -Open-heart surgery -Minimally invasive heart surgery -Mitral Transcatheter Edge-to-edge Repair (TEER) - A mitral valve TEER procedure may include the use of a mitral valve clip (MitraClip) – a device which NUHCS has been using in the treatment of mitral regurgitation. - Just recently, a new treatment method for transcatheter mitral valve repair with the use of a PASCAL device has been introduced.
What is the MitraClip or PASCAL Mitral Transcatheter Edge-to-edge Repair (TEER) treatment?
A patient considered high risk for surgery or in cases where the patient prefers a non-surgical treatment method, the doctor may consider Percutaneous Coronary Intervention (PCI) using a MitraClip or PASCAL clip implant device.
This is a non-surgical approach and no chest incision will be needed during the procedure. The insertion of the device will be via a catheter – a pencil-like device which will be inserted through a vein in the leg. The implant, which is around 1-2 cm, will be advanced via the sheath to reach the mitral valve and treat the leaking or abnormal segment.
The procedure will be performed under the guidance of a special camera called “3D TEE”, which performs similar to a scope and a X-ray imaging. The patient will be under General Anaesthesia (GA) during the procedure.
What can one expect for a MitraClip or PASCAL Mitral Transcatheter Edge-to-edge Repair (TEER) treatment?
The patient will be admitted to the hospital the day before the procedure, and will then be put under GA for two to three hours. After the procedure is completed, the patient will be monitored in the Intensive Care Unit (ICU) for at least one night. Older patients may require post-procedure cardiac rehabilitation.
A simple procedure may take two hours, and a complex procedure may require three to four hours. Follow-up clinical visits will be required.
What to prepare for this treatment? •A couple of clinical visits will be arranged for the patient to consult a structural cardiologist •Pre-procedure admission
Success rates: An ideal anatomy success rate stands at 95%, but this may vary for more complex anatomy cases. The doctor will offer treatment options best suited for the patient’s condition.
Potential risks & complications: As with all cardiac interventions, there are risks associated with the procedure. Although in general, the risks are lower as compared to an open-heart surgery.
The risks may include stroke, heart attack and other non-cardiac related risks such as kidney problems and access injury. Therefore, it is important that every patient is assessed by the medical team before a treatment option is considered.
Home care: Generally, the patient will be given a couple of weeks of hospitalisation leave to ensure proper rest and care. Most patients should be able to do light walking once they are discharged from the hospital.
When to call the doctor: If the patient experiences worsening of shortness of breath, swollen legs after being discharged from the hospital, or bleeding from the sheath access site, it is advised to see a doctor immediately.
Living with Severe Mitral Regurgitation
In the past, the only way to treat patients with severe Mitral Regurgitation is via an open-heart surgery. Transcatheter mitral valve repair therapy can offer effective treatment with lower risks for patients.
The availability of a newer device such as the PASCAL TEER treatment at NUHCS enables medical professionals to achieve effective severity reduction of mitral regurgitation. This has improved the recovery outcomes of patient, allowing them to return back to their daily lives sooner and be able to perform their usual activities.
