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The mitral valve sits between the top and bottom chamber of the heart on the left side. It allows blood to flow from the left atrium into the left ventricle. It acts as a gate and should only allow blood to flow forward. Sometimes the blood flows back in to the left atrium because the valve doesn’t work properly. This backwards flow of blood is called mitral regurgitation.
Patients can become short of breath at rest and with exercise, develop swelling in their legs and ankles and have trouble doing their normal activities when they have mitral valve regurgitation. These symptoms are called heart failure. Most of the time the symptoms improve with the use of medication, like blood pressure medications and diuretics or water pills. However, some patients remain symptomatic and the only way to help their symptoms is to do surgery.
Mitral regurgitation is diagnosed using an echocardiogram or a transesophageal echocardiogram (TEE). Your health care provider may have heard a murmur when listening to your heart and referred you for an echo. The echo is an ultrasound that allows us to look at the heart muscle, the valves of the heart and how blood flows through the heart. While you are lying down on a bed, we slide an ultrasound probe (special camera) across your chest with the help of clear gel. The cardiologist will look over the pictures and based on the pressures and flow of blood through the heart can diagnose mitral regurgitation.
Mitral valve repair or replacement is the preferred ways of treating mitral regurgitation. This requires open heart surgery by a cardiothoracic surgeon and either a ring is place around the valve to keep it from leaking or the valve is replaced with an artificial valve.
Mitraclip is indicated for patients who have severe, degenerative mitral valve disease (the valve itself doesn’t work) and who are not candidates for open heart surgery (prohibitive risk). In October 2013, the FDA approved the use of the MitraClip to treat patients with degenerative mitral valve regurgitation. Transcatheter or percutaneous mitral valve repair using the mitraclip is a minimally invasive procedure that is done with catheters or small tubes that are guided through the vein from the leg to the heart.
The MitraClip device is delivered to the heart through a small incision in the blood vessel in the leg. The heart continues to beat during the procedure and does not require a heart-lung bypass machine, which is common for open heart surgery. During the mitral valve repair procedure, a catheter (a thin, flexible plastic tube) is inserted through the patient’s skin in the groin area and is guided through the femoral vein to the affected area of the heart. Then, a catheter that holds the MitraClip device goes in through the first catheter so that the MitraClip can be guided into place and attached to the leaflets of the mitral valve. Once the clip is properly placed and securely attached, it is deployed and the catheters are removed. A clip is placed on the leaky part of the mitral valve to prevent the valve from letting the blood flow backwards. It creates a figure 8 opening of the mitral valve.
The MitraClip improves valve closure and reduces backflow of blood. The heart returns to pumping blood to the body more efficiently, relieving the patient’s symptoms and improving their quality of life.
As with any catheter-based procedure there is a risk of bleeding, kidney damage, stroke and death. If there is damage caused to the mitral valve leaflet or to the heart itself, it may be necessary for the patient to have open heart surgery to make repairs. The cardiothoracic surgeon would perform the surgery.
If you have severe mitral regurgitation and are too sick for traditional mitral valve repair or replacement, and if medicine is not improving your life, you may be eligible for MitraClip. The heart team at can evaluate your symptoms and discuss your treatment options during a valve clinic visit. Call (402) 398-5880 or contact us online with questions and to schedule your evaluation.
