Catheter Treatment for Mitral Regurgitation: MitraClip®
What is Mitral Regurgitation (MR)?
The heart works as a pump to send blood throughout the body and is divided into four chambers. The two on the right are called the right atrium and right ventricle, while the two on the left are called the left atrium and left ventricle. Each chamber is separated by valves. Oxygenated blood from the lungs is sent to the left atrium, passes through the mitral valve, and enters the left ventricle, which plays a central role as a pump to send blood throughout the body. The mitral valve is shaped like a parachute and is fixed to the left ventricle by numerous string-like tissues called chordae tendineae. This allows the mitral valve to close completely when the left ventricle contracts to send blood throughout the body, preventing backflow. If these chordae tendineae are stretched or torn, the mitral valve cannot close completely when the heart contracts, resulting in regurgitation. This condition is called mitral regurgitation.
Symptoms of MR
When regurgitation becomes severe, it can cause heart failure, leading to blood congestion in the lungs, fluid accumulation, and symptoms like shortness of breath and swelling. When symptoms begin to appear, medication therapy such as diuretics is used to reduce the heart’s burden and alleviate these symptoms. However, as the condition progresses, these medications may become ineffective, making it difficult to lie down and sleep, and requiring hospitalization. Even after hospital treatment temporarily improves heart failure, it is a progressive disease that can lead to repeated hospitalizations and become life-threatening. To prevent the exacerbation of heart failure, surgery to reduce regurgitation is the most effective measure.
What is MitraClip?
Until now, treatment options for MR were limited to medication and open-heart surgery. While medication has its limitations, open-heart surgery involves cutting open the chest, using a heart-lung machine to stop the heart, and is highly invasive. MitraClip is a catheter-based treatment aimed at reducing mitral valve regurgitation. It is less invasive than open-heart surgery, making it an effective treatment option for patients who cannot undergo surgery or are at high surgical risk.
Indications for MitraClip
MitraClip is indicated for patients with severe mitral regurgitation who still have heart failure symptoms such as shortness of breath despite adequate medical treatment. It is considered when improvement in mitral regurgitation is expected to alleviate symptoms, and open-heart surgery is deemed difficult (due to factors such as advanced age, frailty, previous heart surgery, or coexisting malignancies). Some patients may not be suitable for MitraClip treatment due to the shape of their mitral valve. Therefore, the mitral valve is evaluated using echocardiography, and the final decision on MitraClip suitability is made after discussion by a specialized cardiac care team (Heart Team).
Treatment Process
General anesthesia is required for patient comfort and pain management during the procedure. After anesthesia, a sheath (plastic tube) is inserted into the femoral vein in the groin to allow catheter access. A needle is advanced through this tube to the atrial septum, which separates the right atrium and right ventricle. A hole is made in the atrial septum, and a guidewire is inserted. An 8mm guidecatheter is then inserted into the left atrium along the guidewire. The clip is transported to the mitral valve through this guidecatheter and attached to the area causing regurgitation to improve the condition. Transesophageal echocardiography and X-ray fluoroscopy are used to ensure proper clip placement. If one clip is insufficient to improve regurgitation, up to three clips may be used. If valve opening becomes restricted after clip placement, the clip may be removed. The procedure ends when regurgitation is sufficiently improved without causing obstruction, and the catheter is removed.
Strengths of MitraClip at St. Luke's International Hospital
1. Comprehensive Support System by the Heart Team
A Heart Team consisting of catheterization specialists, echocardiography specialists, cardiovascular surgeons, anesthesiologists, nurses, physical therapists (rehabilitation), technicians, and administrative staff work together to provide optimal treatment for patients. In addition to maintaining a high standard of medical treatment, all multidisciplinary team members, including nurses and physical therapists, function at a high level, providing comprehensive support from pre-operative care to post-operative rehabilitation and outpatient follow-up.
2. Seamless Collaboration Between Medical Departments
Management of comorbidities is essential when treating high-risk surgical patients. Our hospital has many specialized departments and emphasizes interdepartmental collaboration, allowing patients to receive specialized support for conditions beyond cardiac diseases with peace of mind.
3. Safe, Secure, and Comfortable Recovery Environment with All Private Rooms
If post-operative progress is favorable, patients can be moved to the general ward the day after surgery to focus on rehabilitation (*This depends on individual patient progress). All general wards in our hospital are private rooms, allowing patients to relax in a quiet environment and concentrate on post-operative recovery. This not only ensures privacy but also reduces the risk of infection from other patients, providing a safe and secure environment.
