Mitral Valve Regurgitation (MR)
Mitral valve regurgitation (MR) is a condition where the valve that prevents blood from flowing back between the left atrium and left ventricle malfunctions, causing blood to flow backward in the heart. This puts strain on the heart and leads to symptoms of heart failure such as shortness of breath.
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 in pumping blood to the entire 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 and prevent backflow when the left ventricle contracts to send blood throughout the body. If these chordae tendineae are stretched or torn, the mitral valve cannot close completely when the heart contracts, resulting in regurgitation. This condition is mitral valve regurgitation.
Symptoms of Mitral Valve Regurgitation
When regurgitation becomes severe, the backflowing blood accumulates in the lungs, causing shortness of breath and swelling. When symptoms first appear, drug therapy such as diuretics can be used to reduce blood volume, alleviate lung swelling, reduce the burden on the heart, and relieve symptoms. However, as the condition progresses, these medications may become ineffective, making it difficult to breathe even when lying down, necessitating hospitalization. Even after hospitalization and temporary improvement of heart failure, the condition is progressive, leading to repeated hospitalizations and potentially life-threatening situations. To prevent the exacerbation of heart failure, surgery to reduce regurgitation is the most effective measure.
What are the treatment options for mitral valve regurgitation at St. Luke's International Hospital?
What are the treatment options for mitral valve regurgitation at St. Luke's International Hospital?
While observation may be sufficient for cases without heart failure symptoms or mild to moderate mitral valve regurgitation, medical treatment is recommended for cases with heart failure symptoms. For severe mitral valve regurgitation with medical issues such as heart failure, surgical treatment to replace or repair the mitral valve may be considered. Surgical treatments can be broadly divided into open surgery and catheter-based treatment.
Medical Treatment for Mitral Valve Regurgitation
– Treatment to support the heart that has lost balance due to valvular disease
For cases with heart failure symptoms, oral medications such as beta-blockers, ACE inhibitors/ARBs/ARNIs, diuretics, and SGLT2 inhibitors are used to reduce the burden on the heart and improve symptoms. However, there are no medications that can directly improve valve degeneration or chordae abnormalities. Therefore, as mitral valve regurgitation progresses, medical treatment alone may not be sufficient to control heart failure symptoms.
Surgical Treatment for Mitral Valve Regurgitation
– Valve repair that preserves the patient’s own valve and artificial valve replacement
There are two methods for treating the valve: repair, which modifies and uses the patient’s own valve, and artificial valve replacement. For mitral valve regurgitation, valve repair has shown better long-term survival rates compared to artificial valve replacement, making it the first choice of treatment. However, in cases where the valve is stiff and degenerated, making repair difficult, artificial valve replacement may be chosen.
MICS, Robot-Assisted Surgery
– Minimally invasive surgical treatment
At our hospital, to reduce the burden of mitral valve surgery, we have been performing MICS (Minimally Invasive Cardiac Surgery) since 2011. This involves making a small incision in the right chest and operating with endoscopic assistance. We have actively performed this procedure not only on young patients but also on elderly patients with concerns about physical strength. Compared to the conventional method of opening the chest through the sternum, MICS features shorter hospital stays (about 12 days for median sternotomy, about 7 days for MICS), fewer post-operative activity restrictions, and faster recovery. Furthermore, in 2019, we initiated a robot-assisted mitral valve repair program using the da Vinci system. The key feature of robotic surgery is that the forceps tips have joints, allowing for free manipulation as if the wrist were inside the body. These joints enable surgery that more closely matches the surgeon’s image, potentially improving the quality of valve repair.
For more details about robot-assisted surgery, please see here.
Catheter Treatment for Mitral Valve Regurgitation
– What is MitraClip?
Until now, treatment options for MR were limited to medication and open surgery. Medication has its limitations, while open surgery involves opening the chest, using a heart-lung machine to stop the heart, and is physically demanding. MitraClip is a catheter-based treatment aimed at reducing mitral valve regurgitation. As it is less physically demanding than open surgery, it can provide effective treatment for patients who are ineligible for surgery or at high surgical risk.
MitraClip Indications
MitraClip is indicated for patients with severe mitral valve regurgitation and persistent heart failure symptoms despite optimal medical therapy. It is considered when improvement in mitral valve regurgitation is expected to alleviate symptoms, and open surgery is deemed difficult (due to advanced age, frailty, history of cardiac surgery, presence of malignant tumors, etc.). Some patients may not be suitable for MitraClip treatment due to the morphology of their mitral valve. Therefore, we conduct a thorough evaluation of the mitral valve using echocardiography and other methods, and the heart specialist medical team (Heart Team) discusses extensively to determine if MitraClip is the optimal treatment before proceeding.
Treatment Process
General anesthesia is required for patient comfort and pain control during the procedure. After anesthesia, a catheter is inserted through a vein in the groin. The catheter is advanced to the interatrial septum, which separates the right atrium and right ventricle. A small hole is made in the interatrial septum to insert the guide catheter. Through this guide catheter, the clip is transported to the mitral valve, where it is attached to the area of regurgitation to improve the leak. Transesophageal echocardiography and X-ray fluoroscopy are used to ensure proper clip placement. If one clip is insufficient to improve the regurgitation, up to three clips may be used. If valve opening becomes restricted after clip placement, causing obstruction, the clip may be removed. The procedure is completed when regurgitation is sufficiently improved without causing obstruction.
After the procedure, if there are no other medical issues, patients can typically be discharged within 5 to 7 days.
Strengths of Mitral Valve Regurgitation Treatment at St. Luke’s International Hospital
1. Comprehensive Support System by the Heart Team
Our Heart Team consists of cardiovascular surgeons, catheterization specialists, echocardiography specialists, anesthesiologists, nurses, physical therapists (rehabilitation), technicians, and administrative staff, all working together to provide optimal treatment for patients. In addition to maintaining high standards 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 Departments
Many patients with valvular disease also have issues with other organs. Managing these comorbidities is essential when treating such patients. Our hospital has a wide range of medical departments, and we prioritize interdepartmental collaboration. This allows patients to receive specialized support for conditions beyond heart disease with peace of mind.
3. Safe, Reassuring, and Comfortable Healing Environment with All Private Rooms
If post-operative progress is favorable, patients are transferred to the general ward the day after surgery to focus on rehabilitation (*this may vary depending on individual patient progress). All rooms in our general ward are private, allowing patients to relax in a quiet environment and focus on post-operative recovery. This not only protects your privacy but also provides a safe and reassuring environment by reducing the risk of infection from other patients.
