Percutaneous Mitral Valve Repair
Traditionally, mitral regurgitation (leakage of blood across the mitral valve back to the lungs) has only been treated by open heart surgery to either replace ...
Traditionally, mitral regurgitation (leakage of blood across the mitral valve back to the lungs) has only been treated by open heart surgery to either replace or repair the mitral valve. Recently, cardiologists and surgeons at UVA have been testing a new device called the MitraClip in a clinical trial.
The MitraClip is a tiny metal device that is inserted using a catheter introduced from a small incision on the blood vessel in the leg and threaded up to the heart. One or two MitraClips are then placed on the leaking portions of the mitral valve, effectively creating a repair of the mitral regurgitation without the patient undergoing open heart surgery.
Who Is Eligible?
Currently in the United States, the MitraClip is still under investigation by the FDA. Doctors at UVA are involved in a clinical research trial with patients with either degenerative mitral valve disease (leaking mitral valve due to abnormalities of the mitral valve, such as prolapse or flail leaflets) or functional mitral regurgitation (mitral valve leakage due to weak heart muscle from a prior heart attack) have had successful percutaneous mitral valve repairs. Patients with mitral regurgitation due to rheumatic fever or prior infection are not candidates for percutaneous mitral valve repair.
Evaluation for Percutaneous Mitral Valve Repair
Tests may include:
- Chest x-ray
- Electrocardiogram (ECG, EKG)
- Transesophageal echocardiogram
- Cardiac catheterization
- Holter monitor
About the Procedure
Study participants undergoing percutaneous mitral valve repair with the MitraClip are put to sleep using general anesthesia. Then an ultrasound testcalled transesophageal echocardiogram is done. During this test the ultrasound transducer is passed through the mouth and down the esophagus to the stomach. This tranducer then stays in place allowing the doctors to clearly see the mitral valve. This helps guide the placement of the MitraClip.
To insert the MitraClip, a small incision is made in the leg and a catheter is inserted into the femoral vein. From this point, the catheter is threaded up into the heart.
Using ultrasound to safely guide the catheter, the catheter then punctures the thin wall between the upper two chambers (atria) of the heart, gaining access to the left side where the mitral valve is located.
Through the catheter, the MitraClip is then inserted and positioned on the leaking portions of the mitral valve. Following insertion of the MitraClip, cardiologists assess the results and determine whether a second MitraClip is needed. The catheter and the transesophageal echocardiogram are then removed, and the patient is awakened by the anesthesiologist.