According to Abbott, “Mitral Regurgitation is the most common type of heart valve insufficiency in the United States.” The prefered treatment for mitral regurg is with open heart surgery to replace the insufficient valve. However for many patients, surgery is not an option due to their age, and underlying health conditions. Doctors started to look for a new way to help treat patients with mitral regurg. One that could be performed non invasively, without surgery. Thus the mitraclip was born! To help you,the reader get a better understanding about mitral regurgitation allow me to explain to you what that is. I’ll also explain to you how mitral regurgitation is treated, what a mitraclip is,contraindications for use, potential complications, set up of the mitraclip, and how the mitraclip is deployed.
Mitral Regurgitation is caused by blood leaking backwards through the mitral valve and into the left atrium during systolic contraction of the left ventricle. There are two forms of mitral regurg, degenerative and functional. Degenerative mitral regurgitation is caused by damage to the mitral valve leaflets. This backward leaking of blood can provoke
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the mitral valve leaflets not to seal properly thus triggering the degenerative mitral regurge to develop. Functional mitral regurgitation is an enlargement of the heart caused by a heart attack or heart failure. This backwards leaking of blood can generate a malformation of the mitral valve. This leakage of blood would promote an increase in blood volume inside the left atrium and an increase in pressure inside the pulmonary veins. This increased pressure could cause fluid to build up inside the lungs. Patients with mild regurgitation may not develop any symptoms. Where as a patient with severe mitral regurgitation will have symptoms. Some of these symptoms include; palpitations, shortness of breath, coughing, increase of fluid surrounding their heart and lungs, swelling of their hands and feet, and heart failure. A condition that is often related to mitral regurgitation is an enlargement of the left atrium which could potentially cause a patient to go into atrial fibrillation. Patients diagnosed with mitral regurg may be prescribed medication as a way to help treat their symptoms. The decision to use medication may be the best course of action for a patient whose valve disease may be mild. Medications like ace inhibitors, anti-arrhythmic drugs, anticoagulants, beta blockers, diuretics, and vasodilators are often used to help reduce symptoms. Each of these drugs work in different areas of the heart. Ace inhibitors are type of vasodilator, they help to open up blood vessels more fully and help to reduce high blood pressure. Anti-arrhythmic drugs help keep a patient in normal sinus rhythm. Anticoagulants help prevent patients from developing blood clots caused by inadequate blood flow around the leaky heart valve. Beta blockers reduce the heart’s workload by slowing down the heart which in turn reduces palpitations that a patient may be experiencing. Diuretics help to reduce fluid buildup inside a patient’s bloodstream and tissues by decreasing the heart’s workload. The use of these medications can help alleviate a patient’s symptoms but they can’t protect the heart. The diseased valve will continue to damage the heart. Treatment with medication may work for some time, however, in some cases; medication alone is not enough. The patient may benefit more if their valve is replaced. There are three kinds of replacement valves, each are performed with open heart surgery. The first replacement valve is the mechanical valve. It’s made of strong durable material that is made to last through the remainder of the patient’s life. The patient would need to be on blood thinner medication for the remainder of their life to prevent the formation of clots. Without the medication clots could potentially attach to the new valves flaps or hinges, and cause the valve to malfunction. The second kind of replacement valve is a donor valve. Donor valves can last up to 10-20 years. They are most often used for patients who have suffered from an illness like infective endocarditis. This type of treatment is the least common choice. The third replacement valve is a bioprosthetic valve. Also called a tissue valve. This type of valve is created from a animal donor valves or tissue that is strong and flexible. They can last up to 10-20 years and they don’t require a long term use of medication. However, if they are implanted into a younger patient; the patient would need additional surgeries or valve replacement later in life. Patients undergoing mitral valve replacement are typically on cardiopulmonary bypass machine. It may take several months for these patients to regain their strength and normal activity level. The percutaneous mitral valve repair also known as the mitraclip, is a new treatment option for patients. This procedure is minimally invasive and uses catheter based technology. The clip is made of metal and is covered in a polyester fabric to promote healing. The mitraclip is indicated for the use of percutaneous reduction of severe mitral regurgitation that is caused by degenerative mitral regurgitation. It’s also used for patients who have been determined by a cardiac surgeon not to be a good candidate for mitral valve surgery or patients with existing comorbidities that doesn't preclude any benefit from reducing of mitral regurgitation. Contraindications for the use of the mitraclip are: patients who can’t tolerate anticoagulation therapy, patients with active endocarditis of the mitral valve, patients who have had rheumatic mitral valve disease, or patients with previous evidence of thrombus in their intracardiac, inferior vena cava, and femoral vein. Precautions are taken to ensure that the patient is safe and that they fully understand the procedure. A surgical consult between the cardiology team and the patient may be needed to further evaluate the patient. They would discuss any and all risk associated with mitraclip. They would even discuss why surgery is not an option for them at this time. They would discuss with the patient about any drugs they may need to take prior and after the procedure including prophylactic antibiotics, and anticoagulants. Their doctor would advise them to limit any and all strenuous activity for at least a month or longer if warranted after their procedure. Potential complications can occur at any time during a procedure that is why it is very important that the patient to be well informed prior to the procedure. Some of these complications include: an allergic reaction to the anesthetic, medications, contrast, or even latex. The patient could develop an arrhythmia, have a ASD needing repaired. They could develop problems with bleeding. A possible chordal entanglement or rupture could occur. Emboli could form. Mechanical failure to deploy or retrieve the mitraclip and it’s delivery system. Patient could have an injury to their mitral valve, they could have a stroke and even death could occur. The mitraclip system is set up in a sterile fashion and will be used on the sterile cath lab table during the procedure.
The mitraclip system comes in two parts: the Clip Delivery System and the Steerable Guide Catheter. The Clip Delivery System and Steerable Guide Catheter are distributed in a sterile tray with a lid and are in sealed packaging. The Clip Delivery System consists of three components: the delivery catheter, the steerable sleeve and the mitraclip device. The Clip Delivery System is used to advance and properly align the mitraclip device so it can be delivered safely on to the mitral valve leaflets. The Steerable Guide Catheter is used to introduce the Clip Delivery System into the Left Atrium of the heart across the septum and it’s used to position the Clip Delivery System correctly above the mitral
valve. The Stabilizer, Support Plate and Lift do not come in sterilized packaging therefore each of these tools must be cleaned and sterilized prior to being used. The Stabilizer provides support and helps position the Steerable Guide Catheter and Clip Delivery System during the procedure. The Lift and Support Plate provide a stable platform for the Stabilizer and MitraClip System to rest on during the procedure. The Dilator, Fasteners and the Silicone Pad are intended for single use only. The dilator is used to do two things: 1. To advance the steerable guide catheter into the femoral vein, 2. To advance the steerable guide catheter across the heart’s septum and into the left atrium. The Silicone Pad and Fasteners come inside the Steerable Guide Catheters sterile packaging. The Silicone Pad is set underneath the Stabilizer on the sterile table to help prevent the Stabilizer from any incidental movement during the procedure. The Fasteners are used on the table to secure the Steerable Guide Catheter and Clip Delivery System to the Stabilizer. Once the system is set up it’s ready to be used for the procedure. The Mitraclip system is made up of the these two parts; the Clip Delivery System and the Steerable Guide Catheter. Each device is used to perform a different function. Before the procedure begins, patients are given general anesthesia and put on a ventilator to prevent them from moving during the procedure, but also to protect their airway in case of an emergency. It also helps keep them from touching anything that is sterile. After obtaining access, the steerable guide catheter is introduced into the femoral vein and over a guidewire that has been placed using standard technique. The dilator and guide catheter are gradually advanced across the septum and into the left atrium. The guidewire and dilator are removed from the steerable guide catheter. The clip delivery system is advanced into the body through the guide catheter and slowly introduced into the left atrium. The clip is precisely positioned above the leak in the valve and the clip arms are opened in the left atrium for final positioning. The device arms can be manipulated to any position from fully open, inverted, and fully closed. This allows the mitraclip to be positioned in the best possible place. The clip is advanced into the left ventricle below the valve leaflets. It is retracted towards the mitral valve and closed onto the leaflets holding them together. Therefore reducing the mitral regurg. If the mitral regurg can be further reduced the leaflets are released and the clip is readvanced. Positioning adjustments may be made to ensure the best possible fit and location of the clip. The double orifice opening allows blood to flow on both sides of the clip. Securely attached to both leaflets, the clip moves with the valve allowing blood to flow through each opening easily. The grasp and MR reduction are assessed before the clip is deployed. Once the clip grasp location is approved the catheters are then removed. The mitral valve has been successfully repaired without surgery. Most patients who have the mitraclip implanted have seen immediate results. They notice right away that the majority of their symptoms disappear overnight and diminish greatly. After the procedure patients will stay in the hospital for a couple of days just for observation and to ensure they have no complications following the procedure. With this new treatment option it has given patients a new lease on life, so they may again continue to do the things they love the most. This new technology has profoundly changed the way mitral regurgitation can be treated. It has brought hope to patients who didn’t think their condition could get better. I hope that this new information would inspire you ,reader; to challenge yourself to find a new solution to something or perhaps maybe educate someone else about mitral regurgitation.
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
When MVP occurs, the left ventricle contracts, one or both flaps of the mitral valve flop or bulge back (prolapse) in the left atrium, this prevents the valve from forming a tight seal. As a result, blood may leak back into the atrium which is referred to as regurgitation (nhlbi.nih.gov).
Ebstein’s Anomaly is a rare congenital condition, present at birth, in which the tricuspid valve is malformed and the valve itself is not in the correct anatomic place (Mayo Clinic Staff). This anomaly affects the right side of the heart – the tricuspid valve is located too deep into the ventricle, causing a smaller and weaker right ventricle. The space above the decreased right ventricle is made up of atrial tissue and this can be referred to as right ventricle dysplasia or an atrialized right ventricle (Reynolds). Typically the tricuspid valve has three freely moving leaflets, but in Ebstein’s anomaly one or two of those leaflets get fused to the heart walls causing regurgitation. Since the heart does not work as efficiently in those who have this anomaly, the heart usually compensates and becomes enlarged. It...
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The aim of this report is to provide an overview of chronic heart failure, examining signs symptoms and treatment related to the case study, and the anatomy and physiology of the heart will be discussed, and the pathophysiology of chronic heart failure. The size of the heart is approximately the size of a persons closed fist. The weight is less than a pound, the heart is snugly enclosed within the Infer mediastinum, and the medial section of the thoracic cavity, the heart is flanked on each side by the lungs (Marieb, 2014). Pericardium surrounds the heart, the fibrous pericardium the superficial part of the pericardium aids in protection of the heart from moving freely around the thoracic cavity.
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The thickening of the muscle cells do not necessarily have to change the size of the ventricles, but can narrow the blood vessels inside the heart. Hypertrophic cardiomyopathy can be grouped into two categories: obstructive HCM and non-obstructive HCM. With obstructive HCM, the septum (the wall that divides the left and right sides of the heart) becomes thickened and blocks the blood flow out of the left ventricle. Overall, HCM usually starts in the left ventricle. HCM can also cause blood to leak backward through the mitral valve causing even more problems. The walls of the ventricles can also become stiff since it cannot hold a normal amount of blood. This stiffening causes the ventricle to not relax and entirely fill with
..., Welsh R, Feindel C, Lichtenstein S. Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28:520-8.
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Hypertrophic cardiomyopathy is an inherited disease that affects the cardiac muscle of the heart, causing the walls of the heart to thicken and become stiff. [1] On a cellular level, the sarcomere increase in size. As a result, the cardiac muscles become abnormally thick, making it difficult for the cells to contract and the heart to pump. A genetic mutation causes the myocytes to form chaotic intersecting bundles. A pathognomonic abnormality called myocardial fiber disarray. [2,12] How the hypertrophy is distributed throughout the heart is varied. Though, in most cases, the left ventricle is always affected. [3] The heart muscle can thicken in four different patterns. The most common being asymmetrical septal hypertrophy without obstruction. Here the intraventricular septum becomes thick, but the mitral valve is not affected. Asymmetrical septal hypertrophy with obstruction causes the mitral valve to touch the septal wall during contraction. (Left ventricle outflow tract obstruction.) The obstruction of the mitral valve allows for blood to slowly flow from the left ventricle back into the left atrium (Mitral regurgitation). Symmetrical hypertrophy is the thickening of the entire left ven...
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Most often the disease starts in the left ventricle, and then often spreads to both the atrium and right ventricle as well. Usually there will also be mitral and tricuspid regurgitation, due to the dilation of the annuli. This regurgitation will continue to make problems worse by adding excessive volume and pressure to the atria, which is what then causes them to dilate. Once the atria become dilated it often leads to atrial fibrillation. As the volume load increases the ventricles become more dilated and over time the myocytes become weakened and cannot contract as they should. As you might have guessed with the progressive myocyte degeneration, there is a reduction in cardiac output which then may present as signs of heart failure (Lily).