Percutaneous Mitral Valve Interventions
Mitral Regurgitation (Leaky valve)
Mitral regurgitation (MR) is a common heart disorder that causes blood to leak backwards through the heart’s mitral valve. There are two types of MR ─ degenerative and functional.
Degenerative MR – Commonly called mitral valve prolapse or myxomatous mitral valve disease. The leaflet(s) (the flaps inside the valve that open and close to let blood flow through) and chordae (tough, fibrous strings attached to the leaflets) become stretchy. The leaflets become floppy and they do not close tightly. When this happens, surgery is the best treatment option. However, surgery is too risky for some patients. A new treatment option, called the MitraClip, was recently approved by the FDA to treat these high-risk patients.
Functional MR – The mitral valve leaks due a secondary cause such as dilatation (widening) of the annulus (a ring attached to the leaflets) or damage to the papillary muscles or chordae that support the leaflets. This damage can be caused by changes in how well the left ventricle works as a result of a heart attack or cardiomyopathy. The left ventricle is the bottom left chamber of the heart that does the majority of pumping. If you have functional MR, your valve leaflets may be normal. Many patients with functional MR also develop heart failure.
Although it has been shown that surgery is the best treatment for patients with degenerative MR, there isn’t the same type of recommendation for patients with functional MR. The American College of Cardiology (ACC), American Heart Association (AHA), Heart Failure, and Society of Thoracic Surgeons (STS) treatment guidelines consider surgery as a treatment option but do not recommend it for all patients.
A new study is designed to study how well the MitraClip works compared with medical therapy to treat patients who have heart failure with functional MR and who are extremely high-risk for surgery. The study is called the COAPT trial. Cleveland Clinic will be taking part in this study.
Treatment with the MitraClip
To see if you are a possible candidate for treatment with the MitraClip, you’ll have a comprehensive evaluation (based on ACC and STS guidelines) by a multidisciplinary team. The evaluation focuses on your condition, current management, and quality of life.
Cleveland Clinic’s Interventional Mitral Valve physician team
- Heart failure (Drs. Jacob, Taylor, Starling)
- Interventional cardiology (Drs. Kapadia, Tuzcu, Krishnaswamy)
- Cardiac Surgery (Drs. Mick, Gillinov, Smedira)
You will have a transthoracic echo (TTE) and transesophageal echo (TEE) to determine if treatment with the MitraClip is possible and to check for MR. The testing is also used to see if your leaflets are normal, if the leak or jet is central (not broad), and to evaluate how well your left ventricle is working.
The team will evaluate how well your condition has been managed with medications or devices (biventricular pacing). They will determine whether you need other surgical interventions, if surgery is right for you, and if you would benefit from treatment with the MitraClip.
Mitral Valve Clip
Percutaneous Valve Repair System
Images used with permission from Abbott Vascular, Inc.
Preparation for treatment with the MitraClip starts a day or two before the procedure. You will come to Cleveland Clinic to meet your team (nurse practitioners, surgeon, cardiologist, and anesthesiologist) and learn about what to expect.
You will receive a detailed explanation at the hospital, but here are some general notes:
- The procedure is done under general anesthesia.
- The actual procedure takes about 2 to 4 hours. Preparation and recovery require additional time.
- The MitraClip is inserted using a catheter (a thin tube that is inserted through a small incision in your groin).
- The catheter with the MitraClip attached is threaded through the femoral vein to the mitral valve.
- The clip is put into place and the catheter is removed.
- The clip stays in the heart to allow the valve to close tightly.
- You will stay in the hospital for about 4 days after the procedure.
- You should be able to go back to your normal routine in about 2 weeks.
- You will see your doctor for three follow-up visits: 30 days after the procedure, 6 months after the procedure and one year after the procedure.
Mitral Stenosis (Narrowed Valve)
Balloon Mitral Valvotomy is used to treat patients with mitral valve and pulmonic valve stenosis (narrowing of the valve). The procedure can also be used to treat stenosis of the aortic valve; however, this treatment is not as widely used. All patients must be carefully screened and selected to make sure the procedure will provide satisfactory results.
During mitral valvotomy, a catheter is placed in the femoral vein (in the groin) and guided into the chambers of the heart. The cardiologist then creates a tiny hole in the wall between the heart’s two upper chambers (atria). This hole provides an opening for the cardiologist to access the left atrium using a special catheter that has a balloon at the tip.
The catheter is positioned so the balloon tip is directly inside the narrowed mitral valve. The valve opening is widened (dilated) by rapidly inflating and deflating the balloon. Once the cardiologist has determined that the opening has been widened sufficiently, the balloon is deflated and removed.
The procedure is similar when performed to treat aortic and pulmonic valve stenosis.
Doctors who treat
Cleveland Clinic has the nation's largest valve treatment program.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Cardiologists and Surgeons
Patients are evaluated for Percutaneous Mitral Valve Treatments by our Interventional Mitral Valve Physician Team. This multidisciplinary team includes surgeons, cardiologists and nurses from:
A full evaluation is required to determine if you are a candidate for a percutaneous procedure. For more information on how to be evaluated, please contact our Heart and Vascular Institute Resource Nurses.
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
To obtain a consultation, or if you have additional questions or need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
Diagnostic tests are used to diagnose your valve disease and the most effective treatment method.
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Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.