Pioneering heart valve repair procedure can save lives

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CHATTANOOGA, Tennessee: Simple tasks such as cooking, cleaning and walking to the mailbox are not so simple for people with symptoms of severe mitral regurgitation, a condition that causes blood to leak backward into the heart.

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“Imagine that for the last six months of your life, all those things that you enjoy doing you can’t do, because you are so fatigued,” said medical doctor Sam Ledford, an interventional cardiologist at CHI Memorial’s Chattanooga Heart Institute.

That was the case for 96-year-old Donald Seesenguth, of Chattanooga, who underwent treatment at Memorial to repair his mitral valve in August.

“I’d had a heart murmur for years with no problem, but it suddenly got worse to the point where I went to church one day and couldn’t drive home,” Seesenguth said.

Mitral valve regurgitation is the most common valve disease in the United States and often goes unnoticed, but a study from the American Journal of Cardiology estimates it may affect 2.0 percent of the population.

Symptoms include trouble breathing, coughing, swollen legs and congestion around the heart and lungs.

Although abrupt failure of the valve can occur in rare cases and be life-threatening, most mitral regurgitation progresses over years and may lead to decreased quality of life or heart failure that requires surgery to repair or replace the valve.

Seesenguth needed a valve repair, but because of his age was a “high-risk” candidate, which meant traditional open-heart surgery wasn’t an option. Until recently, patients such as Seesenguth had no option to fix their valve.

“In times past, you would go see a surgeon who would potentially say, ‘I’m sorry, you’re too high risk for surgery, and so I’m afraid this is the way it’s going to be for the rest of your life,’” Ledford said.

But a new technology called the MitraClip, which Ledford described as “a very fancy staple,” was able to repair Seesenguth’s valve.

The device has been used in about 6,000 people across the country since the Food and Drug Administration approved it in 2013, said Dr. Vinod Thourani, former chairman of the American College of Cardiology’s Surgeons Council.

“MitraClip was an exciting breakthrough, because it allowed for the first time treatment of patients who were not candidates for surgery,” Thourani said, who performs open-heart and catheter-based procedures, like the MitraClip, as chairman of cardiac surgery for MedStar Heart and Vascular Institute in Washington, D.C.
The Chattanooga Heart Institute is the only facility in the region currently able to perform the MitraClip procedure. Before it performed its first procedure in June, patients had to travel to Nashville or Atlanta to get a clip.

“When you’re sick and puny, even a couple of hours is just absolutely miserable,” Ledford said. “If we can do that locally, that’s a great convenience to the patients.”

The clip procedure is catheter-based, making it less invasive for people who cannot withstand open-heart surgery, such as those with kidney or lung disease, older adults and people with a previous heart surgery.
Physicians make a small puncture near the groin and pass the instrument through a leg vein into the heart, where they make tiny incisions while moving into the upper-left heart chamber to find the mitral valve.

“We’re continuously watching every beat of the heart as we move these catheters, position them and perform the clip procedure — remember, we’re doing this on a beating heart — the heart is beating 60 to 80 times a minute,” Ledford said.

Revolutionary technology

The mitral valve is between the upper and lower left chambers. It has flaps of tissue, called leaflets, that open and close to push oxygenated blood into the lower chamber and out into the body. If the valve doesn’t close properly, blood leaks backwards, causing regurgitation.

“Like any pump that’s supposed to allow fluid to go in one direction, if you have a valve that’s allowing it to wash back where it came from, that fluid is going to back up,” he said. “In this case, where the fluid and the extra pressure back up are into the blood vessels of the lungs and into the lungs themselves, and that’s what leads to the shortness of breath, the fatigue.”

Cardiologists use the MitraClip to pinch together the leaflets that aren’t closing properly, creating a seal that still allows blood flow to the lower chamber and correcting the regurgitation.

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