Written by ◆Chen Qiulei and compiled by ◆Liang Yingxiu
Mitral valve insufficiency means that when the heart pumps blood, the valve cannot completely close, causing blood to flow backwards, which can lead to heart failure or arrhythmia in severe cases.
Patients can receive open valve repair surgery or artificial valve replacement surgery; while high-risk groups can undergo minimally invasive mitral valve clipping surgery to control and improve the condition.
(Kuala Lumpur News) The heart can be divided into 4 chambers, namely the left atrium, left ventricle, right atrium and right ventricle. The heart pumps blood from the right side to the left side, and then from the left side of the heart into the aorta, where it is transported to other parts of the body.
Pumping blood relies on four valves of the heart
Dr Al Fazir Omar, consultant cardiologist, pointed out that the process of pumping blood relies on the four valves of the heart, namely the aortic valve, mitral valve, pulmonic valve and tricuspid valve. These 4 valves maintain the normal flow of blood. As blood is pumped, they flow in one direction, guiding blood through the heart without leaking. This means that when the heart contracts, the valve opens to allow blood to flow to the next chamber; when the valve closes tightly, it prevents blood from flowing back.
“When heart valves become diseased, stenosis, regurgitation, or sometimes both stenosis and regurgitation may occur.”
If one of the valves mentioned above, the mitral valve, cannot close completely when closed, a gap appears, or the size and shape of the valve change, the heart may prolapse during the pumping process, causing blood to flow backwards into the left atrium. .
Over time, the heart chambers gradually become enlarged, followed by a series of symptoms. In severe cases, it can lead to heart failure and arrhythmia. This disease is Mitral Regurgitation (MR).
He said that the first symptoms of MR are shortness of breath and fatigue, which is due to the accumulation of fluid in the lungs.
“For example, I used to be able to climb up two flights of stairs without taking a break. However, if there is a problem with my body, I may feel tired after climbing only one flight of stairs and have to stop. Usually, climbing stairs is a test to check whether the breathing is smooth. indicator. That is to say, we can preliminarily judge the patient’s illness through the patient’s breath after climbing stairs.”
“It is precisely because of breathing problems that many patients cannot lie flat at all. Lying down causes difficulty in breathing. Therefore, they often need to raise pillows when sleeping, and some even have to sleep on a chair; some patients are admitted to the hospital for medical treatment. I can only sit in a wheelchair until my condition is relieved after taking medicine, and I can’t lie down.”
“In addition, when the heart is pumping blood, the upper and lower heart chambers pump simultaneously. However, due to the reflux of blood, the heart chambers become enlarged, resulting in irregular heartbeats. This is another symptom of MR, and it also aggravates breathing problems. Difficult condition.”
Abnormal valve function causes fluid accumulation in the lungs
As mentioned earlier, fluid reflux due to valve dysfunction may not only cause water accumulation in the lungs, but may also cause water accumulation in the lower limbs, causing swelling of the legs and feet.
“MR is mainly divided into two types, namely primary and secondary. The former means that as people age, various functions of the human body begin to degrade, and mitral valve problems may occur, such as valve The leaflets, sub-valvular apparatus, chordates, and papillary muscles develop lesions. This is usually mucinous mitral valve disease.”
He mentioned that the situation is more complicated regarding secondary causes, which refer to functional abnormalities, generally involving the attachment of the heart muscle to the valves. The structure of the valve is like a parachute cord, which controls the opening and closing of the valve. When a lesion occurs, it causes left ventricular dysfunction, resulting in annular dilatation of the mitral valve and limited leaflet tethering. As a result, the mitral valve cannot close properly. The causes can be divided into defects. There are two types: hemorrhagic (ischemic) and non-ischemic (non-ischemic).
“1 in 5 patients with heart failure has moderate to severe secondary MR;
According to the European Journal of Heart Failure,
If severe secondary MR does not receive treatment, the predicted mortality rate is 57%. “
“The Lancet” medical journal was published in 2006.
Titled “The Burden of Valvular Heart Disease:
According to the article “Burden of valvular heart diseases: a population-based study”,
The incidence of mitral valve disease is 2 to 3 times higher than that of aortic valve disease.
The main diagnostic method for MR is echocardiography (echo-cardiogram). From the echocardiogram scan, we can observe the condition of the valve, including whether the aortic valve is operating normally and whether the blood is flowing back.
Heart swelling with multiple symptoms requires opening of the heart
He revealed that there are also some patients who seek treatment for irregular heartbeats, and the screening method for such symptoms is electrocardiogram (ECG). There are many causes of irregular heartbeat, so ECG needs to be used to check the real cause, such as whether it is related to valve disease, etc.
“In some cases, we use two other more specific echocardiographic examination methods, namely transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TOE). Through one of them With this examination, we can evaluate the condition of the heart and valves in great detail.”
After diagnosis, patients with mild or moderately severe conditions generally only need to take medication to improve or control the condition. In severe cases, such as heart swelling accompanied by multiple symptoms, and if certain conditions are met, open surgery may be performed.
Valve repair surgery is the best option. After the surgeon examines the valve, he performs Alfieri stitch repair to correct the prolapsed valve; however, some patients are in very bad condition and require surgery. , an artificial valve is implanted to replace the original valve.
Replace traditional open surgery Good news for high-risk patients
The medical community has developed mitral valve clipping surgery to replace traditional open surgery, which brings good news to elderly and high-risk patients, or groups with hidden health diseases.
This new medical technology has only been available at home and abroad for about 10 years.
What is mitral valve clipping surgery? Al-Fazl pointed out that through TOE, the surgeon inserts a thin, flexible catheter into the patient’s groin and slowly leads it through the vein to the heart valve area.
Next, the second catheter with the valve clamp attached is passed through the first catheter to clamp the valve to the mitral valve. When the clip is properly seated, open the clip followed by grasping the prolapsed valve and immediately close the clip. When the valve closures are successfully closed or brought together, the clips can be deployed and the catheter removed, and the procedure is complete.
Decreased patient mortality
This surgery takes 3 to 4 hours. The surgeon uses relevant instruments to perform the surgery outside the body, and the patient is given general anesthesia. Coupled with the clear TOE three-dimensional imaging analysis, we clearly understand the situation inside the human body and the surgical results are ideal.
According to some testing studies in the United States, patients after mitral valve clipping have fewer visits to the hospital and lower mortality rates. The recurrence rate is quite low, the valve clip is durable, and there have been no problems to date. After 5 years of research, it is more effective than drug treatment.
“All treatment options have their pros and cons. The advantage of open surgery is that doctors can see the lesions clearly and repair the valve during the operation to the minimum or even no reflux, so the medical effect is ideal. However, the patient needs to be hospitalized for a week. , the recovery period is as long as one month, and you need to go to the hospital for review from time to time.”
Recover quickly after being hospitalized for 3 days
“Patients who undergo mitral valve clipping are hospitalized for about 3 days after the operation, and the recovery speed is very fast. However, it must be mentioned that after a clip is placed during the operation to achieve the curative effect, the patient can recover, which is No problem.”
He pointed out that if the blood reflux is serious, blood leakage will occur even if a clamp is inserted. At this time, one can only place an additional clamp to reduce the degree of reflux. When two clips are put in, the severity drops from 4 to 1, which is an acceptable result for us. The above-mentioned surgery is a good technology, but to some extent it still cannot completely replace traditional surgery.
He would like to remind the public that if you have symptoms of shortness of breath, please seek medical attention immediately. After examination, if the disease is related to MR, the severity must be considered before deciding on the treatment. If circumstances permit, open repair surgery is the first choice. For high-risk groups, mitral valve clipping surgery is appropriate.
Mitral valve clipping surgery is less invasive
Question 1. Who is suitable for the new transcatheter mitral valve clipping surgery?
Answer 1.For patients suffering from mitral regurgitation (MR), whether the condition is chronic or severe, in addition to requiring medication to control the condition, repair or replacement of the abnormally functioning mitral valve has always been necessary. is the main treatment option.
Medically, a less invasive method is the transcatheter implantation of a mitral valve clip instrument. This clip is mainly used to suture the mitral valve and increase the adhesion of the mitral valve.
This treatment is suitable for patients with seven types of degenerative mitral insufficiency who are at high risk for traditional cardiac surgery.