Mitral Yetersizliği

Mitral regurgitation is the condition in which blood leaks backward from the left ventricle into the left atrium because the mitral valve does not close completely. The mitral valve is the bileaflet (two-leaflet) valve that lies between the left atrium and the left ventricle. Under normal conditions it closes completely while the left ventricle contracts and thereby prevents blood from flowing back into the left atrium.

In mitral regurgitation the valve fails to close completely during contraction of the left ventricle and part of the blood is driven back into the left atrium. This may lead to a rise in left atrial pressure, to enlargement of the left atrium and, over time, to left-sided heart failure.

The causes of mitral regurgitation include rheumatic heart disease, mitral valve prolapse, papillary muscle dysfunction due to coronary artery disease, infective endocarditis, congenital anomalies and degenerative changes related to aging.

Symptoms include shortness of breath (dyspnea), reduced exercise tolerance, palpitations, cough and, at an advanced stage, signs of heart failure. Mild mitral regurgitation is usually asymptomatic, whereas symptoms begin to appear once the regurgitation is moderate or severe.

Mitral regurgitation is diagnosed by echocardiography. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are used to assess the severity of the regurgitation, its underlying cause and the patient’s suitability for treatment.

Today, in the treatment of mitral regurgitation, transcatheter (“closed”) techniques are used in appropriately selected patients in addition to open surgical methods. Interventional treatment such as mitral clip therapy (MitraClip) offers an alternative option for patients who are at high surgical risk.

How is the diagnosis made?

Mitral regurgitation can now be diagnosed readily with the highly advanced ultrasound systems known as echocardiography. The diagnosis is first established by transthoracic echocardiography (TTE), which requires no more than placing an ultrasound probe on the front of the chest. The severity of the regurgitation, its cause, the structure of the valve and its suitability for treatment are then assessed in detail by transesophageal echocardiography (TEE), in which a probe is passed through the mouth and positioned in the esophagus. In addition to two-dimensional TEE, three-dimensional echocardiography shows the structure of the valve more clearly. In our clinic, TTE together with two-dimensional and three-dimensional TEE is performed in every patient in whom mitral regurgitation is suspected.

Transcatheter (mitral clip) therapy: for whom and how is it performed?

Mitral clip therapy (MitraClip / TEER – transcatheter edge-to-edge repair) is an advanced interventional treatment performed in order to reduce the regurgitation at the mitral valve without the need for open heart surgery.

How is the procedure performed?

The procedure is carried out in the angiography laboratory under echocardiographic and fluoroscopic (X-ray) guidance. Access is gained with a thin catheter through the vein in the groin (femoral vein), and a dedicated crossing is then made from the right side of the heart to the left side. Once the mitral valve has been reached, a dedicated clip system is attached to the valve leaflets. In this way the valve is able to close properly and the regurgitation is reduced to a substantial degree. More than one clip may be used when required. After the procedure, patients are generally discharged within 1–3 days.

In which patients is it performed?

Mitral clip therapy is performed particularly in patients who:

• have severe mitral valve regurgitation;
• have symptoms of shortness of breath, reduced exercise tolerance or heart failure;
• are at high risk for open heart surgery;
• are of advanced age or have comorbidities;
• are judged suitable after assessment by the Heart Team.

In addition, in some patients with heart failure in whom mitral regurgitation persists despite medical therapy, it may also be used in order to improve quality of life and to reduce hospital admissions.

What are the advantages of the method?

• It is performed without opening the chest.
• It carries a lower risk than open heart surgery.
• The recovery period is shorter.
• It can provide marked improvement in symptoms such as shortness of breath and fatigue.
• It can reduce hospital admissions due to heart failure.

Mitral clip therapy is a modern treatment option that is recommended by international guidelines for appropriately selected patients and that is performed successfully in experienced centers.