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TMVR

Transcatheter Mitral Valve Replacement. The mitral valve is important among the four valves in the heart. Just like tricuspid valves, these valves help in controlling blood flow to the ventricles from the atria. The most common problem that is seen in the mitral valve is degenerative valve disease. This valve ailment is progressive in nature and is a slow degeneration from mitral valve prolapse. This is a condition in which there is improper leaflet movement and almost 4-5 percent of the general population is affected by this problem. Over a long period of time, the attachments of the valve thin out. Sometimes, the valve also ruptures and the leaflets become redundant and floppy. As a result, there’s leakage through the valves.

Regurgitation happens when blood flows backward in the valves as there might be leaks in the valve leaflets after they are closed. In such a situation, the heart has to work harder to pump a larger volume of blood. In case there is a leaky mitral valve, blood will flow back to the left atrium from the ventricle when there is a contraction in the ventricles.

Stenosis is also a condition, which might affect the heart valves including the mitral valve. A stenotic mitral valve restricts the flow of blood from the left atrium to the left ventricle.

There are many patients with severe mitral regurgitation, and extensive open-heart surgery might not be possible for all kinds of patients. For such patients, transcatheter mitral valve replacement (TMVR) is an alternative treatment. TMVR can be applied to annuloplasty rings, degenerated prosthetic valves, or other kinds of native mitral valve ailments.

Transcatheter mitral valve replacement is a surgical procedure in which the mitral valve is replaced in the heart, without the need for open-heart surgery. Patients suffering from either mitral valve regurgitation or mitral valve stenosis or a combination of both, who are not able to undergo general open heart surgery are candidates for this kind of surgery.

This is a minimally invasive surgical procedure, which helps in improving the quality of life significantly without any open-heart surgery. For TMVR, a special kind of device is needed, which should be approved. The device is built from polyester and metal, and made in such a way that it provides relief from mitral regurgitation and also helps in preventing hospitalization for heart failure.

A patient undergoing TMVR will have to get admitted to the hospital or nursing facility the day before the surgery. This gives the healthcare team time to prepare the patient for the surgery in a proper manner.

Here is a brief description of what happens during the process of transcatheter mitral valve replacement (TMVR):

  • The patient is made to lie on their back and they are put on a life support system so that they can breathe during the procedure.
  • The surgery is done under complete anesthesia.
  • An opening is made in the femoral vein of the groin. Through this opening, a guidewire and catheter are inserted towards the heart.
  • The guidewire is gradually moved into the left atrium, which is the upper left chamber of the heart and once it reaches there, the guidewire is removed.
  • The clip is eased through the catheter and is moved into the atrium.
  • The arms of the clips are opened and are placed over the two flaps of the valves, which are also known as leaflets.
  • The arms are then closed for clipping the leaflets together in the center. As a result, two small channel-like structures are created. This helps in preventing the flow of blood in a backward direction.
  • The catheter is slowly removed, but the clips remain in place.

The patient is generally released after one or two days of the procedure. After they go back home, they have to follow some rules and regulations and also take the medicines properly as instructed. Follow-ups also need to be done at regular intervals to understand the progress taking place.

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