To understand better
To understand how the mitraclip works, you have to start from the beginning.
The heart has 4 valves
The heart is a muscular pump which makes the blood circulate in the whole body.
The heart has four valves following the blood to always move forward.
The mitral valve
One of the valves is the mitral valve. It is located between the left atrium and the left ventricle. It can be compared to a double door.
It controls the passage of blood from the left atrium to the left ventricle.
Under normal circumstances, when the heart contracts and pushes blood into various body organs (brain, arms, bowels, etc.), the mitral valve closes in a tight way to prevent blood from going backward into the left atrium.
During life, the mitral valve can become less competent and may lose its sealing properties for various reasons.
Many terms have been used to describe this situation. Some say that the valve is leaking, that the valve is regurgitating or that the valve is insufficient.
Those terms mean that blood goes backward into the left atrium when the valve is closed. The degree of insufficiency is described as light, moderate or severe depending of the amount of blood going back into the left atrium.
Eventually, mitral insufficiency can cause heart failure with symptoms of shortness of breath, fatigue and accumulation of water in the lungs.
Possible treatments of the leaking valve
Normally, in severe cases requiring a repair, the standard treatment consists of a surgical repair or valve replacement.
However, some patients are too sick or to frail to undergo surgery, so a less invasive procedure such as a Mitraclip could be considered.
Mitraclip is the name of a catheter procedure used to reduce severe mitral insufficiency, i.e. to reduce valve leaking in a significant way.
How does it work?
In mitral insufficiency, the problem is that the two leaflets of the valve are not closing properly. In other words, it’s like having a western door instead of having a double door closing tightly.
The Mitraclip concept can be compared to a clothespin. It brings the two leaflets together where the leak is observed.
How is it done?
This procedure is performed in the catheterization laboratory, the same type of operating rooms where angiography and stents are performed.
Before the procedure
Usually, you have to come for a preparation visit. The procedure is explained, your questions are answered and some blood work is done. For the procedure itself, you will be admitted to the hospital for about 2 days.
The day of the procedure
when you come for your procedure, you will be asked to be fasting from the night before.
You will be prepared in the recovery room, which is usually just besides the catheterization laboratory.
You must take off all your clothes and wear a hospital gown.
A nurse will insert an IV line in your arm, in order to be able to give medications during the procedure
Shaving of the groins is done as catheters will be inserted in your right or left femoral veins (veins in the groin).
Preparation in the procedure room
You will be brought to the procedure room on a stretcher.
During the procedure, the nurses and the doctor take the same precautions as in an operating room, in order to prevent bacterial contamination or infection.
The procedure table may be uncomfortable.
The temperature in the room is cool, even cold, but it is necessary for the proper functioning of the radiology equipment
The procedure will be performed under general anaesthesia. You will also get a medication to relax while the equipment is getting prepared.
Transesophageal echocardiography, i.e. an echography device that looks like a gastroscopy probe, is used to guide the doctor during the procedure. But don’t worry, you won’t be awake.
Under steril condition
Once the equipment is ready for the procedure, the nurse will dysfect your groins with a special solution.
Then a sterile sheet will be used to cover your body.
The heart specialist begin the procedure
During the procedure, keep in mind that you will be put asleep.
To access the heart, the cardiologist makes a puncture in the of the groin, the femoral vein.
A plastic tube called introducer is inserted in this vein, which makes it possible to maintain an access during the whole procedure.
A catheter is introduced and goes up to the heart.
The doctor goes to the mitral valve by advancing through the femoral vein to the inferior vena cava then to the right atrium.
From there, to access the left atrium, he must create a small hole into the structure that separates the two atria, the interauricular septum.
Transesophageal echocardiography facilitates this step.
Once at the mitral valve location
The doctor brings the device at the level of the mitral valve and uses reference points using cardiac echography where do valve leaks the most.
Once at the right place, the edges of the 2 leaflets are caught and the clip is closed.
The impact on the mitral leak is checked immediately
Once the device is in place, the effect of the device on the leakage is assessed by echography.
The doctor judges if the result is satisfactory using these images. If the residual leakage is still too important, another clip is inserted.
Are there risks?
Like any procedure involving puncture of a blood vessel, there is a risk of bleeding.
The other risks, less frequent (less than 1 out of 100) are:
- the accumulation of blood around the heart i.e. in the pericardium
- a stroke (CVA)
- the need for urgent surgery.
The complete detachment of a clip has never been observed.
What to expect?
The goal of this procedure is to decrease the symptoms related to mitral insufficiency, and to decrease the number of hospitalizations for heart failure, i.e. for accumulation of water in the lungs.
What is the follow-up?
If all goes well, the patient goes home the day after the procedure.
Drugs to be taken
Following the procedure, it is necessary to take blood thinners for at least 6 months.
This treatment is composed of drugs that slow down the action of platelets.
Precautions to take
The Mitraclip is a small foreign body which “pins” the two leaflets of the mitral valve. It could be get infected in the situation where bacteria enter the blood circulation.
This is why a good oral hygiene is required.
It is also recommended to take antibiotics as a preventive measure before dental procedures or before some types of surgery.
Follow-up is ensured by the doctor who referred you for that procedure. You should expect to have echocardiograms that over time to monitor the degree of valve insufficiency and your heart function in general.
The regular activities of everyday life can be resumed gradually a few days following the procedure.
The patient is told not to take a bath or enjoy a swimming pool for the first 3 to 4 days because of the little incision in the thigh. The use of the shower is possible.
A small stiffness in the groin used may be perceived for a few days. It is possible to apply dry heat of hot water to soothe and reduce inflammation.