Interventional Treatments for Mitral Valve Disease

Minimally invasive treatment options for mitral valve disease

Minimally invasive treatment options for mitral valve disease

The mitral valve allows blood to flow between the two chambers on the left side of your heart. When the heart relaxes, the valve is open, allowing blood to flow from the lungs to the main pumping chamber of the heart. When the heart squeezes, the valve closes, so that blood goes forward toward the brain and body and not to the lungs. 

There are two main types of mitral valve disease: mitral regurgitation and mitral stenosis. 

Mitral regurgitation

The most common type of heart valve disorder, mitral regurgitation, is a condition in which the mitral valve does not close completely. As a result, the blood can flow backward, into the upper heart chamber and toward the lungs, reducing the amount of blood that flows to the rest of the body and placing an abnormal amount of pressure on the lungs.

Your heart works harder to pump blood, and your lungs feel strained. This can lead to shortness of breath, irregular heartbeats, elevated blood pressure in the lungs, stroke or congestive heart failure. If the amount of mitral regurgitation is severe, surgery or catheter-based therapy may be required to repair or replace the valve. Learn more about mitral regurgitation. 

Mitral stenosis

In mitral stenosis, the mitral valve does not open enough to let blood flow freely through it. This means less blood flows to the body, and blood and fluid may collect in the lung tissues, which makes breathing difficult. Mitral stenosis usually comes from an infection called rheumatic fever that affects children and often goes unrecognized. Learn more about mitral stenosis.

Often, medication is not sufficient to control severe mitral regurgitation, and surgery may be needed to repair or replace the mitral valve. Scripps physicians perform several types of surgical and catheter-based procedures to treat mitral stenosis and mitral regurgitation.

Transcatheter mitral valve repair

Patients who are not able to have heart surgery, most commonly because of other medical problems that make surgery problematic, may have a minimally invasive procedure called transcatheter mitral valve repair using the MitraClip. Scripps interventional cardiologist Matthew Price, MD, performed the first transcatheter mitral valve procedure in San Diego as part of a clinical trial; the procedure can now be performed on many patients without having to be involved in a trial. 

The MitraClip device treats mitral regurgitation by clipping together the leaflets of the valve at the spot where they are not coming together correctly, thereby fixing the leak. The physician inserts a thin tube called a catheter into a leg vein and guides it up to the heart, and then guides the MitraClip through the catheter and carefully positions it on the mitral valve. Once the device is in place and working properly, the catheter is removed. 

Generally, patients spend one or two nights in the hospital after the procedure. Most patients experience an immediate reduction of mitral regurgitation and significant improvement in symptoms and quality of life soon after the procedure.

Transcatheter mitral balloon valvuloplasty

Mitral stenosis, or narrowing of the valve, that is due to rheumatic fever is first treated with medication that slows down the heart. If shortness of breath still occurs despite medication, the valve narrowing can be treated with a catheter-based, minimally invasive procedure where a catheter with a balloon is threaded up into the heart and across the valve.

The balloon is then inflated and removed, which alleviates the narrowing and allows the blood to flow across the valve more normally. On occasion, the valve cannot be fixed with this balloon; in such cases, surgery to replace the valve is usually recommended.