Percutaneous mitral valve repair (MVR) is a minimally invasive technique employed for treating mitral regurgitation (MR). The mitral valve is situated between the two left chambers (left atrium and left ventricle) of the heart. In mitral valve regurgitation, there is improper closure of the mitral valve allowing the backward flow of blood into the heart. MR condition is usually seen in adults and elderly people, due to degeneration of the valves that may occur with age or due to genetic influence.
MR is treated either by mitral valve repair or replacement surgery. Percutaneous mitral valve repair, also referred to as Mitraclip procedure, is usually employed for treating MR.
The percutaneous mitral valve repair is an edge-to-edge repair technique, based on surgical Alfieri technique in which the posterior and anterior leaflets are joined with a suture, creating double-orifice mitral valve. The technique is most appropriate for treating degenerative as well as functional mitral regurgitation.
The percutaneous mitral repair valve system is composed of 3 main parts:
A steerable guide catheter
A clip delivery system
The MitralClip device (implant)
Percutaneous mitral valve repair procedure creates a double orifice competent mitral valve by employing MitraClip in the middle of the damaged valve. This procedure is performed in the catheterization laboratory on a beating heart and involves the following steps:
The patient is laid on the operation table and is anesthetized
A specially-designed steerable, guiding catheter is advanced through the femoral vein across the inter-atrial septum into the left atrium; under transesophageal echo (TEE) and fluoroscopic imaging guidance
A metal implant, the MitraClip device, is attached to the end of a steerable clip delivery system
MitraClip device is advanced through the guide catheter and positioned in the LA or left atrium at the place of the leakage
The clip is pointed perpendicular to the line of mitral leaflet and then moved on across the valve into the left ventricle
MitralClip device grips the leaflets and is closed to create a competent double orifice valve
In case the MitralClip is not fixed properly, the clip can be re-opened and re-positioned to the desired location. The normal functioning of the mitral valve may be confirmed through transesophageal echo (TEE) and fluoroscopic imaging technique.
The percutaneous mitral valve repair procedure is a safe and significantly effective procedure for high surgical risk patients. The major limitation of the percutaneous technology is as follows:
The technique is to be typically used with an annuloplasty (plastic repair of a cardiac valve) for significant results
The possibility of developing iatrogenic mitral stenosis (MS)