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Using Minimally Invasive TMVR in Certain Patients

There are four valves in the heart –mitral valve, tricuspid valve, aortic valve and pulmonary valve. All of them should work together and in tandem with each other. We will talk about mitral valve here. It is present in the left side of the heart. The primary function of this valve is to allow the blood from the left atrium to pass flow to the left ventricle. In simpler words, it controls the flow of blood from the lungs to the body. But in some diseases and conditions, the flow of blood is obstructed. It may either flow backwards through the valve or it may be narrowed which obstructs the blood flow. This may cause grave problems in the body. Open heart surgery is the most common option to treat this condition but everyone is not a candidate of this procedure. This is when transcatheter mitral valve repair is needed.

Transcatheter Mitral Valve Repair (TMVR) is a minimally invasive surgery to replace the diseased and affected mitral valve. There is no need of conventional open heart surgery. It is a catheter based therapy performed using venous access and real time imaging such as echocardiography and fluoroscopy. It therefore avoids cardiopulmonary bypass surgery.

There are many advantages of having this procedure. Some of them are as follows –

Not everyone is a candidate of open heart surgery. People in need of replacement of mitral valve but not eligible of open heart surgery are given TMVR.

There is no need of bigger incisions. Instead of a large incision, several smaller incisions are made.

As there is no big incision involved, there is no issue of scarring.

No blood loss is there.

It is a relatively pain free procedure.

There is reduced risk of infection and complication.

The recovery time is less and you are able to return to your daily work in a shorter span.

There are two main causes of undergoing TMVR. These are explained below –

Mitral Valve Stenosis

It is the condition in which our heart valve becomes narrowed. It is not able to open properly, thus blocking the flow of blood. This condition progresses over time and the following symptoms are observed –

1. Shortness of breath in even lying down.

2. Excessive fatigue while doing physical activity.

3. Sensation of fluttering heart.

Following are the causes of this condition –

1. Rheumatic fever is the most common cause. It causes the flaps to thicken.

2. With age, there is calcium deposit around the ring of the mitral valve known as annulus.

3. It may be due to congenital defect that progresses over time.

Mitral Valve Regurgitation

It is a medical condition in which the mitral valve is not tight enough causing blood to flow in backward direction. In extreme cases where the regurgitation has reached an advanced stage, blood won’t be able to reach the body and you will feel short of breath. Other symptoms are –

1. Murmuring of heart heard through a stethoscope.

2. Swollen feet and ankles.

3. Fluttering heartbeat.

Causes of mitral valve regurgitation include –

1. Torn tissue cords causing leakage through the mitral valve.

2. Infection of the lining of the heart affecting the mitral valve.

3. Certain medications like Cafergot, Migergot etc.

The procedure of TMVR is done with the help of a mitral clip. It is implanted inside the body using a catheter. The mitral clip is made of metal and polyester. In this procedure, incisions are made in the thighs through which a guide wire and a catheter are threaded. The guided wire is removed after it has reached the upper left chamber of the heart. The clip is eased through the catheter and into the atrium. The clips arm are opened and placed over the valve’s leaflets. Two smaller channels are created by closing the arms to clip the leaflets together in the middle. The catheter is finally removed but the clip is kept in place.

Eternal Hospitals should be thanked for bringing TMVR to Rajasthan. Doctors present in this hospital used this advanced technique for the first time in Rajasthan. The patient, Kamala Jain, was not in an able condition to undergo a major surgery. Dr. Ravinder Singh Rao, Director TAVR Programme, Interventional Cardiology at Eternal Hospital said “Dr. Samin Sharma and his team used this technique successfully and has opened a new vista of hope for other patients.

Eternal Hospital is the first and only hospital to perform this procedure in Rajasthan. They have brilliant doctors amongst them who are highly capable in imparting modern techniques like TMVR.

Tags: TMVR treatment, minimally invasive surgery, open heart surgery, mitral valve regurgitation, eternal hospital