Medical breakthroughs aiding the management of Mitral Regurgitation
Performing open heart surgeries for complex heart diseases is not new. India witnessed its first open heart surgery case in 1961 when our heart-care experts treated a heart defect in a 19-year-old girl. The country has not looked back. Six decades since our first open heart surgery, and science has evolved for the better, offering us smarter solutions and innovative tools to improve patient outcomes. Today, even in cases of a leaking mitral valve or mitral regurgitation which affects nearly 10 percent of the population who have suffered from heart attacks, coronary artery disease or have undergone a bypass surgery, we have minimally-invasively ways to treat them without opening the patient’s heart.
“The four valves of the heart—mitral, aortic, tricuspid and pulmonary enable flow in the right direction. Normally they flap open and close tight during each heartbeat. At times though, when these flaps do not open and close properly, blood flows backward through the heart, compromising supply to other parts of the body. A person is diagnosed with Mitral Regurgitation (MR), when the blood leaks backward into the left atrium as the valve between the upper left atrium and the lower left ventricle, the mitral valve, does not close tightly”. Dr. Sai Satish, Senior Interventional Cardiologist, Apollo Hospitals, India.
For some people, symptoms of mitral regurgitation are not visible for many years. However, these can surface with advancing age and are seen mostly in patients who have either suffered a heart attack previously or have some other underlying heart condition leading up to this. Symptoms include fatigue, shortness of breath even with minor exertion, palpitations (rapid hear beat), rapid weight gain (2-3 pounds in a day or over 5 pounds in a week), swollen feet or ankles, cough which gets worse on lying flat, discomfort when lying flat and waking up in the middle of the night short of breadth.”
Patients with mild symptoms might not need any treatment at all and regular check-ups and a healthy lifestyle can go a long way in keeping the heart working well. “High blood sugar from diabetes can damage the hearts blood vessels, ultimately damaging the heart and worsening MR (Mitral Regurgitation). Therefore, diabetics should be meticulous about keeping their sugars under control by eating healthy and exercising regularly. Other lifestyle changes include maintaining a healthy weight, moderate alcohol consumption, quitting smoking and regular visits to the doctor. In severe cases, surgical intervention might be necessary.”
Mitral regurgitation cannot be treated permanently, however, symptoms can be managed with timely diagnosis and early medical intervention. “Usually heart valve problem is diagnosed by analyzing the sound heard through stethoscope. The blood will produce a murmur If it leaks back into the left atrium. After that, a follow-up test is carried called echocardiogram. Drugs that can lessen fluid build-ups and prevent blood clots are recommended by the doctors. For patients who have aggravated symptoms, surgical treatment options are recommended,” said Dr. Ravinder Singh Rao, Director TAVI and Structural Heart Disease Programme, Interventional Cardiology at Eternal Hospital, Jaipur
For years, open heart surgery has helped to treat mitral regurgitation. Today, advanced technological advances have made it possible for doctors to treat mitral regurgitation without the need of opening the heart. Patients who are above the age of 50 and have a history of non-cardiac diseases related to kidney, brain or lungs and are either ineligible or a very high risk for open-heart surgery now have the option of these minimally invasive procedures. Trained interventional cardiologists now use a needle stick to insert and move a small clip to the right side of the heart through a vein in the thigh, much like
in an angioplasty. Manoeuvred through the septum and across the exact point of leak in the mitral valve, the clip is then used to grasp the malfunctioning leaflets and bring them together, drastically reducing or abolishing the leak. All this is done on a beating heart, under 3 dimensional echocardiographic and fluoroscopic guidance. If the results are less than satisfactory, it can be removed, and the process can be repeated until the desired optimal result is obtained.
This procedure has been shown to not only reduce hospitalizations from heart failure, but also drastically improve the quality of life of these patients.
At a time when India is reeling under the burden of cardiovascular diseases, medical breakthroughs are reshaping the future of cardiac care. By providing innovative heart treatments, advanced technological procedures have given a respite to millions of patients. A procedure that replaces open heart surgery, and provides an option for patients who are unfit for the same, with a minimally invasive option that takes just a couple of hours, is one such breakthrough that is redefining quality of life for patients with mitral regurgitation. Awareness however remains a major hindrance in the delivery quality cardiac care and there is a need to educate the masses on the importance of regular check-ups and on getting the best therapeutic option available.
