Have you or someone you know or a close friend ever been told by a doctor that you have a problem with your heart's 'Mitral Valve' and that you need surgery? When we hear the word "heart surgery," many of us get a little scared, right? That's normal. Because we've heard about surgeries that involve opening the chest and doing major surgeries. But did you know, medical science has advanced a lot now. Therefore, there is a new method that can replace this valve without opening the chest and through a very small incision. Today, we are going to talk about a treatment method that has been a great relief for many people, called `Transcatheter Mitral Valve Replacement` or TMVR for short.
Simply put, what is TMVR?
Okay, let's put it very simply. TMVR is a procedure that replaces the mitral valve in your heart. But the special thing about it is that it's not done by completely opening your chest like open-heart surgery. Instead, a thin tube (catheter) is inserted through a very small incision, and the new valve is then inserted into your heart.
Imagine that instead of removing a large valve and replacing it with a new one, you take the parts of the new valve through a small hole and fix them inside. This is a much less invasive procedure than major surgery. The new valve that is inserted this way can be artificial. Or it can be a biological valve made from cow, pig, or human heart tissue. After the new valve is inserted, it starts doing exactly the same thing that your old, diseased valve did.
Who needs this TMVR treatment?
To understand this, let's first look at what this 'mitral valve' is and what happens to it.
Our heart has four main chambers. Two on the top and two on the bottom. The mitral valve is located between the left atrium and the left ventricle. It's like a door between two rooms. This door has two flaps (leaflets). Each time the heart beats, these flaps open and close. This allows blood to flow in only one direction, from the top chamber to the bottom chamber. The main function of this valve is to prevent blood from flowing backward.
But sometimes, either from birth or later, various problems can occur with this valve. There are mainly two types of problems.
| The condition of the valve | Simply put, what happens? |
|---|---|
| Mitral valve regurgitation | What happens here is that the valve doesn't close properly. It's like the two door leaves don't close properly and there's a little gap. Then some blood leaks backwards, into the upper chamber. |
| Mitral valve stenosis | What happens here is that the valve becomes narrow or blocked. That means the door doesn't open completely. Then the amount of blood that needs to flow forward is obstructed. |
When these conditions become severe, they can cause symptoms such as shortness of breath, fatigue, and chest pain. They can also lead to more serious conditions such as atrial fibrillation (irregular heartbeat), pulmonary hypertension (high blood pressure in the lungs), or heart failure.
This treatment method, called TMVR, is usually a very good option for people who are older or have other medical conditions and cannot tolerate major open-heart surgery.
Are TMVR and MitraClip the same thing?
No. Although both are less invasive treatments for mitral valve problems, there is a difference between the two.
- TMVR is a total valve replacement .
- MitraClip™ is a valve repair . It's like putting a small clip between the two flaps of a leaking valve, stopping the leak.
Your cardiologist will decide which treatment is best for you.
What happens before TMVR treatment?
Before this treatment, your medical team will examine you carefully. This will mainly include the following tests:
- Echocardiogram: This is an ultrasound scan of the heart. It can clearly see how the heart's chambers and valves are working.
- CT Scan: This takes three-dimensional (3D) images of the heart and blood vessels and helps plan treatment.
Using the information from these tests, the medical team plans the best valve size and treatment method for you.
In addition, an anesthesiologist will talk to you and decide on the best type of anesthesia to keep you from feeling pain during the procedure. You may be put completely to sleep (general anesthesia), or you may be put to sleep and not feel pain (conscious sedation).
A few days before your treatment, your doctor will give you clear instructions on how to prepare. These may include:
- Some medications, such as blood thinners, may require discontinuation for a few days.
- On the day of the treatment, you will be asked to fast (without eating or drinking) for a few hours.
- After treatment, they ask to arrange a vehicle to take you home from the hospital.
What happens during TMVR treatment?
The entire procedure usually takes about two to three hours and is performed by a large team of doctors, including cardiac surgeons, interventional cardiologists, imaging specialists, and anesthesiologists.
Here's a simple step-by-step breakdown of what happens during treatment:
1. First, the area where the incision will be made (often the groin or a small area on the chest) is cleaned and hair is removed if necessary.
2. Then, a cannula (IV line) will be placed in a vein in your arm, through which you will be given the necessary medications and fluids.
3. Next, the new valve is attached to the end of a thin, flexible tube called a catheter .
4. Now, a very small incision is made at a predetermined location in the groin or chest, and through that, this catheter is inserted into a blood vessel.
5. Using special imaging technology, such as X-rays, doctors carefully guide this catheter through the blood vessels to the mitral valve in the heart.
6. Once in place, the new valve is placed inside the old, diseased valve.
7. Once the new valve is properly in place, the catheter is carefully removed and the small incision is closed.
Throughout this time, the medical team will continue to monitor everything from your blood pressure and blood oxygen levels to how your heart is working using an echocardiogram.
What happens after treatment?
After the treatment is over, you will be taken to a recovery room. The medical team will take good care of you until you recover from the anesthesia. Some people may need to stay in the intensive care unit (ICU) for a while. Usually, you will have to stay in the hospital for a few days.
Before you go home, the doctors will clearly explain what you need to do next.
- Cardiac rehabilitation: Advice on exercises and lifestyle changes to help strengthen the heart again.
- Follow-up appointments: Days when you need to see the doctor again.
- Medications: Advice on new medications to start or old medications to restart.
- Normal work: When can you return to work and resume normal activities?
What are the benefits of TMVR treatment?
Compared to open heart surgery, this catheter method has several advantages.
- Mitral valve disease can be corrected.
- Reduction of symptoms caused by the disease, such as shortness of breath and fatigue.
- Reduced risk of serious health problems.
- Able to recover faster than open surgery.
- Reduced impact on the body and pain.
Are there any risks or complications with this treatment?
Yes. Although the risks are lower than open heart surgery, as with any medical procedure, TMVR can have some risks and complications. However, these are very rare.
Most importantly, if an emergency arises during treatment, the medical team is ready to switch to open-heart surgery immediately if necessary.
These are some of the main complications that can occur:
- Blood clots: If these blood clots travel to the brain, a stroke can occur.
- Tissue damage: A wall of the heart (left ventricular perforation) or a blood vessel that supplies blood to the heart (coronary artery) may be injured.
- Left ventricular outflow tract obstruction: The new valve obstructs the path of blood flowing out of the left lower chamber.
- Valve movement: Movement of the valve from its fixed position.
Some complications may require further treatment or surgery.
How long does it take to recover?
Most people can return to their normal activities and work within a few weeks. However, it can take two to three months to fully recover . The most important thing is to follow your doctor's instructions carefully. Don't rush into heavy work or strenuous activity.
In what cases should you seek medical advice after treatment?
This is a very important part. When you go home after treatment, you should pay attention to the changes in your body. There are some symptoms, if they appear, you should seek medical advice without delay .
| Emergencies: If you have these symptoms, go to the hospital's Emergency Department (ETU) immediately! | |
|---|---|
| Symptoms of a stroke may include: | |
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| Symptoms of a heart attack may include: | |
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| Other things to watch out for: Talk to your doctor if you have these. | |
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TMVR is a very valuable treatment option for people with mitral valve disease who cannot undergo open heart surgery. If you have any further questions about this, please feel free to talk to your doctor. He or she will be able to explain the best treatment option for you.
Take-Home Message
- TMVR is a modern treatment method that replaces the heart's mitral valve through a small incision, without opening the chest.
- This is especially suitable for patients who have difficulty enduring open heart surgery.
- Recovery is faster and the impact on the body is less than with open surgery.
- As with all treatments, there are some risks, and it's important to discuss these with your doctor.
- After treatment, if symptoms of a stroke or heart attack appear, you should go to a hospital immediately.
- Only your cardiologist can provide the most accurate advice on what treatment is best for you.
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