Our heart is an amazing organ that works non-stop. Inside this heart, there are four valves that act like four gates to precisely control the flow of blood. These allow blood to flow in only one direction. One of these valves is called the 'Mitral valve'. This is located on the left side of the heart between the upper chamber (left atrium) and the lower chamber (left ventricle). But sometimes this mitral valve can become diseased. That means that blood can leak backward without closing properly, or it can become blocked without opening properly. So in this case, that valve has to be replaced.
So what is TMVR?
Simply put, TMVR (Transcatheter Mitral Valve Replacement) is a modern treatment method that replaces the damaged mitral valve with a new valve without undergoing major open-heart surgery.
Imagine, instead of a major surgery that involves opening the chest and stopping the heart, a thin tube (catheter) is passed through a very small incision in the groin or chest, along a blood vessel, into the heart, and a new valve is inserted through the tube and fixed in place of the old, diseased valve. This new valve can be a man-made valve, or it can be made from animal tissue (cow, pig). In this procedure, the old valve is not removed, but instead the new one is placed inside it and fixed.
Who really needs this treatment?
There are two main types of mitral valve disease:
1. Mitral valve regurgitation: This is when the two flaps of the valve do not close properly, causing some of the blood pumped by the heart to leak backward. It's like water leaking from a broken faucet.
2. Mitral valve stenosis: This is when the valve becomes narrow and does not open properly. This limits the amount of blood that can flow forward. Just like when a pipe is blocked, the flow of water decreases.
When both of these conditions become severe, severe symptoms such as shortness of breath, atrial fibrillation, pulmonary hypertension, and heart failure can occur.
Typically, open-heart surgery is performed in cases like this. However, TMVR is a great option for those who are older, have other medical conditions, and cannot afford the risks of such a major surgery.
Are TMVR and MitraClip the same thing?
No. Even though both of these are treatments that are performed without opening the heart, they are two different methods.
- MitraClip™: This involves repairing a leaking valve. This involves placing a small clip-like device between the two leaflets of the valve to stop the blood from leaking.
- TMVR: This is not a repair, but a completely new valve implant.
What happens before TMVR treatment?
After deciding to give you this treatment, the medical team will examine you carefully.
- Tests: Several tests are performed, such as an ``Echocardiogram`` to check the function of the heart and a ``CT scan`` to check the structure of the heart. These are used to plan the treatment.
- Talking about anesthesia: A specialist will talk to you about the type of anesthesia you will be given to avoid pain during the treatment. The decision will be made based on your condition, whether you will be given general anesthesia or conscious sedation.
- Instructions: The doctor will give you some special instructions.
- Some medications (especially blood thinners) may require discontinuation for a few days.
- You will be asked to fast for a few hours on the day of the treatment.
- You will be informed to bring someone home after treatment.
What happens during treatment?
This treatment usually takes about two to three hours. A team of specialists, including cardiac surgeons, cardiologists, and anesthesiologists, is involved in this.
In short, these are the things that happen.
1. The incision site (groin or chest) is cleaned and prepared.
2. A cannula (IV line) is placed in a vein in the arm, through which the necessary medications and fluids are administered.
3. The new valve is attached to the end of a thin tube (catheter).
4. This tube is inserted into a blood vessel through a small incision made in the groin or chest.
5. Using special imaging technology, this tube is guided to the mitral valve of the heart.
6. The new valve is inserted into the old, diseased valve, positioned correctly, and installed.
7. The tube is then removed and the incision is closed.
The medical team is monitoring everything, including your blood pressure and oxygen levels, throughout this entire time.
What happens after TMVR?
After the treatment, you will be taken to a recovery room. You will be closely monitored until you recover from the anesthesia. Some people may need to stay in the intensive care unit (ICU) for a day or two. Usually, you will need to stay in the hospital for a few days.
When you go home, your doctor will advise you on the following:
- How to participate in cardiac rehabilitation programs.
- Follow-up appointments.
- About medications to start again and new medications to take.
- When can I return to normal activities and work?
Benefits and risks of TMVR treatment
As with any medical treatment, there are benefits as well as risks. Let's take a look at them.
| Advantages | Risks & Complications |
|---|---|
| Mitral valve disease is corrected. | There is a risk of blood clots forming and traveling to the brain, causing a stroke. |
| A noticeable decrease in symptoms (such as shortness of breath). | Damage to heart tissue. For example: Left ventricular perforation. |
| Recovering faster than open heart surgery. | Left ventricular outflow tract obstruction. |
| No large scar and less pain. | The implanted valve may move or shift from its location. |
The important thing is that these risks are very rare, and if any complications arise, the medical team is ready to immediately convert to open surgery or take other appropriate measures.
When should you seek emergency medical advice?
When you go home after treatment, you should be very careful about certain symptoms. If you experience the following symptoms , go to the hospital's Emergency Department (ETU) immediately.
| Go to ETU urgently! | |
|---|---|
| Symptoms of a stroke |
|
| Symptoms of a heart attack | |
| If you have these symptoms, inform your doctor. | |
| Cut-related problems | Stitches coming loose, bleeding from the wound. |
| Signs of infection | Pain, redness, pus or fluid discharge, fever at the site of the wound. |
| Symptoms of a blood clot | Pain, swelling, and discoloration in areas such as the thigh, knee, or ankle. |
| Other symptoms of a heart attack | Sudden weight gain, swelling of the legs and ankles. |
Take-Home Message
- TMVR is a modern treatment method that replaces the mitral valve without opening the heart, with low risk and a quick recovery.
- This is a great option, especially for the elderly or those with other medical conditions who may find it difficult to tolerate major surgery.
- If you or someone close to you has mitral valve disease, talk to your cardiologist about this treatment option. He or she will decide which treatment is best for you.
- After treatment, following your doctor's instructions exactly is essential for a speedy recovery. Always be aware of warning signs.
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න