Your Heart Valves
Additional information you may also be interested in:
Non-surgical approaches
Heart valve disease refers to several conditions that prevent one or more of the valves in the heart from opening and closing properly. Heart valve disease can cause either a leaky valve (regurgitation) or a valve that does not open wide enough (stenosis). Untreated heart valve disease can cause symptoms and reduce a person's quality of life and overall survival.
Traditionally, when the heart’s valves become severely damaged, heart surgery is used to repair or replace the valve. Heart surgery can restore the heart’s normal function and allow the patient to return to his or her usual activities. In some heart conditions non-surgical approaches via catheters can provide equally satisfactory results.
Most patients are able to undergo surgery without difficulty. However, for people whose heart function is too severely compromised to withstand surgery, several approaches to treat heart valve disease without surgery have been developed.
These approaches can be divided into three categories:
Clinical Practice
PERCUTANEOUS MITRAL, AORTIC AND PULMONIC VALVOTOMY FOR STENOSIS
Percutaneous valvotomy (also called valvuloplasty) is performed in many patients to treat mitral valve and pulmonic valve stenosis (narrowing of the valve). Percutaneous valvotomy may also be performed in carefully selected patients to treat stenosis of the aortic valve.
Mitral valvotomy
During mitral valvotomy, a catheter is placed through the femoral vein (in the groin) and guided into the chambers of the heart. The cardiologist then creates a tiny hole in the wall between the heart’s two upper chambers. This hole provides an opening for the cardiologist to access the left atrium with a special catheter that has a balloon at the tip.
The catheter is positioned so the balloon tip is directly inside the narrowed mitral valve. The valve opening is widened (or dilated) by rapidly inflating and deflating the balloon. Once the cardiologist has determined that the opening has been widened sufficiently, the balloon is deflated and removed.
The procedure is similar when performed in the aortic and pulmonic valves.
Investigational
PERCUTANEOUS AORTIC VALVE REPLACEMENT
Percutaneous aortic valve replacement (AVR) is a new treatment being investigated for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening). Research at Cleveland Clinic is evaluating a percutaneous technique for implanting a prosthetic valve inside the diseased calcific aortic valve. The procedure is performed in the catheterization lab.
During the procedure a catheter is placed through the femoral artery (in the groin) and guided into the chambers of the heart. A compressed tissue heart valve is placed on the balloon-mounted catheter and is positioned directly over the diseased aortic valve. Once in position, the balloon is inflated to secure the valve in place.
For patients with severe peripheral vascular disease, surgeons and cardiologists are testing an alternative approach through the left ventricular apex of the heart.
Percutaneous AVR
a) Balloon valvuloplasty; b) Balloon catheter with valve in the diseased valve; c) Balloon inflation to secure the valve; d) Valve in place
Cleveland Clinic is participating with two additional centers in a Food and Drug Administration study to determine the feasibility of this treatment. It may be a viable non-surgical treatment option for high-risk patients who are too ill to undergo surgical aortic valve replacement.
PERCUTANEOUS MITRAL VALVE REGURGITATION TREATMENT
A clinical trial is currently being performed to determine the effectiveness of a percutaneous approach for treating mitral valve regurgitation. The procedure is performed in the cardiac catheterization laboratory with the aid of echocardiography.
Mitral Valve Clip Study
Mitral Valve Clip
Percutaneous Valve Repair System
Images used with permission from Evalve, Inc.
During this procedure, a very small, specially made metal clip device is delivered through a catheter inserted into the femoral vein (in the groin) and advanced to the heart.
Guided by echocardiography, the cardiologist attaches the clip to the flaps of the mitral valve. Placement of the clip is adjusted until optimal improvement in blood flow and pressures through the valve are observed.
Then, the clip is released, and the catheter is withdrawn. The clip holds the valve flaps in position, which limits the leakage.The phase II trial demonstrated the safety and feasibility of this method. Currently a randomized trial is underway to test if catheter based treatment of mitral regurgitation using the clip is effective as a non-surgical alternative to open heart surgery.
B) The prosthesis (shown within catheter) straightens the natural curvature of the vein and exerts pressure on the dilated annulus, pushing it and its attached leaflet forward to help restore more normal valve leaflet alignment.
[Images used with permission from Viacor, Inc.]
A) The catheter (shown in white) resides within the coronary sinus.
Anatomic and preclinical studies at Cleveland Clinic suggested that in some patients, mitral regurgitation could be treated percutaneously by placement of a device in the coronary sinus via a catheter. In a small clinical trial conducted at the Cleveland Clinic, safety and feasibility were confirmed in patients undergoing heart surgery.
Placement of the prosthetic device pushes the support structures of the mitral valve and its leaflets back into more normal alignment, mimicking a surgical annuloplasty (see images). Patients in the study had already consented to having mitral valve surgery.
The prosthesis is a metal bar, about 7 cm in usable length and 1.5 mm in diameter, flexible at both ends and stiff in the middle. Guided by fluoroscopy and transesophageal echocardiography, the bar is positioned within the coronary sinus, near the posterior valve annulus. By exerting pressure on the dilated annulus and pushing it and its attached leaflet closer toward the other leaflet, the device helps restore more normal valve alignment and hemodynamics. We anticipate a larger study of this technology at the Cleveland Clinic in the near future.
Early Development
PERCUTANEOUS TRICUSPID VALVE REPLACEMENT
Patients who have received prior radiation to the chest present a difficult challenge for surgeons treating radiation-induced heart valve disease. For some patients, valve replacement surgery can be strenuous. Percutaneous approaches may provide a treatment option for this challenging patient population.
Cleveland Clinic investigators are exploring devices for this purpose and performed the first percutaneous valve placement to remedy the impact of tricuspid regurgitation on the body using a special device developed at the Cleveland Clinic.
This three-dimensional image depicts the implanted valve (white arrow) inside the inferior vena cava (the large vein that carries blood from the lower half of the body back to the heart) immediately below the right atrium. The absence of dye below the valve (orange arrow) demonstrates that it is functioning correctly without leakage.
Although some of these percutaneous approaches for repairing heart valves have not yet been validated in large clinical trials, they may lead to the development of less invasive treatment options for heart valve disease in the future.
If you want more information about valve disease or valve surgery , click here to contact us or call the Heart and Vascular Institute Resource & Information Nurse at 216/445-9288 or toll-free at 866/289-6911. We would be happy to help you.
Additional information:
