Mitral Clip: Indications and Complications

The heart is divided into four major chambers, the left atrium, left ventricle, right atrium and the right ventricle. The valve present between the left atrium and the left ventricle is called the mitral valve. The valve present between the right atrium and the right ventricle is called the tricuspid valve. When the mitral valve doesn’t close properly, it may allow the blood to backflow into your heart, because of which enough blood doesn’t reach your body; this condition is called Mitral Regurgitation (MR). Mitral clip is a small clip like device developed to reduce the backflow of blood in individuals with mitral regurgitation.

Procedure

Your doctor will insert a small tube called a catheter into a vein in your groin. The catheter moves forward until it reaches the right atrium. From here it pierces the inter-atrial septum and enters the left atrium. A device containing the mitral clip is introduced into the tube and positioned above the mitral valve. The device then moves into the left ventricle via the mitral valve and grasps the flaps of the mitral valve. When there is a proper hold achieved the device is deployed and the mitral clip gets attached to the leaflets of the valves giving the opening, between the left atrium and ventricle, an eight shaped opening. This reduces the back flow through the mitral valve during the contraction phase of the ventricle.

The procedure is done in the cardiac catheterisation lab, under general anaesthesia.

Indications of Mitral clip

This procedure is indicated for individuals with severe mitral regurgitation and contraindications for a major surgery.

Complications of Mitral clip

Mitral valve repair is associated with an overall complication rate of 15-19% at 30 days. The complications seen are:

• Bleeding: the large size of the device used to deploy the mitral clip increases the chances of bleeding at the site from where the device entered the body.
• Detachment of the clip
• Mitral stenosis: the clip may cause development of narrowing of the mitral valve (mitral stenosis) in rare cases
• Infective endocarditis: bacterial infection of the valves of the heart because of the procedure.

Recovery

After the procedure you will be taken to the recovery room where your treatment team will be continuously monitoring you. After an overnight stay in the ICU you will be shifted to the normal ward. You will be gradually allowed to sit in your bed, then a chair and then walk around on your own. On the second day a number of tests will be done to check the function of the heart. You may feel some pain in the groin at the site of access, talk to your healthcare provider if the sight is inflamed or has a discharge oozing from it. Most individuals can go home 2 days after the procedure.

Post procedure you will be advised to not lift heavy weights for some days. An exercise regime might be suggested to help you recover faster and better.

Alternative

The alternatives for mitral clip are mitral valve replacement and open heart surgery for repair or replacement of the mitral valve.

Resources:

• SCAI Clinical Guidelines. http://www.scai.org/Guidelines/Default.aspx
• American Heart Association. www.heart.org