The experts of the “Health and prevention” blog analyze, in a new post, the blood leaks that can occur in the heart due to the decision to have a prosthetic valve
The four valves of the heart are responsible for circulating the blood. That’s why they open and close. It’s not common, but sometimes they can fail. Faced with these cases, the most common solution is the placement of a valve prosthesis through a surgical intervention. But sometimes this bond between the implant and the patient’s heart tissue can fail, resulting in small leaks of blood into the heart and malfunctioning of the prosthetic valve.
This would be the case of Macarena (fictitious name), a 65-year-old patient who underwent mitral valve replacement in 2000. Since two years ago he presented again problems related to his heart; specifically, severe mitral periprosthetic regurgitation and severe aortic stenosis. Initially, the aortic valve was treated by transcatheter aortic valve implantation (TAVI) with good outcome and clinical improvement.
However, in recent months he had presented a significant deterioration in heart failure symptoms, the main cause of which was perivalvular leakage from the mitral prosthesis.
Close the escape of the heart
For this rare complication, which can be serious, a procedure of high technical complexity called ‘mitral leak closure’ has been developed in recent years – basically closing this leak in the heart by means of a catheter (as explained in detail later -.
After this last operation, this patient showed “immediate improvement”, celebrate doctors Rafael García de la Borbolla and Mariano García de la Borbolla, from the Cardiovascular and Endovascular Surgery Service of the Hospital Quirónsalud Infanta Luisa de Sevilla, experts in this technique.
Specifically, according to the register of the Hemodynamics section of the Spanish Society of Cardiology, a total of 117 mitral leak closure procedures were performed in Spain in 2020. It is an intervention, of course, that cannot be done in all patients, so a previous study by specialists is always required.
High complexity in the procedures
“These are procedures with high technical complexity that require multidisciplinary teams that include interventional cardiologists, cardiovascular surgeons, cardiologists expert in cardiac imaging and anesthetists, among others,” emphasize the experts at the Quirónsalud Infanta Luisa Hospital.
Specifically, they state that perivalvular leakage is a complication that can occur in 1-5% of patients undergoing valve replacement. The last is the percutaneous treatment, thus avoiding a high-risk surgical reintervention.
“Most of the time, these leaks are small and have no clinical implications, although when the defect is large, a significant perivalvular insufficiency occurs, which conditions the appearance of heart failure refractory to conventional treatment,” maintain the cardiovascular surgeons.
A safe alternative to reintervention
Even more, they maintain that in some of these patients surgical reintervention is a high-risk surgery. To avoid this, percutaneous techniques have been developed for the treatment of these complications, such as the one they did in Macarena.
This type of intervention, as explained by Mariano García de la Borbolla, is complex and is carried out guided by X-rays and a 3D transesophageal echocardiogram. This is why patients are usually sedated and, guided by X-rays, catheters are directed into the leak in the patient’s heart, where a new umbrella or mushroom-shaped device is placed to close the leak.
“It is necessary to locate the leak with the images and from the inguinal region it is accessed through a catheter to place a device that manages to seal the leak and that improves the insufficiency that was occurring”, points out Rafael García of the bubble
According to him, it is a matter of “threading the orifice on the side of the valve with a small tube or catheter to place the closure device from the femoral region, with all the difficulty this entails. This type of procedure had not been carried out in Andalusian private healthcare until now”, points out this expert from Quirónsalud Infanta Luisa.
What is common in these cases is that the degree of mitral regurgitation decreases significantly and the patient improves. After the operation the patient usually spends the first few hours in the intensive care unit and if there are no complications, he can be discharged after a few days of the procedure.