SOME PATIENTS, HOWEVER, were not candidates for surgery due to their age, or other serious conditions such as lung or kidney disease that made such an invasive procedure too risky. As a result, they had to live with a heart problem that would inevitably worsen, compromise their quality of life, and eventually lead to heart failure and death.
Now, however, doctors have developed a less-invasive MR treatment known as the MitraClip™ transcatheter mitral valve repair [see Physicians’ Roundtable on page 44]. In this procedure, an interventional cardiologist inserts a catheter with a clip attached into the femoral vein in the groin and navigates it — under X-ray and ultrasound guidance provided by another cardiologist — to the mitral valve, where the clip is used to reshape the valve.
For patients with severe mitral regurgitation who are not candidates for surgery, this procedure can offer them a second chance at life.
When Eisenhower began offering the MitraClip in May 2018, it became the first — and remains the only — Coachella Valley hospital to do so. Since then, nearly 40 desert residents have successfully undergone this life-changing procedure. Palm Desert resident Joan Freeman, 88, is one of them.
“I hadn’t seen a heart doctor in nine years, so I thought I should have an evaluation,” says Freeman. “I had noticed that when I went for a walk — and I always walk fast — I’d get out of breath. My husband said, ‘Well, you are getting older; maybe it’s just a sign of that.’ But I decided I should see a doctor.” It was a smart decision.
Last April, Freeman went to see Board Certified Cardiologist Chanaka Wickramasinghe, MD. As part of his initial examination, he listened to Freeman’s heart with a stethoscope, which revealed the telltale “whooshing” noise of a heart murmur, the sound of blood leaking backward (regurgitating) through the mitral valve.
Located between the heart’s two left chambers, the mitral valve has two flaps of tissue, called leaflets, that open and close, ensuring that blood flows in only one direction. When the leaflets fail to close completely, however, regurgitation occurs.
To better understand the severity of her condition, Dr. Wickramasinghe ordered an echocardiogram (an ultrasound of the heart); it revealed that Freeman’s regurgitation was significant. And while moderate shortness of breath was her chief complaint, it was worsening; on a subsequent treadmill test, Freeman couldn’t go more than two minutes.
Medications — to prevent fluid retention and to slow the heart rate and lower blood pressure — are often the first-line treatment for valve disease. But they only help manage symptoms and don’t resolve the underlying structural valve problem. The severity of Freeman’s MR indicated that more aggressive intervention was appropriate.
Dr. Wickramasinghe referred Freeman to Board Certified Interventional Cardiologist Khoi Le, MD, to determine whether she was a candidate for either traditional mitral valve surgery or the MitraClip. As part of the evaluation, she underwent a trans esophageal echocardiogram (TEE) and coronary angiogram to further assess her condition.
“Even though shortness of breath was her only symptom, Mrs. Freeman’s mitral valve regurgitation was quite severe,” Dr. Le relates. “MR is graded on a scale of zero to 4+, with 4+ being the worst, and she was a 4+.”
Freeman’s test results and medical history were then evaluated by both Dr. Le and Board Certified Cardiothoracic Surgeon Joseph Wilson, MD. By bringing together different clinical perspectives and expertise, this multidisciplinary assessment ensures that the valve team arrives at the right treatment solution for the individual patient.
“Dr. Wilson felt that due to her age and some underlying kidney issues, Mrs. Freeman was too high risk for surgical treatment, even with a smaller incision that would have been possible with robotically assisted surgery,” Dr. Le says. “He recommended going ahead with the MitraClip.”
On May 13, 2019, Freeman became the 26th patient to undergo the MitraClip procedure at Eisenhower.
“It went very well,” says Dr. Le, who implanted the clip with the help of Dr. Wickramasinghe, who provided the imaging guidance. “The only thing out of the ordinary was that Mrs. Freeman spent two nights in the hospital due to her sensitivity to the anesthesia. The usual stay is just one night.
“Most important, the MitraClip improved her mitral regurgitation grade from 4+ to 1+,” he says. “Studies show that if we can reduce it by two grades, we can dramatically improve a patient’s outlook. So we’re very happy with how this went for her.”
“The MitraClip program has been invaluable for patients like Mrs. Freeman,” Dr. Wickramasinghe adds. “For people like her who cannot tolerate or wouldn’t qualify for surgery, it’s a game-changer that gives them a second chance at life.” Freeman is happy with the outcome, too.
“I have no more shortness of breath and I feel great in that regard,” she says. Dr. Le affirms that many of the common MR symptoms go away quickly after the MitraClip procedure. In addition to shortness of breath, these symptoms can include fatigue, fluid accumulation in the feet, ankles and lungs, a dry, hacking cough that’s often worse when lying down, fainting, and a decrease in appetite.
Freeman is also glad she stayed in the desert to have the procedure, even though her family had encouraged her to go to Los Angeles. But after she — and they — met with Dr. Le, she says that they felt secure with him. And she appreciated the convenience of having the procedure at Eisenhower, close to their desert home.
“Dr. Le was wonderful, and I couldn’t have chosen a better place to have it done,” she says.
For more information about the MitraClip procedure, call 760.346.0642.