The Medical Minute: Minimally invasive treatments for structural heart disease
Heart disease comes in many forms. Although blockages in the arteries of the heart, also known as coronary artery disease, are the best known, there are many other diseases that involve the actual structures inside the heart. These are sometimes collectively referred to as structural heart disease, which in adults describes a broad category of conditions.
In general, structural heart disease pertains to damage to the valves or other structures within the heart chambers. This can occur over time as a result of wear and tear.
Symptoms of these conditions may include shortness of breath, fatigue or lack of energy, chest discomfort, or lightheadedness or dizziness. Some people may present with episodes where they pass out or almost pass out.
“Some of these symptoms can develop gradually over time, and people can present with a wide spectrum of symptoms,” said Dr. Sarah Hussain, a heart rhythm specialist at Penn State Heart and Vascular Institute. “An individual may have a condition for many years before they're even aware of it.”
In the past, the only way to treat such conditions was open heart surgery, which requires lengthy recovery and rehabilitation.
“A surgeon would cut open the chest, take out the old valve and sew in the new one,” said Dr. Pradeep Yadav, an interventional cardiologist at the Heart and Vascular Institute. “Open heart surgery is a big operation and it’s not easy for an older patient who has multiple medical issues.”
That's why minimally-invasive, catheter-based techniques have emerged. They include procedures such as transcatheter aortic valve replacement (TAVR), the MitraClip procedure and the Watchman procedure.
Transcatheter Aortic Valve Replacement (TAVR)
TAVR is used to replace a severely damaged heart valve, a condition called aortic stenosis.
“It commonly causes shortness of breath, chest discomfort and if left untreated, can be deadly,” Yadav said.
Through TAVR, doctors place a new aortic valve in the patient’s heart without opening the chest.
“We insert a small tube commonly through an artery in the groin and use it to route a new valve all the way up to the heart,” Yadav said.
Once in the appropriate position, the new valve is expanded and it starts to function immediately. Recovery is typically quick, and patients are discharged within one to three days.
MitraClip procedure
The MitraClip procedure is used to repair a leaky mitral valve – also known as mitral valve regurgitation, the most common valve problem in the United States.
The procedure, which involves general anesthesia, is done through a small hole near the groin where a device is advanced through a vein all the way up to the heart, where the damaged mitral valve is fixed.
This procedure also involves a quick recovery, with most patients going home within one to two days.
Watchman procedure
Candidates for the Watchman procedure are those diagnosed with an irregular heart rhythm, called atrial fibrillation (AFib). AFib patients are at increased risk for strokes, the majority of which originate from clots in the atrial appendage, a pouch within the heart.
Generally, the conventional treatment for AFib is blood thinners, which carry a risk of bleeding and may not be tolerated by some patients.
“The Watchman is an implantable device that can be an alternative to taking long term blood thinners for some patients with AFib,” Hussain said.
The umbrella-shaped device is inserted via a minimally invasive approach through a vein in the leg. It is then guided into the heart in collapsed form using a flexible tube and placed at the opening of the left atrial appendage.
“We cross over to the left side of the heart and slowly release the Watchman device so it is deployed at the opening of the left atrial appendage, which is like a pouch. The device prevents blood clots from exiting and going to the brain and causing a stroke,” Hussain said.
While the procedure requires general anesthesia, patients typically only stay in the hospital for one night.
Learn more about structural heart disease on this edition of Good Day PA on WHTM-TV (ABC27):
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