Our Summary

The MitraClip procedure is a treatment for people with mitral valve regurgitation, a condition where the heart’s mitral valve doesn’t close tightly enough, causing blood to flow backward into the heart. This procedure is usually performed by inserting the MitraClip through the femoral vein in the leg. However, in some cases, patients may have conditions that prevent this approach, such as blocked or twisted veins.

When this happens, doctors face the challenge of finding an alternate route to perform the procedure. This paper discusses a successful case where the MitraClip procedure was performed via the right internal jugular vein (a vein in the neck), in a patient who had a particular kind of mitral valve malfunction (flail A3 scallop) and a previous mitral valve repair.

The authors also reviewed similar cases from previous studies and detailed the important clinical and technical considerations for performing this procedure via the jugular vein. The paper concludes that the right internal jugular vein can serve as a viable alternative for the MitraClip procedure when the usual femoral approach is not possible. Understanding the technical aspects of this approach is important for improving the chances of successful treatment.

FAQs

  1. What is the MitraClip procedure and how is it typically performed?
  2. Under what conditions might transfemoral delivery of MitraClip not be feasible?
  3. What are the technical considerations for performing the MitraClip procedure via the right internal jugular approach?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve repair is to follow post-procedure guidelines closely, including taking medications as prescribed, attending follow-up appointments, and making lifestyle changes such as maintaining a healthy diet and regular exercise routine. It is important to communicate any symptoms or concerns to your healthcare provider promptly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for mitral valve repair are those with severe mitral regurgitation, mitral valve prolapse, or other structural abnormalities of the mitral valve. These patients may present with symptoms such as shortness of breath, fatigue, palpitations, or swelling in the legs. Mitral valve repair is often recommended for patients who are at high risk for mitral valve replacement surgery, such as those with previous heart surgery, advanced age, or other medical conditions that make them poor candidates for open-heart surgery.

In some cases, patients may not be candidates for the standard transfemoral approach for MitraClip procedure due to anatomical constraints, such as occluded inferior vena cava or tortuous iliofemoral venous anatomy. In these cases, an alternate route such as the right internal jugular (IJ) approach may be considered. This approach allows for successful MitraClip placement in patients who would otherwise not be able to undergo the procedure.

Overall, patients who are recommended for mitral valve repair are those who would benefit from the procedure and are at high risk for complications from mitral valve replacement surgery. The decision to undergo mitral valve repair should be made in consultation with a cardiac surgeon and interventional cardiologist to determine the best course of treatment for each individual patient.

Timeline

Before Mitral Valve Repair:

  • Patient may experience symptoms such as shortness of breath, fatigue, and palpitations
  • Diagnosis of mitral valve regurgitation or prolapse is made through imaging tests such as echocardiogram
  • Patient may undergo medical management to control symptoms and prevent complications
  • Mitral valve repair is recommended by the cardiologist or cardiac surgeon as the preferred treatment option

After Mitral Valve Repair:

  • MitraClip procedure is recommended as a less invasive alternative to traditional open-heart surgery for mitral valve repair
  • Patient undergoes pre-procedural evaluation and testing to determine eligibility for MitraClip procedure
  • MitraClip procedure is performed, either via transfemoral approach or alternate routes such as transjugular approach
  • Post-procedure, patient is monitored in the hospital for complications and recovery
  • Patient may experience improvement in symptoms such as reduced shortness of breath and fatigue
  • Long-term follow-up is necessary to monitor the effectiveness of the mitral valve repair and overall cardiac health.

What to Ask Your Doctor

  1. Is mitral valve repair the best treatment option for my condition?
  2. What are the potential risks and complications associated with mitral valve repair?
  3. How experienced are you in performing mitral valve repair procedures?
  4. What is the success rate of mitral valve repair in patients with my specific condition?
  5. Will I need to take any medications after the procedure? If so, what are they and what are the potential side effects?
  6. What is the recovery process like after mitral valve repair?
  7. How long will I need to stay in the hospital after the procedure?
  8. Will I need to make any lifestyle changes after mitral valve repair?
  9. Are there any long-term effects or considerations I should be aware of post-procedure?
  10. What follow-up appointments will I need after mitral valve repair, and how often should I have them?

Reference

Authors: Yap J, Chen S, Smith TWR, Rogers JH, Singh GD. Journal: Catheter Cardiovasc Interv. 2020 Sep 1;96(3):699-705. doi: 10.1002/ccd.28902. Epub 2020 Apr 7. PMID: 32259371