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Structural Heart Programme

Structural Heart Programme: Aortic Stenosis & TAVI

The Structural Heart Programme at CVSKL is a one stop centre for screening, diagnosis, surveillance and treatment for all heart valve disease such as aortic stenosis.

Structure & function of the heart

Our heart consists of four chambers. There are two upper chambers called the left and right atrium, and two lower chambers called the left and right ventricles. Each chamber of the heart has one valve, making it 4 valves in total. The valves allow the blood to move through the heart in a single direction only.

The valves are called the aortic valve, pulmonary valve, tricuspid valve and mitral valve.

The mitral valve and tricuspid valve are located between the atria and the ventricles.

The aortic valve and pulmonary valve are located between the ventricles and the major blood vessels leaving the heart.

Your heart is a pump with four chambers and four valves. Each valve works like a one-way door to make sure enough blood flows into the next part of the heart and to the rest of the body, including the heart muscle. (Source image: Heart Foundation)

Types of heart valve disease

When heart valves become diseased or damaged, they may not completely open or close. Your heart will find it hard to pump properly. As a result, your heart will pump even harder to make sure there is enough blood circulating around your body. As the heart muscles become overworked, other heart problems follow.

Stenosis and regurgitation are the two types of heart valve diseases. Some people may even have a combination of both.

Stenosis occurs when your valve does not open properly. The heart becomes strained as the pressure and blood can back up.

Regurgitation, also known as an insufficiency, occurs when your valve does not close properly. Blood leaks through the valve rather than flows in one direction only. Also, the heart is forced to work harder to maintain enough blood circulating around your body.

Valvular heart disease is a general term used when one or more heart valves has a defect or is malfunctioning. The valve(s) either do not open completely (stenosis), close completely (regurgitation), or could be a mix of both. (Source image: Heart Foundation)

Aortic Stenosis

What is Aortic Stenosis (AS)?

Valves in the heart act like windows to ensure blood flows from one chamber/structure to the next in a single direction.

Aortic stenosis is a disease described by the narrowing of the valve opening due to congenital abnormality, age-related degeneration and rheumatic valve disease. This will interrupt the ability of the heart to pump blood out to supply the body. Over time, the heart function will progressively weaken.

Patients with moderate to severe AS may not show any symptoms at all. However, in the late stages, patients may complain of chest pain (angina), shortness of breath (dyspnea) and even fainting spells (syncope). These symptoms are made worse with physical activity.

Normal aortic valves have three tissue leaflets (or flaps). These leaflets open-and-close like "swinging doors" managing blood flow. Valves with stenosis, however, are rigid and fail to "swing" properly. Over time, this can lead to many complications for the patient -- including atrial fibrillation, an enlarged heart and congestive heart failure.

What are the causes of aortic stenosis?

Several conditions can cause your aortic valve to thicken. Among them are:

What are the aortic stenosis symptoms?

When you have mild aortic stenosis, you may never feel any symptoms. For serious cases, there are some symptoms worth noting. They include:

Transcatheter Aortic Valve Implantation (TAVI)

What is TAVI ?

TAVI, an acronym for Transcatheter Aortic Valve Implantation (or Replacement, TAVR), is a minimally invasive procedure to replace the diseased aortic valve as opposed to conventional heart surgery.

With advancements in device technology, non-invasive imaging, increasing operator expertise and proper patient selection, the outcome of TAVI may be comparable but with less morbidity, shorter hospital stays and resumption of normal activities in a much shorter time.

How does TAVI Work?

The prosthetic aortic valve is mounted within a special catheter. This catheter is carefully advanced from the groin or shoulder artery and delivered across the diseased valve. The procedure is performed under the guidance of x-ray imaging and transesophageal echocardiography.

Once the valve is optimally positioned, it will be deployed. This new valve will immediately take over the function of the diseased valve.

This TAVI procedure may be conducted under general anaesthesia or conscious sedation.

Benefits of TAVI

  • A shorter length of stay in ICU and hospital
  • Faster or almost no need for wound recovery
  • Less bleeding
  • Earlier ambulation and return to a normal quality of life

Complication of TAVI

  • Stroke
  • Electrical Conduction abnormalities that may require permanent pacemaker implantation
  • Perivalvular Leak
  • Obstruction of the coronary arteries
  • Possible complications related to the Vascular Access site
  • Death

Mitral Valve Regurgitation

What's mitral valve regurgitation?

Mitral regurgitation is backward blood leakage through the mitral valve each time the left ventricle contracts.

A leaking mitral valve causes blood to flow in two directions during the contraction. Some blood flows through the aortic valve (as it should normally) and some blood flows back into the atrium.

What's the problem that results from mitral regurgitation?

Leakage can increase the blood volume and pressure in the left atrium. This increased pressure can increase pressure in the veins coming from the lungs emptying into the heart (pulmonary veins).

Increased pressure in the case of severe regurgitation causes fluid build-up or congestion in the lungs.
The mitral valve is one of the heart’s four valves. It has flaps (leaflets or cusps) that control the flow of blood from the left atrium to the left ventricle. If the flaps do not close tightly or the valve’s size and shape are altered, blood may leak backward. This leak is called mitral regurgitation or mitral insufficiency. (Source image: American College of Cardiology)

What are the causes of mitral valve regurgitation? 

Possible causes of mitral regurgitations are:

  • Mitral prolapse
  • Damaged tissue cords
  • Rheumatic fever
  • Endocarditis
  • Heart attack
  • Cardiomyopathy
  • Congenital heart defects

What are the mitral valve regurgitation symptoms?

Some people who have mitral valve disease may not experience any symptoms for many years. Depending on its severity and how quickly the condition progresses, signs and symptoms of mitral valve regurgitation include:

  • Abnormal heart sound (heart murmur) heard through a stethoscope
  • Shortness of breath (dyspnea), worsened by physical activity or when lying down
  • Fatigue
  • Heart palpitations — sensations of a rapid, fluttering heartbeat
  • Swollen feet or ankles

MitraClip Transcatheter Mitral Valve Repair

What is MitraClip?

The MitraClip is a device delivered to the heart through a small incision made in the blood vessel in the groin area. The heart continues beating during the procedure and does not require a heart-lung bypass machine as in open heart surgery.

During the mitral valve repair procedure, a catheter (a thin, flexible plastic tube) is inserted through the patient’s skin in the groin area and is guided through the femoral vein to the affected area of the heart.

Then, a catheter that holds the MitraClip device goes in through the first catheter so that the MitraClip can be guided into place and attached to the leaflets of the mitral valve. Once the clip is properly placed and securely attached, it is deployed, and the catheters are removed.

The MitraClip improves valve closure and reduces backflow of blood (regurgitation). The heart returns to pumping blood to the body more efficiently, relieving the patient's symptoms and improving their quality of life. (Source of Image : Abbott)

Benefits of MitraClip

  • Improved quality of life.
  • Improved symptoms.
  • Reduced chance of hospitalization.
  • Likely reduction in heart size.
  • Improvement of heart shape.
  • Reduction in mitral regurgitation.
  • Avoidance of high surgical risk.

Complication of MitraClip

  • Stroke
  • Possible multiple uses of MitraClip
  • Vascular access site-related complications

Know Your Treatment Options at CVSKL

CVSKL is one of the very few Cardiovascular Centres of Excellence in Malaysia capable of performing TAVI  & Mitraclip procedures. Our Heart Team comprises a group of experienced and internationally renowned cardiologists, cardiothoracic surgeons, vascular surgeons, cardiac anaesthetists and cardiac imaging specialists who work cohesively and collaboratively to ensure the best outcomes for our TAVI & Mitraclip patients.

Our renowned interventional cardiologist, who is an in-house TAVI proctor, has made significant contributions in the field of TAVI procedures, particularly for patients with aortic stenosis in Malaysia.