Mitral Valve Leak Repaired Through Tiny Puncture Hole Using Live 3D Images

Drs. Sashi Guthikonda and Neal Kleiman, interventional cardiologists at Methodist, recently used a catheter to close a leak surrounding a 65 year old patient’s mitral valve, rather than exposing her to a potential 4th open heart surgery. The leak was causing such damage to her blood that she was constantly weak and needed multiple blood transfusions.

“Many physicians and cardiologists don’t know this procedure is available at all, but closing a leaky valve this way saves our patients from the trauma of open heart surgery,” said Guthikonda, who learned this procedure during his fellowship at Emory University Medical Center. “This procedure, which only requires a 3 mm incision, leads to significantly less pain, much faster recovery and much lower overall risk than surgery.”

Marisa Helfrich’s heart disease stemmed from a bout with rhuematic fever when she was a young child growing up in Italy. By the time she was 20, both her mitral valve and her aortic valve had hardened. She had both valves replaced with mechanical valves, then her mechanical mitral valve failed and she had to have it replaced a second time. When it recently began leaking, she was referred to Methodist because of the high risk associated with an additional open heart surgery.

During the procedure, the cardiologist snaked a catheter from Helfrich’s groin into her heart, where a small device called a duct occluder was deployed, like an umbrella, to close the leak around the mitral valve.

Live 3D transesophageal echo (TEE) imaging helped guide the movement and placement of the device to accurately close the leak. This advanced visualization provided the cardiologist with a more precise view of the leak from all sides. Methodist is the only hospital in Texas/Houston/the Texas Medical Center to offer this advanced imaging technology to patients.

“Live 3D images help us quantify the severity of the injury like never before,” said cardiologist Dr. Stephen Little, who specialized in cardiac imaging and participated in the treatment. “It also provides us with a higher degree of confidence in the placement of the device and enables us to better assess the success of the repair.”

The minimally invasive technique is called a percutaneous paravalvular leak repair, and it is performed in a catheterization lab rather than in an operating room. The duct occluder is made of a metal mesh that holds its place once deployed in the leak.

The Heart Valve Service at the Methodist DeBakey Heart & Vascular Center provides patients like Ms. Helfrich with a true multidisciplinary approach to treatments of valvular disease. The Heart Valve Institute includes cardiologists with specialties in interventional cardiology, cardiac imaging, cardiac surgery, basic sciences and translational research.