The Leaking Heart Valve

The Leaking Heart Valve: Advancements in Treatment

A new lease on life through less invasive transcatheter heart valve repair

PULSE Issue 45 | July 2025

Feeling unusually breathless or constantly fatigued? It might be more than just stress. These symptoms could be signs of Mitral Valve Regurgitation (MR) - a heart condition where blood leaks backwards in the heart, making it harder to circulate blood and, if left untreated, could potentially lead to heart failure. The good news? Less invasive treatments are available to improve this condition, especially for patients who are not suitable candidates for an open-heart surgery.

Mitral valve acts as a door that connects the heart's left atrium and left ventricle.

What is Mitral Valve Regurgitation?

Marked by symptoms of fatigue, palpitations, shortness of breath during exercise or even at rest, MR happens when the mitral valve - which controls blood flow from the left atrium into the left ventricle - is unable to close properly. The improper closure causes backward flow (leaking) of blood, leading to dilation of the heart chambers. If left untreated, MR can eventually result in heart failure.

Who is at risk?

MR can affect anyone, but certain groups are more vulnerable:

1. Elderly individuals with heart conditions such as Atrial Fibrillation (AF)^1, which can enlarge the heart chambers.
2. Those born with an abnormal mitral valve shape, most commonly known as mitral valve prolapse.
3. People who had a heart attack, which can weaken the heart function, and enlargement of the heart chambers.
4. Elderly with degenerative³ or calcified⁴ (calcium buildup) mitral valves.

How is MR diagnosed?

While some heart problems share similar symptoms, patients with severe MR typically have a distinctive heart murmur. Diagnosis is typically confirmed using:

• Transthoracic Echocardiogram (TTE) - a painless ultrasound scan of the heart
• Blood tests
• Transoesophageal Echocardiogram (TEE) - for more detailed imaging

Treatment for MR: A Non-invasive Approach

A damaged mitral valve can either be repaired or replaced, depending on the severity of the condition. Traditionally, severe mitral regurgitation was treated through an open-heart surgery. Now, a less invasive alternative is available, the Transcatheter Edge-to-Edge Repair (TEER) treatment procedure, which uses a MitraClip or PASCAL clip implant device inserted through a catheter via the groin.

TEER, typically taking two hours, uses implant devices to repair and restore normal blood flow. Expanding the pathway of treatment options for patients with complex heart confitions, the TEER approach enables precise treatment of mitral valve regurgitation through a less invasive method compared to traditional open-heart surgery.

In early 2025, the National University Heart Centre, Singapore (NUHCS) became one of the first in the region to offer a next-generation TEER treatment using the PASCAL device. This approach improves precision for clinicians, potentially leading to better patient outcomes.

Benefits for the Patient:

• Lower surgical risks
• Faster recovery time
• A less invasive approach for high-risk patients

Living with Severe Mitral Regurgitation

As the population ages, mitral regurgitation is becoming increasingly prevalent. Fortunately, advanced devices such as the PASCAL TEER system and MitraClip are paving the way for safer, more effective treatments. Theses innovations not only address current challenges in heart valve disease but also signal a shift towards more personalised and less invasive cardiac care for patients. At NUHCS, the future of heart health is progressing steadily - with every valve repair offering patients renewed strength, resilience, and a better quality of life.

PASCAL TEER proce dure co-led by Dr Ivandito Kuntjoro, Director of Structural Heart Programme, Dept. of Cardiology, NUHCS. NUHCS was one of the first regional centres to offer this PASCAL TEER procedure.