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Dec 26, 2023

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A leaky mitral valve left Rob Koenig, 86, with extreme fatigue, no appetite and

A leaky mitral valve left Rob Koenig, 86, with extreme fatigue, no appetite and a dry cough. "I would lie on the couch most of the day, feeling just terrible," he says. After heart surgeons and interventional cardiologists at Valley Health's Advanced Valve Center fixed his valve with MitraClip in December, Koenig says "all those nasty symptoms are gone. I feel like myself again."

MitraClip is a tiny metal and polyester device implanted during a minimally invasive procedure where it is threaded through blood vessels to the heart. There's no open-heart surgery and no need to stop the heart. It's one of many advances in heart valve repair and replacement now available through Valley Health's Structural Heart Program, enabling people with valve problems and other structural heart conditions to live longer, healthier lives and get back to activities they love.

"Five or 10 years ago, a large percentage of people with structural heart problems were considered too sick for therapy," says Ernesto Jimenez, MD, a cardiothoracic surgeon and member of the advanced valve program team at Winchester Medical Center's Heart & Vascular Center. "Now we have effective, proven therapies right here. Patients see our excellent outcomes and the passion we have for taking care of them as our own family."

The number of people choosing Valley Health for valve and other structural heart procedures increased by 30 percent in 2022 alone—a sign that more people and their doctors are aware that new treatment options are available here, close to home, Dr. Jimenez says.

Here's what to know about structural heart care at Valley Health, including new options for repairing and replacing damaged mitral valves, which is a common problem among patients.

Heart Valves and Structural Heart Disease

Unlike heart disease caused by blockages inside blood vessels, structural heart disease "focuses on the actual anatomy of the heart—the muscle and other tissue that allow it to work efficiently as a pump," Dr. Jimenez explains. This includes the walls of the heart's four chambers, along with the heart's four valves, which open and close like doors during heartbeats so blood flows in the right direction.

Many things can go wrong with the heart's structure. Aging, infections and other health conditions such as diabetes can make a heart valve floppy and leaky, or stiff and thick, which causes it to not open completely. Also, a previous heart valve replacement may stop functioning well. Meanwhile, heart wall problems include holes such as atrial septal defects, a birth defect, and patent foramen ovule, when part of the heart wall doesn't close normally early in life.

These conditions disrupt blood flow to the rest of the body and can cause overwhelming tiredness that makes working, taking care of a home, enjoying family and friends, and doing simple things like taking a walk or washing the dishes difficult or even impossible. Valvedisease can also contribute to other serious conditions including heart failure, stroke, blood clots, and off-beat heart rhythms—and it can shorten life. A hole in the heart may cause similar serious problems.

At Valley Health, advanced care for structural heart problems includes:

• Innovative minimally invasive heart valve replacement therapies—including transcatheter aortic valve replacement (TAVR) for aortic valve replacement and valve-in-valve transcatheter mitral valve repair (TMVR) when a previous mitral valve replacement is failing

• Minimally invasive mitral valve repair with MitraClip

• Repair of the heart's tricuspid valve

• Conventional surgical valve repair or replacement

• Medical management of heart valve disease

• Cutting-edge investigational procedures and research protocols

• Sophisticated, noninvasive imaging of the heart valves

"We have the infrastructure and expertise to deal with most if not all structural heart disease problems," says Aref Bin Abdulhak, MD, a board-certified interventional cardiologist and structural heart specialist at Valley Health. "In the past, I don't think anyone would imagine that we could replace heart valves, plug holes or close heart walls without open-heart surgery. Now it is an option for many people. This is a new and evolving field in cardiology that's very exciting."

Inside Valley Health's Structural Heart Program

Most people with a structural heart issue are referred to Valley Health's program by their cardiologist or primary care physician, Dr. Jimenez says. Rob Koenig arrived for his first appointment last fall after his cardiologist—whom he sees regularly for care of other heart issues including atrial fibrillation—suggested a visit to find out more about potential treatments for his leaky mitral valve. "My cardiologist told me my options were open-heart surgery that comes with a long recovery time or a MitraClip operation that's minimally invasive, where you can go home the next day if everything's OK."

Koenig met with members of the Structural Heart Program team. Heart imaging and other tests confirmed he was a candidate for MitraClip. "Our multidisciplinary group of cardiologists, surgeons, anesthesiologists, physician assistants, the ICU team, and our team members in our hybrid lab work together to improve outcomes in people with structural heart disease," Dr. Jimenez says. "Team members meet every week to discuss every single patient in our clinic. We discuss their condition and test results and give an assessment of best treatment options. These are always discussed with the patient, who plays an important role in our shared decision-making about choosing the final treatment."

MitraClip is FDA approved for people with significant mitral valve damage who would face high risks with conventional valve surgery. Koenig's MitraClip procedure took place in Winchester Medical Center's hybrid room, which combines cardiac catheterization and surgical capabilities and is equipped with advanced imaging and support technology to perform procedures such as TAVR and TMVR. Dr. Bin Abdulhak implanted Koenig's clip, which helps the valve close properly, by maneuvering it through blood vessels from Koenig's groin to his heart. "The clip holds the leaflets of the valve together," Dr. Bin Abdulhak explains. "It comes in different sizes to fit different people's mitral valve. The procedure is guided by X-rays and by a transesophageal echocardiogram that we watch in real time. Most people can go home the next day and are back to regular activities quickly."

The day after Koenig's procedure, he was up and walking the medical center hallways. He went home shortly after that—and recently helped spread a delivery of mulch in front of his Moorefield, West Virginia, home. "I go to cardiac rehab three times a week," says the retired U.S. Army computer center manager. "And I swim laps at a local pool. I couldn't have done that last fall."

Replacing a Worn-Out Prosthetic Valve

Her mitral valve damaged by childhood rheumatic fever, Judy Eye received a replacement valve about nine years ago—after living for years with fatigue and breathing problems that made it challenging to work full time in a food processing plant and raise two children with her husband, Ronald. But the replacement valve eventually failed, leaving Eye, 76, of Old Fields, West Virginia, more tired than ever. "My husband had to cook dinner, but I’d still do the dishes sitting on a stool," she says.

In January of this year, Eye received a new mitral valve at Valley Health's Heart & Vascular Center. It was installed through a minimally invasive procedure, guided through her femoral vein to her heart from a small incision at her groin. The new valve is implanted in the place of the old valve, which is moved to the side. Until recently, valve replacements like this could be done only with open-heart surgery, Dr. Bin Abdulhak says.

"Afterward, I could breathe without feeling all that pressure in my chest from fluid backing up," Eye says. "I walk around easily. And on the telephone my friends say how good I sound—I’m not breathing heavy and coughing anymore."

A few weeks after the procedure, Eye was able to go to her great-granddaughter Hartley's second birthday party. "I couldn't have done that before the new valve," she says. The birthday decorations included plenty of hearts—a tribute to Hartley's name, but a quiet reminder of her great-grandmother's new valve and new lease on life.

"That brings us the most joy," Dr. Jimenez says. "Our patients tell us that they’re enjoying a marked improvement in their quality of life. They’re not homebound any longer, unable to walk. They’re living their lives."

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To learn more, visit valleyhealthlink.com/heart.