Treatment of Mitral Valve Insufficiency (prolapse) in Germany

Mitral valve insufficiency is a pathological condition in cardiology, accompanied by dysfunction of the heart valve located between the atrium and ventricle. 

It occurs in 2,4% of the population, with 30 – 40% of cases being asymptomatic. Sometimes mitral valve prolapse is accompanied by subjective symptoms. A patient complains of abnormal heart rhythm, shortness of breath, fainting, performance disorders, and increased fatigue. With age, the pathology may progress. The patients in the risk group are offered comprehensive prophylaxis, and in some cases, targeted treatment.

Content

1. Overview
2. What causes mitral valve insufficiency?
3. Symptoms of mitral valve insufficiency
4. Treatment tactics
5. Surgery for mitral valve insufficiency
6. Novel German transcatheter mitral valve treatment
7. Benefits of treatment in Germany
8. Best hospitals in Germany for the treatment of mitral valve insufficiency
9. The cost of treatment
10. Treatment with Booking Health

Overview

The mitral valve connects the left atrium and the left ventricle of the heart. This valve closes with every heartbeat so that blood can be pumped under high pressure into the aorta. Any leakage caused by the valve dysfunction, which usually regards mitral valve insufficiency, reduces the performance of the heart muscle. This results in increasing dyspnea on exertion and marked physical weakness. The quality of life of patients is significantly limited.

At the stage of mitral valve insufficiency progressing, heart failure occurs. It often happens that it is too late to perform surgical reconstruction or open-heart valve replacement. In this case, surgery would be too risky for some patients. However, in recent years, it became possible to repair the mitral valve by catheter interventions. Doctors reduce the prolapse of the mitral valve, which reduces the backflow of blood. Mitral valve clipping is a widely used and well-proven technique for mitral valve insufficiency treatment in Germany. Nevertheless, valve leaks can rarely be completely eliminated, and it is not always possible to prevent their development in the long run. In addition, experts refer to a surgical comparative study, which showed that in the first two years after mitral valve reconstruction, recurrence of mitral valve insufficiency occurs significantly more often than after valve replacement.

What causes mitral valve insufficiency?

From 1 to 3% of people are affected by mitral valve prolapse. Both females and males have the same incidence. Very often, mitral valve prolapse is diagnosed first in adolescents, which is facilitated by active overall growth.

The common cause of pathology development is myxomatous degeneration. The condition is characterized by a reduction of collagen in the valve. This results in enlargement and supra-extension of its chordae. They become longer and thinner. All this leads to prolapse. And if the chordae become ruptured, it can lead to severe regurgitation.

Myxomatous degeneration can be of the normal range, or it can be caused by changes in the sporadic tissue due to various diseases or muscular dystrophy. Apart from rheumatism and ischemic disease, such conditions as sickle cell anemia can cause mitral valve prolapse. Dehydration of the body can also lead to a negative course of the disease.

Symptoms of mitral valve insufficiency

Mitral valve prolapse can sometimes be manifested by quite pronounced symptoms, which usually include:

• Dyspnea (at first during exertion, but then changing to orthopnea or nocturnal asthma attacks).
• Physical weakness and increased fatigue.
• Heart palpitations (seizure-like tachycardia is quite common).
• Brief nagging dull pains (most often at the moment of increased physical activity).
• Disorders of the central and autonomic nervous system manifested by migraine (severe pain in the left or right side of the head), fainting, mood swings, and panic attacks.

Treatment tactics

Diagnosed mitral valve prolapse without impairment of the valve’s function (without reversed circulatory flow) usually does not require any treatment, but it requires monitoring, i.e. electrocardiography monitoring once every two years to detect possible complications at an early stage.

With the presence of symptoms typical for mitral valve prolapse, their medical treatment is necessary.

At the development of mitral valve deficiency, closer monitoring for timely identification of indications to surgical valve correction and drug therapy of cardiac deficiency is necessary. Surgical treatment that is carried out in such cases is usually of two types: reconstruction (plastic repair) and prosthetics (replacement surgery).

Surgery for mitral valve insufficiency

Surgery to repair or replace a mitral valve takes several hours. The damaged valve can be repaired, supported by a special "ring", or replaced by an artificial valve. Although biological and mechanical valves function similarly, there are different advantages and disadvantages to each. The advantage of mechanical valves is that they can last forever. Their disadvantage, however, is that they require anticoagulants for the rest of the patient's life. The advantage of biological valves is that they do not require any additional medication. However, the disadvantage is that they usually wear out after 12 to 15 years, which means that a new surgery will be required to replace the worn valve.

The intervention itself requires general anesthesia. A surgeon opens the sternum by dissecting the breastbone. Tubes are inserted into the heart. The moment blood is redirected to the cardiopulmonary resuscitation machine, the heart is stopped, which allows the surgeon to safely work on the heart. The cardiopulmonary resuscitation machine continues to pump fresh oxygenated blood into the rest of the body, effectively taking over the role of the heart and lungs.

The surgeon then opens the heart, and accesses the mitral valve. If it is only partially damaged, it is repaired and the rim or mitral annulus is supported by a "ring". If, however, the valve cannot be repaired, it will be replaced. The valve is checked for safe opening and closing, after which the left atrium is closed. When the heart regains its strength, the patient is disconnected from the cardiopulmonary resuscitation machine, and the heart and lungs resume their normal functions.

The drainage catheters around the heart are usually taken out after 24 hours. Temporary stimulation wires to regulate the patient's heart rhythm, sewn to the surface of the heart, are also removed before the patients are discharged home. The cannulas from inside and around the heart are removed, the sternum is closed, and the skin is stitched together.

After surgery, patients are transferred to a specialized unit that deals with patients with open heart failure. Patients usually awaken from anesthesia about four hours after surgery. The next morning, all drainage catheters and control lines are usually removed, and patients are transferred to a standard hospital room at the inpatient clinic. Hospitalization usually lasts 5-7 days after surgery.

Some cases allow mitral valve surgery to be minimally invasive. Instead of the typical sternum access, a small incision between the ribs is made. In addition, this approach can be used for atrial fibrillation and tricuspid valve surgery. With this less invasive approach, some patients can quickly return to their normal level of activity.

Novel German transcatheter mitral valve treatment

After aortic valve stenosis, mitral valve insufficiency is the second most common heart valve defect treated in Europe. In Germany, approximately 800,000 to 1 million people have mitral valve insufficiency requiring treatment. The incidence increases with age, and at the age of 75, ten percent of all people have an insufficient mitral valve.

At a press conference in Berlin, the experts presented reports on current experience in transapical mitral valve replacement. Then they also informed about the state of technical developments concerning valve replacement.

The scientific findings contributed to the development of a new German transcatheter mitral valve insufficiency treatment. When performing this procedure, doctors place an artificial heart valve over the defective natural heart valve. This form of valve prosthesis has been used for several years for mitral valve narrowings and insufficiency that often come together.

Mitral valve replacement has a different route than the one that intervention on the aortic valve has. This route involves opening the apex of the heart. The catheter is inserted transapically, and the new valve is placed instead of the damaged one. The risks of transapical intervention are low. The intervention requires only a small incision in the chest. The intervention is performed under anesthesia with the heart beating.

Many patients have undergone this procedure worldwide, many of them successfully in Germany. With this technique, it is often possible to permanently eliminate the backflow of blood. It is suggested that the number of cases will increase in the coming years, saying that hospitals might be facing a demand for such treatment.

Benefits of treatment in Germany

Medicine in Germany has long been recognized as one of the best in the world. And this is all for several reasons, including impeccably accurate diagnostics, and sparing surgical techniques widely used.

Germany leads the world in the detection of pathologies. German doctors make no mistakes in establishing a medical diagnosis. With such impeccable diagnostics, they can select the most suitable method for each patient and perform the surgical intervention with pinpoint accuracy.

Today in Germany, open heart surgeries are replaced by various minimally invasive interventions. Minimally invasive techniques with a guide directed through a puncture in a vein or artery to the heart chambers to deliver the necessary tools (stenting for coronary angioplasty, electrodes for radiofrequency ablation, etc.) have gained great popularity.

Every year, the clinical practice of German Departments of Cardiology is enriched by the latest technologies. Thus, hospitals in Germany currently use only original medical diagnostic and therapeutic agents from certified pharmaceutical companies guaranteeing the quality of their products.

This is one of the reasons why the effectiveness of both surgical and conservative treatment at hospitals in Germany is high, and patients treated at German hospitals stock up on medications for a long time.

After cardiac and/or vascular surgery, the majority of patients are sent to specialized hospitals in Germany, which are well known in the world for their rehabilitation capabilities.

Best hospitals in Germany for the treatment of mitral valve insufficiency

With the timely initiation of therapeutic measures, the progression of valve insufficiency can be if not reversed, then at least slowed down, thereby significantly increasing the duration and improving the quality of life of patients. Very good results can often be achieved by conservative therapy and physical therapy in the phase of rehabilitation.

However, sometimes the only effective method of therapy for detected pathology is surgery. The surgical treatment of heart defects, such as mitral valve insufficiency, cardiomyopathy, heart failure, pericarditis, and ischemic heart disease is within the competence of specialists of German Departments of Cardiology.

The doctors at the German Departments of Cardiology adhere to the international standards in treating heart and vascular diseases. A wide range of cardiology problems can be prevented, diagnosed, and treated in the following medical facilities:

• University Hospital Oldenburg.
• University Hospital Essen.
• University Hospital Ulm.
• University Hospital Frankfurt am Main.
• University Hospital Tuebingen.

Please visit the Booking Health website for more information about the services mentioned German hospitals provide.

The cost of treatment

The calculation of the cost of treatment in Germany is the same everywhere. The cost of treatment is calculated using criteria from a special catalog, which is updated annually. The calculation is based on the German Diagnosis Related Groups medical pricing system, doctors' fees, and fees for additional medical care, such as rented durable medical equipment for the disabled.

Here are the average prices for the treatment of mitral valve insufficiency:

• The cost of treatment of mitral valve insufficiency with the Carillon Mitral Contour System starts at 27,326 EUR.
• The cost of treatment of mitral valve insufficiency with Mitralign System starts at 29,066 EUR.
• The cost of treatment of mitral valve insufficiency with minimally invasive replacement surgery starts at 10,082 EUR.
• The prices for diagnostics start at 467 EUR.

More information on the prices for the treatment of mitral valve insufficiency is available on the Booking Health website.

Treatment with Booking Health

Prior to your arrival at the hospital, Booking Health organizes diagnostic and treatment programs, preliminary negotiation with the medical practitioners, and translation of medical documents.

Booking Health makes reservations of accommodation for the patient and accompanying person, coordinates all dates of consultations with doctors and medical procedures, and supervises both diagnosis and treatment.

The Booking Health specialists take care of all organizational work (sending of invitations, advice on collecting documents for the visa, ticket, and transfer bookings).

Fill in the request on the Booking Health website to get a free consultation about the arrangement of treatment in Germany.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed