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Catheter-based repair of a leaking mitral valve
The two leaflets of a leaking mitral valve are joined with a small clip, placed using a catheter advanced through the vein in the groin. The chest is not opened; the aim is to reduce the leak.
What is it?
The mitral valve lies on the left side of the heart, between the left atrium and the left ventricle, and has two leaflets. When the left ventricle contracts, the mitral valve closes so that blood is pumped into the main artery (the aorta) and on to the body. If the valve does not close fully, some blood leaks backward into the left atrium with every heartbeat. This is called mitral regurgitation, or a leaking mitral valve. The leak may come from a problem in the valve itself, or from a weakened heart muscle that lets the left ventricle enlarge. When the leak is severe, the heart has to work harder. Breathlessness, tiring easily, palpitations and swollen legs may occur. Transcatheter edge-to-edge repair (TEER) is done without opening the chest. The heart is reached with a catheter advanced through the vein in the groin. A small clip joins the front and back leaflets of the valve where the leak is, most often in the middle part of the valve. The valve then works with two openings instead of one, and the backward leak lessens. Prof. Dr. Barış Kılıçaslan performs catheter-based valve treatments, including catheter-based mitral valve repair, in his clinical practice.
Who is it for?
- Patients with severe mitral regurgitation who have ongoing symptoms such as breathlessness or tiring easily
- Patients for whom open-heart surgery carries a high risk, or who are not suitable for surgery
- Patients whose leak is caused by a weakened heart muscle and whose symptoms continue despite appropriate medical treatment
- The valve must be found suitable for repair on echocardiography; the decision is made by a heart team of cardiologists and cardiac surgeons
Before the procedure
Before the procedure the structure of the valve and the severity of the leak are examined in detail with echocardiography. This includes an echo performed through the gullet (transoesophageal echocardiography, TOE). These images show whether the valve is suitable for repair with a clip. If needed, other tests such as coronary angiography are also carried out. Your medications, especially blood thinners, are reviewed with your doctor before the procedure. Do not stop any medication on your own. Because the procedure is usually done under general anaesthesia, you will be asked not to eat or drink for a period beforehand; you will be told how long.
How is it done?
- Anaesthesia and imaging: The procedure is usually done under general anaesthesia. An echo probe passed through the gullet (TOE) shows the valve live throughout the procedure.
- Access: A thin sheath is placed in the vein in the groin (the femoral vein). Through it, the catheter is advanced to the right atrium of the heart.
- Crossing between the atria: The catheter is passed through the thin wall that separates the two atria and reaches the left atrium (transseptal crossing).
- Placing the clip: The clip is steered to the mitral valve and opened. It grasps the front and back leaflets where the leak is and holds them together. The valve now works with two openings.
- Check and closure: Echocardiography is used to check how much the leak has lessened and whether the valve has become narrowed. If needed, the clip is repositioned or a second clip is added. When the result is found appropriate, the clip is released, the catheter is removed and the access site is closed.
Recovery
After the procedure you are woken from anaesthesia and monitored for a while in intensive care or a close-observation unit. The access site in the groin is checked for bleeding. The timing of discharge depends on your general condition and the access site. After discharge the clip and the valve are followed with regular check-ups and echocardiography. Your heart medications, especially any heart failure treatment, continue as your doctor advises. You will be told about any new medications and how long to take them.
Risks
Like every interventional procedure, this procedure has risks. Possible complications include bleeding or bruising at the access site, the clip coming loose from a leaflet or moving, narrowing of the valve, heart rhythm disturbances, and a small opening remaining in the wall between the atria where the catheter crossed. Serious complications such as stroke or fluid collecting around the heart are rare. Your doctor will explain the possible benefits and risks for you in detail, based on your personal situation, before the procedure.
Frequently asked questions
- Is this procedure surgery? It is not open-heart surgery: the chest is not opened and the heart is not stopped. It is a catheter-based procedure. Because an echo through the gullet is used throughout, it is usually done under general anaesthesia.
- Will the leak go away completely? The aim is to reduce the leak. How much it lessens depends on the structure of the valve, and in some patients some leakage may remain. The result is checked with echocardiography during the procedure.
- Does the clip stay in my heart permanently? Yes. The clip stays on the valve, and the valve continues to work with two openings. The valve is followed with regular echo check-ups.
- When can I return to daily life? Most patients return to their daily activities quickly. You will be given specific advice on lifting and driving when you are discharged.
Medical content reviewed and approved by Prof. Dr. Barış Kılıçaslan. Last updated: 4 October 2026. Editor: Baran Zeydan (info@clinixcrm.app).