Clip Repairs Leaky Heart Valve When Surgery Is too Risky

Gallipo, 66, had always enjoyed active pursuits: dancing, traveling, visiting friends. But she started to notice she had slowed down -- dramatically. “I would sleep half the day. I didn’t have any desire to do anything except rest,” the Raleigh retiree said. “I just thought, ‘I’m getting older.’”

She also wondered if her fatigue and shortness of breath might be related to hepatitis C, which she had contracted decades earlier from blood transfusions during bone cancer treatment. She had heard there were new medications that could cure hepatitis C, so she went to see Duke liver specialist Dr. Andrew Muir, MD, MHS.

“Dr. Muir listened to my heart,” Gallipo recalled. “He said, ‘You’ve got a heart murmur.’ And I said, ‘I do?’” Dr. Muir ordered an echocardiogram. She had the test at Duke Raleigh Hospital a few days later and headed home.

“Before I could even get in the door -- I was in the parking lot at my apartment -- I received a call from the nurse,” Gallipo said.  “She said, ‘You need to see a cardiologist as soon as possible.'”

The next morning Duke cardiologist Dr. Lawrence Liao, MD, delivered the news: Gallipo had severe mitral valve regurgitation.

Your mitral valve has two flaps, called leaflets, that open and close to keep blood flowing in one direction, from your heart’s upper-left chamber to its lower-left chamber. If those leaflets don’t close correctly, blood regurgitates, or washes back into the upper chamber. This makes it hard for your heart to get oxygen-rich blood to the rest of your body and increases the pressure of blood in the lungs, causing shortness of breath.

“One of my heart valves was open all the time. It was like a spring was broken on the door,” Gallipo said. “My blood, beating through my heart, was backing up. That was making me exhausted.”

Untreated, mitral regurgitation can lead to heart failure and abnormal heart rhythms. It can be life-threatening. For severe cases, the treatment is usually surgery to repair or replace the leaky heart valve. Gallipo consulted with Duke heart surgeon Dr. Donald Glower, MD. Because her liver disease made heart surgery risky, Dr. Glower referred her to Duke structural heart disease specialist  Dr. Andrew Wang, MD, to see if she’d be a candidate for a newer, lower-risk type of mitral valve repair.

“It’s a mitral clip device,” Dr. Wang said, “similar to putting a clothespin on curtains that have a gap between them. Rather than having a single opening between the leaflets, it creates two openings, one on either side of the clip. It’s still adequate to allow blood into the heart, but it reduces regurgitation.”

Called the MitraClip^® device, it is implanted using a catheter -- a thin, flexible tube -- that’s inserted in a vein in the groin and advanced to the heart. That’s a much less invasive procedure than open heart surgery.

“Surgery is a very effective and usually very safe option for primary mitral valve regurgitation,” said Dr. Wang. “But fortunately, in the last three years, we’ve had this alternate option for those who are at high risk for complications from surgery.”

Linda Gallipo had the mitral clip procedure at the end of May 2016.

“The feeling of having my normalcy back was immediate. I could breathe,” Gallipo said. “I was in bed in the hospital, and Dr. Wang came in and asked, ‘How are you feeling?’ I said, ‘I feel like I can get up and dance!’”

Dr. Wang says that’s not uncommon. “If there’s adequate reduction in regurgitation, people notice a benefit immediately,” he said. He also noted that surgery is still the standard approach for restoring mitral valve function. “There’s usually mild or moderate residual regurgitation after the mitral clip procedure,” he said. “So the FDA has outlined certain criteria for use of this device.”

As for Linda Gallipo, she’s feeling much more energetic. She has returned to her active lifestyle and is planning a trip to California. She can also finally return to Dr. Muir to talk about new medication for her hepatitis C. “I feel like a brand new person,” she said. “I can’t get over it."

The FDA has recently approved the MitraClip^® to treat a different type of mitral regurgitation that is caused by a weakened heart muscle. This is called secondary mitral valve regurgitation. The device has been shown to reduce hospitalizations and improving quality of life and survival in people with heart failure and severe secondary mitral valve regurgitation.