Floppy Valve Syndrome: How Advances in Structural Heart Repairs are Saving Lives

Everyone’s heart pumps with the vital help of four valves that direct blood in and out of each chamber. When the valves are diseased or structurally deficient, the result can be critical or even deadly for heart patients.

Heart valve disease occurs if one or more of the heart valves — the tricuspid, pulmonary, mitral, and aortic valves — do not open fully or they allow blood to leak back into the chambers. Heart valves can have three basic kinds of problems: regurgitation, stenosis (narrowing), and atresia (lacking an opening for blood to flow through).

Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at Miami Cardiac & Vascular Institute.

Many more advances have been linked to replacing the aortic valve via a minimally invasive procedure called TAVR, or “transcatheter aortic valve replacement.” The aortic valve is not as complex as the mitral valve, which can present more critical issues, even for young heart patients, explains Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at Miami Cardiac & Vascular Institute.

The mitral valve, which separates the two chambers (atrium and ventricle) of the left side of the heart, creates more challenges for surgeons, especially when symptoms become severe, he says.

“The mitral valve is very complex,” says Dr. Quesada. “In comparison, the aortic valve is a like an odometer of a car. You know that you can take it out and put in a new one — very simple. But the mitral valve is very complex. It’s like the cockpit of a 747.”

One of the most common conditions is mitral valve prolapse (MVP). It can be a simple condition, but it can evolve into a very serious one. The degeneration of the mitral valve can produce severe mitral valve deficiency and MVP, and that’s when the term “floppy valve syndrome” applies, explains Dr. Quesada.

MVP is when the mitral valve’s two flaps don’t close smoothly or evenly, but bulge (prolapse) upward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur. When mitral valve prolapse is severe enough to cause significant leakage, called “regurgitation,” it can lead to serious complications such as heart attack and stroke.

The term “floppy valve syndrome” made national news earlier this year when it was listed as the cause of death in the autopsy of Eleanor Carol Barr, who died suddenly at the age of 39. She was the wife of U.S. Rep. Andy Barr, of Kentucky.

Pioneering Structural Heart Procedures

Miami Cardiac & Vascular Institute has done pioneering structural heart procedures for several years.  Last year, a team at the led by Dr. Quesada, became the first in Florida, and the second in the Southeast U.S., to perform an aortic valve replacement on a patient using a new device which had been approved by the U.S. Food and Drug Administration (FDA).

Since 2006, the Institute also has been at the forefront of MitraClip procedures for several years and involved in many clinical trials. As a result of the Institute’s success in these trials, the MitraClip was introduced in 2013 to treat patients with MVP, and other abnormalities that does not allow the mitral valve to close properly. One of those trials was the so-called COAPT trial which confirmed the safety and effectiveness of the MitraClip System

“COAPT was one the most positive studies that we have seen in years in which an interventional procedure can improve symptoms, quality of life and survival,” said Dr. Quesada, referring to the research that led to a separate FDA approval last year that expanded the use of the MitraClip. “These patients (with severe mitral regurgitation) are very sick.”

Detecting, Treating Heart Valve Disease

Most people with MVP are born with it and it can run in families, according to the National Heart, Lung and Blood Institute. An estimated 4 percent of the population has MVP. Because most patients with MVP don’t have apparent symptoms, a murmur may be detected during a routine annual exam when your doctor listens to the heart with a stethoscope. Common symptoms include bursts of rapid heartbeat (palpitations), chest discomfort and fatigue. But in the most serious cases, MVP can cause abnormal heartbeats (arrhythmias) that can subsequently become life-threatening.

For some, heart valve disease remains stable throughout their lives and doesn’t cause any problems. But for others, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or death due to sudden cardiac arrest.

Dr. Quesada recounts the successful mitral valve procedure done on a patient flown by air ambulance from Panama to the Institute earlier this year. The young male patient was in very critical condition suffering from advanced heart failure. He had been intubated and put on a respirator for weeks. He had severe mitral valve regurgitation.

“We did a transcatheter (minimally invasive) mitral valve repair with MitraClips,” explains Dr. Quesada. “After doing that and removing all of that stress on the valve and making the valve function normally, we drastically reduced the amount of mitral valve deficiency from ‘torrential,’ which is severe, to ‘trace’ — and that’s a spectacular result. The patient was weaned off the ventilator and he returned to Panama. He later sent me a video that showed how he has resumed a normal and healthy life in Panama.”