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Transcatheter Mitral Valve Repair
What you need to know about transcatheter mitral valve repair (TMVR):
TMVR is a minimally invasive way to repair your mitral valve. TMVR is done if mitral valve replacement surgery is not safe for you. Your symptoms should get better soon after your procedure.
How to prepare for your procedure:
- You will need to have an echocardiogram to make sure TMVR is right for you. Your healthcare provider will use sound waves to look to see how severe your leaky mitral valve is. You may need to stop taking blood thinning medicine several days before your procedure.
- Your healthcare provider will talk to you about how to prepare for your procedure. He or she may tell you not to eat or drink after midnight on the day of your procedure. He or she will tell you what medicines to take or not to take on the day of your procedure.
What will happen during your procedure:
- You may be given general anesthesia to keep you asleep and pain-free. A ventilator will breathe for you. You may instead have local anesthesia and medicine to keep you relaxed.
- Your healthcare provider will make an incision in your upper leg. He or she will put a catheter into a vein in your leg. It is put through the vein into the left side of your heart. A clip delivery device will be guided through the catheter to your mitral valve. Your healthcare provider will use fluoroscopy and ultrasound imaging to help guide the device. The clip will be placed so that it holds the middle of the mitral flaps. This will reduce the amount of blood that flows back into your atrium. Your healthcare provider will do tests to make sure the clip is in proper position. He or she may have to place another clip to decrease the backward flow more.
- The delivery device and catheter will then be removed. The incision in your leg will be closed.
What will happen after your procedure:
You will have to stay in the hospital for 1 to 5 days. Your healthcare providers will monitor your heart functions.
Risks of a TMVR:
You may bleed more than expected. You may develop an infection. Damage to your vein or other blood vessels can occur. You may develop an abnormal or fast heartbeat. You may need medicine to correct your heartbeat. The clip may not reduce the back flow of blood enough. You may need different treatment.
Call 911 if:
- You have any of the following signs of a heart attack:
- Squeezing, pressure, or pain in your chest
- You may also have any of the following:
- Discomfort or pain in your back, neck, jaw, stomach, or arm
- Shortness of breath
- Nausea or vomiting
- Lightheadedness or a sudden cold sweat
- You have any of the following signs of a stroke:
- Numbness or drooping on one side of your face
- Weakness in an arm or leg
- Confusion or difficulty speaking
- Dizziness, a severe headache, or vision loss
- You feel lightheaded, short of breath, and have chest pain.
- You cough up blood.
- You have trouble breathing.
Seek care immediately if:
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
- Your heart is beating faster or slower than usual.
- Your leg feels numb, cool, or looks pale.
- You feel weak or dizzy.
Contact your healthcare provider if:
- Your symptoms return.
- You have new pain.
- You have a fever or chills.
- Your incision site is red, swollen, or draining pus.
- Your incision site looks more bruised or there is new bruising near it.
- You have nausea or are vomiting.
- Your skin is itchy, swollen, or you have a rash.
- You have questions or concerns about your condition or care.
- Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
- Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver.
- Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
- Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
- Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
- Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
- Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
- You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
- Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Care for your incision site:
Ask your healthcare provider when your site can get wet. Carefully wash around the site with soap and water. Do not scrub the area. You can let soap and water gently run over your incision site. Gently pat dry the area and put on new, clean bandages as directed. Check your site every day for signs of infection such as swelling, pus, or redness. Do not put lotions or powders on the site. Do not take a bath or swim until your healthcare provider says it is okay. These activities can increase your risk for an infection.
The following will help reduce your risk for problems after your procedure:
- Do not lift objects heavier than 5 pounds.
- Do not do activities that cause you to hold your breath, grunt, or strain.
- Take short walks around the house several times a day. This will help prevent blood clots.
- Ask your healthcare provider what other activities are safe for you to do. Also ask when you can return to your normal activities.
- Carry your clip identification card with you at all times. Inform healthcare providers that you have a clip. The clip is metal. Healthcare providers need to know before you have an MRI and other medical or dental treatment. You may need to take antibiotics before medical or dental treatments.
- Eat heart healthy foods. You may need to eat foods that are low in salt, fat, or cholesterol. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask your healthcare provider for more information about a heart healthy diet.
- Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause heart and lung damage. Nicotine can also slow healing. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
- Do not drink alcohol. Ask your cardiologist if it is safe for you to drink alcohol. Alcohol can increase your risk for high blood pressure, diabetes, and coronary artery disease.
- Maintain a healthy weight. Ask your healthcare provider how much you should weigh. Extra weight can increase the stress on your heart. Ask him or her to help you create a weight loss plan if you are overweight.
- Exercise as directed after you recover. Your healthcare provider can help you create an exercise plan that is right for you. Exercise will help keep your heart healthy.
Follow up with your cardiologist or healthcare provider as directed:
You will need to have repeat tests. Your provider will make sure the clip is working properly. Write down your questions so you remember to ask them during your visits.
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