The TriClip procedure was used for the first time in Hungary in the Clinical Center of the University of Debrecen in the treatment of valvular insufficiency. During the catheter intervention, clips are placed on the valve in the right half of the heart, thus stopping the backflow of blood. After the operation, the patients’ quality of life improves significantly. Among the domestic centers, the procedure is currently only performed in Debrecen.
The tricuspid valve is located in the right half of the heart, between the right atrium and the right ventricle, and ensures the one-way flow of blood. However, in the case of cardiac insufficiency, when the right ventricle contracts, blood flows back into the right atrium and into the venous system, and stagnation develops, and fluid appears in the interstitial space. Patients have watery feet, swelling, flatulence, liver strain, and loss of appetite. Until now, the malfunctioning valve was treated with open heart surgery, but recently a new catheter procedure appeared to cure the disease.
The TriClip technique is used in Hungary only in the Clinical Center of the University of Debrecen.
During the procedure, the sails of the tricuspid valve are pinched together with clips, thus improving the function of the valve and eliminating the backflow of blood. This intervention requires excellent teamwork. A probe integrated with a special ultrasound head is introduced through the esophagus of the anesthetized patient. In the image thus obtained, the specialist performing the intervention can see exactly where he needs to direct the catheter inserted through the femoral vein with the tweezers, so that the intervention can be performed perfectly by holding the flaps of the valve together. Here, by inserting two or three clips, the return of blood can be reduced to a minimum
– explained Attila Kertész, a specialist at the Cardiology and Heart Surgery Clinic.
A similar procedure is used for the bicuspid valve (mitral) separating the left ventricle and the left atrium, but in the case of the tricuspid valve, the intervention is more complicated, since the sails are thinner and their location is not regular.
The intervention can be performed by specialists with extensive experience in the field of clipping, based on an individual plan tailored to the patient in each case. The procedure is preceded by a detailed investigation.
Using an esophageal ultrasound, we check whether there are any structural (organic) changes in the valve, for example, whether a tendon is torn. However, it is more common that the key is intact but does not perform its function properly. This is most often caused by atrial fibrillation that occurs in old age, and in many patients, it is a disease of the left side of the heart. We have several patients in whom the clipping is first performed on the mitral valve on the left, and then on the tricuspid valve as well. During the examination, we evaluate whether the patient’s condition can improve by performing the TriClip. In case of severe, advanced insufficiency, we can no longer achieve adequate results with this procedure. Therefore, it is very important that the patient is referred to a suitable specialist as soon as possible
– explained Csaba Jenei, a specialist at the Cardiology and Heart Surgery Clinic.
Based on experience so far, patients’ quality of life improves significantly thanks to the procedure. Suffocation complaints disappear almost immediately after the operation, but after a month the patient’s diuretic dose can be significantly reduced, his legs are not swollen, his stomach is not tense, and his appetite returns.
After the transcatheter correction of aortic and bicuspid valve defects, as well as septal defects within the heart, as well as the left atrial septum, the TriClip procedure has now also arrived in Debrecen. This completes the range of structural interventions that can be performed through the catheter at our clinic. The rapid increase in the number of interventions and the introduction of newer and newer procedures is one of the most important results of the last 3-4 years at the clinic. This was made possible by the work of colleagues who are not only excellent specialists in their narrower fields, but are also able to work together as a team. In addition to the colleague who directs the catheter, the work of the colleague who performs the ultrasound control, the anesthesiologist, who evaluates the CT scan of the heart or, in some interventions, the cardiac surgeon’s work is equally important. An excellent team was created in Debrecen
– added Professor Zoltán Csanádi, director of the clinic.
At the Cardiology and Heart Surgery Clinic of the University of Debrecen Clinical Center, the TriClip procedure was used for the first time in February this year, and since then 15 patients with valvular insufficiency have been helped with this method.
(unideb.hu)
