New, less invasive ways to treat leaky heart valve

Patients with leaky heart valve have more minimally invasive options to treat the condition, after two new procedures were introduced at the National Heart Centre Singapore (NHCS).

Also known as tricuspid regurgitation, the heart condition occurs when the valve between the two chambers in the right side of the heart does not close properly, causing blood to leak backwards.

When the regurgitation becomes severe, it can lead to congestion in various organs, such as the liver and the kidney, and affect their functions.

Dr Wong Ningyan, a consultant at NHCS' Department of Cardiology, yesterday cited studies which showed that 36 per cent of patients with a severe form of the condition will die within one year of diagnosis if the leaky heart valve is not treated.

Only 14 per cent of patients in the study survived for 10 years or more after their diagnosis.

Dr Wong said patients with the condition were previously given medication to alleviate their symptoms, such as breathlessness or swelling in the legs and belly, and at times, they underwent surgery to repair or replace the valve.

But many patients, who have a high risk of complications from such a surgical procedure, have to leave their condition largely untreated, he added.

The two new procedures at NHCS - TricValve and TriClip - are for selected leaky heart valve patients who are deemed unsuitable for open-heart surgery.

The TricValve procedure involves inserting two bioprosthetic valves through the blood vessel of the patient's leg and placing them close to the chambers in the right side of the heart, said Dr Wong.

The valves then expand in place by themselves, and work to reduce the backflow of blood and pressure on the other organs in the body.

TriClip helps to repair the leaky tricuspid valves by delivering a system of clips to the heart through a vein in the leg, and clipping a portion of the tricuspid valve to reduce the backflow of blood.

Associate Professor Yeo Khung Keong, deputy chief executive of data science and innovation and senior consultant at NHCS' Department of Cardiology, said open-heart surgery on the tricuspid valve - the gold standard in treating cases of severe tricuspid regurgitation - is not easy and the patient's heart will often have to be stopped for the procedure.

"Their recovery time can be anything from a week to a few months," he said, adding that patients will usually need to be admitted to the intensive care unit (ICU) as well.

Recovery could be even longer if there are complications, said Prof Yeo, who is the lead physician for the TricValve and TriClip procedures.

But with the new procedures, patients may be discharged in three days if they do not have any underlying conditions. They may also not require time in the ICU.

Dr Wong said the new procedures will be offered to patients who have severe symptomatic tricuspid regurgitation and are at high risk of developing complications.

Prof Yeo said he expects about 10 to 15 patients to benefit from the new procedures every year.

Mr Tan Boon Chwee, a 52-year-old civil servant, was diagnosed with severe tricuspid regurgitation in 2020.

As he also suffers from Marfan syndrome and had undergone surgery several times for the disorder which affects connective tissues, he was considered to have a high risk of complications for surgery on his tricuspid valve.

In December last year, he underwent the TricValve procedure.

Mr Tan said: "I can feel my energy returning. I feel less bloated, my leg swelling is much better, and most of all, I don't feel breathless. I've been given a new lease of life."