Mitral valvuloplasty performed by the UNC Center for Heart and Vascular Care to treat adult heart disease due to childhood strep infection

Patient in the UNC Center for Heart and Vascular Care treated for rheumatic heart disease as the result of an untreated group A streptococcal infection in childhood, which is commonly known as a “strep” infection.

Mitral valvuloplasty performed by the UNC Center for Heart and Vascular Care to treat adult heart disease due to childhood strep infection click to enlarge Michael Yeung, MD, performs a mitral valvuloplasty in new UNC cardiac catheterization lab in November 2012 to treat mitral stenosis in patient who suffered from untreated strep infection as a child.
Mitral valvuloplasty performed by the UNC Center for Heart and Vascular Care to treat adult heart disease due to childhood strep infection click to enlarge In a mitral valvuloplasty, the mitral valve is opened by inflating a balloon that is delivered via catheter through the patient’s groin, into right atrium, continuing into the left atrium through a transseptal puncture. Photo credit:Toray® Industries, Inc

In November 2012, Michael Yeung, MD, of the UNC Center for Heart and Vascular Care performed a mitral valvuloplasty in the newly-renovated cardiac catheterization lab.  UNC has done this procedure in the past, but this was the first since the lab renovation was completed in August 2012.

A mitral valvuloplasty is used to “open” the mitral valve of the heart when it becomes narrow or calcified.  There are many reasons why the mitral valve could become narrowed.  In this case, the patient had been diagnosed with mitral stenosis due to rheumatic heart disease.

Rheumatic heart disease comes as the result of a group A streptococcal infection, which is commonly known as a “strep” infection.  Children are highly susceptible to strep.  In developed and industrialized countries, they are treated with antibiotics and typically recover quickly with no lasting health problems from the infection.

However, in developing nations, treatment for a strep infection may go untreated and lead to rheumatic fever and heart disease.

“We don’t see a lot of rheumatic heart disease in the United States anymore,” says Dr. Yeung.  “However, North Carolina has a growing population of people from other countries, and this is an important procedure to offer to adults who are now experiencing the effects of rheumatic heart disease stemming from an untreated childhood strep infection.”

The effects of rheumatic heart disease may not be felt for many years after the initial infection.  With mitral stenosis, the patient may experience shortness of breath, fatigue, and regular coughing.

Dr. Yeung says, “Our patient had been diagnosed three years ago with mitral stenosis, but just recently, the symptoms worsened, and the patient began to cough up blood and had to quit working.”

Dr. Yeung joined the UNC School of Medicine faculty in September 2012 with a background in treating valve disorders, such as mitral stenosis, and adult congenital heart conditions.

In a mitral valvuloplasty, a catheter with a balloon to open the mitral valve is threaded through a small puncture in the patient’s groin to the heart, where it enters the right atrium.  A transseptal puncture is then made through the cardiac wall between the right and left atrium.  When the catheter reaches the mitral valve, the balloon is inflated to break down the fibrotic and calcified scar tissue.

“A mitral valvuloplasty is one of the more complicated structural cardiac procedures because of the need for the transseptal puncture to enter the left atrium,” says Dr. Yeung.  “After that, the catheter needs to bend 180 degrees to be in the correct position to enter the mitral valve.”

The only other option to reach the mitral valve is open heart surgery.

Mitral valvuloplasty cannot be used for everyone, and the ideal patient tends to be younger with a more pliable, non-calcified mitral valve. For these patients, percutaneous mitral valvuloplasty is less invasive, less painful, and allows for a shorter and easier recovery than an open surgical approach. The patient is also under less sedation, as they remain relaxed yet semi-alert during the procedure.

In this case, the patient was in their 30’s and spoke Spanish. Dr. Yeung, who is fluent in Spanish, was able to communicate with the patient during the mitral valvuloplasty, asking the patient to perform small, simple actions as needed during the procedure.

Dr. Yeung says, “We are thrilled with the patient’s outcome. We were able to double the size of the patient’s mitral valve, allowing the patient to walk with no chest pressure or shortness of breath.”

“The patient went home 48 hours after the procedure,” he adds.  “We are very happy with this result.”