Surgery
A 77-year-old Emirati has become the first patient in the UAE to undergo tricuspid valve rare heart surgery at Cleveland Clinic in Abu Dhabi. Image Credit:

Abu Dhabi: A 77-year-old Emirati has become the first patient in the UAE with tricuspid valve regurgitation to be treated by means of new minimally invasive surgery.

The procedure was refined by experts at the Cleveland Clinic Abu Dhabi (CCAD), who improved their imaging capabilities and techniques before performing the procedure.

Tricuspid valve

The tricuspid valve is one of the two main valves on the right side of the heart, and its controls the flow of blood from the right upper chamber to the right lower chamber of the heart. Tricuspid valve regurgitation occurs when the valve no longer closes completely as the heart beats. This allows blood that pumps into the heart to flow back out in the wrong direction, leading to increased pressure that floods the body with excess fluid. This fluid can build up in the body’s tissue as well, causing swelling in the legs and organs, and significantly impacting a patient’s quality of life.

Symptoms

The symptoms caused by tricuspid valve regurgitation can usually be controlled with medication to help the body reduce the build-up of fluid. However, until recently, patients who did not respond well to medication had no viable options to control their condition, as surgery to repair the valve was considered extremely high risk.

In Afra’s case, the Emirati had spent years going from hospital to hospital due to the excessive fluid build-up in her legs and internal organs. This had also prevented her from living a full and active life.

Recent technological advances have meant that physicians at a handful of centers around the world have begun exploring non-surgical methods to restore lost heart valve function.

Hardest to work on

Dr Mahmoud Traina

“The tricuspid valve is perhaps the hardest of the four valves of the heart to work on — particularly when taking a percutaneous — or through the skin — approach. The challenge is that the tricuspid valve is significantly harder to see than the mitral valve, for example,” explained Dr Mahmoud Traina, interventional cardiologist at the CCAD.

“Happily, thanks to advances in imaging technology and a tremendous amount of dedication and effort from my colleagues in our cardiovascular imaging section, we are now able to get a good enough view to repair the valve percutaneously, thus helping patients who were previously untreatable,” he added.

Refining procedure

The specialists spent months improving the technology so they could see each individual part during the surgery, including using real time and 3D imaging.

During the three-hour, minimally invasive procedure on Afra, doctors inserted a small device that clipped onto the flaps that seal the tricuspid valve. They thus created a strong seal to prevent blood from flowing back through. This device was inserted through a vein in the patient’s leg and carefully guided to the heart. Doctors could see what they were doing using an advanced form of ultrasound, and placed the sealing device while the heart was still beating. This approach was found to be significantly safer than open heart surgery, and will allow patients to regain lost quality of life caused by fluid build-up.

“This was certainly one of the hardest procedures I’ve ever done in my career. I am very glad that we have such a remarkable team in place here, and a close relationship with our colleagues at Cleveland Clinic in the United States. They’ve done a lot more of these procedures, so were able to give us direct guidance during the procedure, as well as some tips and tricks that proved invaluable,” Dr Traina said.

Improved quality of life

Since undergoing the procedure, Afra’s quality of life has improved significantly, and she is looking forward to being able to return to her farm, where she can care for her plants once again.

“I am so thankful to the people that brought this treatment to the UAE, my doctors and the CCAD. When Dr. Traina told me that the procedure is minimally invasive and is not a major operation, I felt huge relief. The last few years have been hard, but I have faith that we are always in good hands. Now I am looking forward to doing the things I love, including caring for my small farm here at home,” she said.