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Breathe Easy: A Non-surgical Treatment for Mitral Regurgitation

Heart & Vascular Care
“Doing research is the only way to go forward. Having been a nurse since age 19, I know the more we learn, the easier things become for patients. I was excited when I qualified for ENCIRCLE.”

As a retired nurse, Betty Kuelbs appreciates modern medical conveniences like the small, portable oxygen concentrator that helped with her shortness of breath. It ran on a battery so she could freely go about her day without worrying about carrying around a large tank or running out of oxygen. While a blessing, it was still a nuisance.

“When I’d go to the grocery store, I’d have the concentrator in the back of my cart,” explained Betty. “I’d get busy taking items off the shelf and I’d forget about it. Then, suddenly, the short tubing would hook and pull on my nose. I would have to bend over and get it straightened out before I could continue with my shopping.”

Treatment Options for a Leaky Mitral Valve

Betty and Don
Betty and Don Kuelbs
Then last January, Betty learned the leaflets (flaps) on her mitral valve did not close properly, allowing blood to leak backwards into the left atrium (top chamber) of her heart from the left ventricle (bottom chamber of the heart). Called mitral regurgitation (MR), this condition causes the left ventricle to pump harder to keep blood flowing through the body. Severe MR can lead to heart failure, resulting in shortness of breath, fatigue and swollen ankles and feet.

Currently, the only FDA approved treatment for MR is surgery or the MitraClip, a minimally invasive procedure where cardiologists place a small clip on the mitral valve so that it can open and close more completely without leaking. However, these procedures are not suitable for everyone due to age, anatomy or other health issues.

After more testing at the CentraCare Heart & Vascular Center (CCHVC), Betty found out she might be a candidate for a clinical trial, ENCIRCLE, that is exploring a transcatheter-based approach for mitral valve replacement. This minimally invasive procedure is similar to transcatheter aortic valve replacement (TAVR), but rather than replacing the aortic valve, it replaces a person’s native mitral valve with an artificial one.

“We were asked to participate in ENCIRCLE because of the success and reputation of our TAVR program,” said Cardiologist Thom Dahle, MD. CentraCare has completed more than 1,000 TAVR procedures since 2013 and the program was ranked as “high performing” in 2022 by U.S. News & World Report.

“This study is a major milestone in the treatment of mitral valve disease,” said Cardiologist Brian Stegman, MD, who, along with Dr. Dahle, is a co-principal investigator for the ENCIRCLE trial at CentraCare. “We hope this study allows us to treat mitral valve disease not only in a more minimally invasive manner, but also more successfully, similar to what TAVR allowed us to do for aortic valve patients.”

Betty jumped at the opportunity to get off oxygen and to participate in a research study. “Doing research is the only way to go forward,” Betty said. “Having been a nurse since age 19, I know the more we learn, the easier things become for patients. I was excited when I qualified for ENCIRCLE. I wouldn’t need a major surgery and I could help other people. Ever since I was 7 years old and I saw nurses in their white uniforms and white caps, I knew I was going to be a nurse no matter what. I have always had a love in my heart for taking care of people. I hope this research will lead to new ideas that can be shared with others.”

Even with her nursing background, Betty had questions about the upcoming procedure. She found that the CCHVC staff were always well informed, knowledgeable and transparent about what she would experience.

Freedom from Oxygen

When the day came for Betty’s procedure, all went as planned. The procedure took place under general anesthesia with the heart beating the entire time. “The procedure went beautifully,” said Betty. “When I think back to when a chest surgery required us to break ribs, it’s really a miracle what doctors can do today. They can reach your heart through the veins — no cutting, no incisions — and then put in a new valve with little discomfort. I left the hospital in about 24 hours and didn’t even take a Tylenol.” Betty said the one drawback of feeling so good after the procedure is that you go home and try to do too much.

Betty is now back to everyday chores and favorite pastimes like scrapbooking, reading and watching her grandkids and great-grand kids participate in activities. She has not used oxygen since the procedure. “It’s such a blessing,” said Betty. “Recently one of the ladies in church said, ‘Betty, you lost your oxygen.’ I said, ‘Yes, and I’m not shedding any tears over it!’ It is just so nice to sit in church and be able to move around freely and comfortably.”