FOR more than two years, 68-year-old Margaret Lim could not walk the length of a room without becoming breathless. She stopped going out and meeting her friends because she felt tired all the time.

She had the severe form of a condition known as mitral regurgitation, and doctors told her there was no cure because she was not suitable for open heart surgery. Madam Lim also has chronic lung disease and a severely weakened heart, which put her at too high a risk for the surgery.

But thanks to a new minimally invasive procedure at the National Heart Centre Singapore (NHCS), Madam Lim is now better. The retired hawker told The Straits Times that she can easily walk the distance between three bus stops without feeling the strain.

'I didn't feel any pain after the procedure at all, and I was very happy that I could go home after just three days of hospitalisation,' Madam Lim said in Mandarin.

Mitral regurgitation occurs when the mitral valve in the heart does not close as tightly as it should, causing blood that should be pumped out to flow backwards into the heart instead. As the heart has to work harder to pump blood around the body, patients become breathless and tired easily. With time, it can cause heart failure.

Madam Lim, who underwent the operation in April, is the first patient in Asia to receive the new treatment.

The procedure was first performed in Venezuela in 2003.

In this procedure, a small incision is made at the groin. A small metal clip known as a MitraClip is inserted into a vein and delivered to the heart. The parts that close the valve are clipped together, reducing leakage.

The new procedure is targeted at patients with severe mitral regurgitation but who are unsuitable for open heart surgery, like Madam Lim. Previously, they were treated mainly with oral medication, which does not address the underlying condition.

The new method is not only significantly less invasive than open heart surgery, it is also safer as it reduces the time that patients have to be on mechanical breathing machines and the need for blood transfusions. Both increase the risk of infection.

As the procedure requires only a small incision of about 1cm in length, patients also recover faster and have a lower risk of complications. 

Mitral regurgitation affects about 12 per cent of those aged 75 and above. If left untreated, up to 30 per cent of those with the severe form of the disease will die within six years.

The medical director of NHCS, Associate Professor Koh Tian Hai, said: 'As one in five Singaporeans will be 65 and older by 2030, this group of patients is set to rise. We estimate up to 50 patients a year may benefit from this new therapy.'

Since Madam Lim's treatment, the NHCS has performed the procedure on three more patients and all have recovered well. The entire procedure plus hospitalisation costs about $68,000 without subsidies. A grant from SingHealth covers the cost of the MitraClip device, which is $40,000. 

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