Madam Tay Sioh Lian, who was the first patient in Singapore to undergo the Pascal transcatheter valve repair, with NHCS CEO Yeo Khung Keong (left) and Assistant Professor Wong Ningyan.PHOTO: LIANHE ZAOBAO

By Zhaki Abdullah

SINGAPORE – In 2022, Madam Tay Sioh Lian began experiencing bouts of breathlessness while walking or climbing the stairs.

“I couldn’t even walk 30 steps,” recalled Madam Tay, who was then 74 years old.

During a check-up, a geriatrician detected a heart murmur – a whooshing sound that occurs when blood moves abnormally over the heart valves – and referred her to the National Heart Centre Singapore (NHCS). She was diagnosed with a leaky heart valve in July 2024.

Also known as mitral regurgitation, the condition occurs when the heart’s mitral valve does not close tightly, causing blood to flow backward into the heart.

This can lead to fatigue and breathlessness, and can be life-threatening for those with existing heart failure.

Globally, about 3 per cent of people over the age of 70 suffer from moderate to severe leaky heart valve, with the prevalence of the condition increasing with age.

Madam Tay’s condition was severe, but traditional open-heart surgery – typically used to replace or repair the valve – was considered unsuitable for her.

This was because the retired secondary school teacher was deemed high-risk due to her existing medical conditions, such as hypertension and dyslipidaemia – a condition where blood lipid levels are either too high or low, which can disrupt cardiovascular health.

NHCS offered Madam Tay a safer, less-invasive treatment, and in February 2025, she became the first patient in Singapore to undergo the Pascal transcatheter valve repair.

Developed by American medtech firm Edwards Lifesciences, the Pascal device works like a tiny clip, holding the leaky valve in place so that it can close properly and enable blood to flow normally again.  

It is inserted into the body via a small incision made in the leg, and guided up to the heart via a catheter, or a thin, flexible tube.

The device comes in two sizes to suit the different anatomies of patients. It has components that reduce tension on mitral leaflets – or the flaps of a valve – and enhance flexibility and manoeuvrability during the procedure.

"The Pascal device’s innovative design allows us to repair damaged heart valves with precision and control, all through a small incision,” said Assistant Professor Wong Ningyan, a consultant with NHCS’ cardiology department.

While open-heart surgery remains the best option for treating leaky heart valves as it has a more established track record, the Pascal procedure provides an alternative to those who are unable to go through traditional surgery, he said.

Prof Wong, who was part of the multidisciplinary team that performed the procedure on Madam Tay, noted that patients can typically return home and resume their regular activities within days. This is much faster than the several weeks required after open-heart surgery.

The patients also experience less discomfort, he added.

Madam Tay, who is now 77, said: “The day after the procedure, I was already back home and doing my usual activities like bathing and walking, and after a week, I could do some light household chores.”

Since February, five patients – all aged 70 and above – have undergone the Pascal procedure.

It is the latest of the minimally invasive valve procedures offered by NHCS. The centre also provides transcatheter aortic valve implantation – where a new aortic valve is delivered to the heart via a catheter – and the Mitraclip treatment, which also uses a clip to close the mitral valve but is meant for patients with different anatomies.

“By expanding our treatment options, we can now offer more personalised care appropriate for each patient’s unique health needs,” said NHCS chief executive officer Yeo Khung Keong.

“For patients who previously had few alternatives, this advancement could mean the difference between continued suffering and a significantly improved quality of life,” said Prof Yeo, who was also involved in Madam Tay’s procedure.