Modern Heart Valve Diagnosis and Management Pathway

With access to the latest imaging technology and a preference towards minimally invasive solutions such as transcatheter aortic valve implantation (TAVI) and robotic mini-mitral valve repair.

Your heart is simply a pump. Roughly the size of your fist, it pumps blood through a network of arteries to provide oxygen and nutrition to all the organs of the body. Inside the heart and separating the pumping chambers and outlet arteries are four valves:

  • Aortic
  • Mitral
  • Pulmonary
  • Tricuspid

These valves are made up of either two or three thin leaflets which open and close at specific points during a heartbeat. Some of the valves have a parachute-like design with cords that stop the thin leaflets from blowing back from the force of the blood in the high-pressure chambers. It is a beautiful and elegant evolutionary design that ensures blood always flows forward through the heart in the correct direction. When the valves are closed, they stop blood leaking back again.

Dysfunctional valves can either leak (regurgitation) or narrow (stenosis). This can either be:

  • Acquired – usually a consequence of degeneration (aging ‘wear and tear’) or infection/ inflammation.
  • Congenital – something we are born with.

Both leaking and narrowed valves cause the passage of blood to become accelerated or turbulent, and a doctor can hear this as a murmur and make a diagnosis of a valvular problem. The best test to confirm this is an echocardiogram (ultrasound of the heart).

The most common symptom of a valve problem is breathlessness but it can include a range of problems, including lightheadedness, chest pain, palpitations and ankle swelling. Sometimes valve problems are picked up incidentally or through health screening. Early identification and treatment can help prevent a problem or damage to the heart down the line.

For patients with suspected or confirmed heart valve problems we are able to provide a modern valvular heart management pathway. As with all the cardiology services I provide at Circle, this pathway has been specifically designed to be as much of an ‘all-in-one’ service as possible, so that you don’t face unnecessary waits or delays. With access to our advanced diagnostic equipment and technology, which includes the latest echocardiography scanners, we can determine the cause of any heart problems quickly and accurately.

 

Unlike most providers, we are not confined to referrals or expertise within the local geographical network. Depending on your specific needs, once we have performed all the diagnostic tests required locally, if a valve treatment or repair is required, we will look at the best solution across our national specialist network.

The default in the UK for most patients is still traditional open-heart surgery, which includes sternotomy and performing the operation under cardiac arrest with the support of a heart lung machine. Our preference is to always consider minimally invasive options first and we have established links to the best minimally invasive valve teams both locally and nationally.

Some examples of modern minimally invasive valve treatments:

  • Transcatheter aortic valve implantation (TAVI) for aortic valve narrowing is an endovascular treatment (performed from within the blood vessels) where a new valve is delivered within the old narrowed valve, usually via the artery in the leg. Technically this is a bit like implanting a big stent (that contains valve leaflets) through a catheter and there is a ’ship in a bottle’ elegance to the technique. We believe that in the future all patients with aortic valve narrowing will be treated by TAVI, but currently in the NHS the treatment is limited to certain groups.
  • Robotic mini-mitral valve repair is an elegant solution for patients with leaking mitral valves. There are only a handful of surgeons in the UK that are trained in this modern approach and we have a specific treatment pathway linked to what is probably the leading mitral valve centre in the UK. We have seen some amazing results and rapid recovery.

We act on your behalf and make any and all arrangements needed, taking that pressure off your shoulders.

Historically, heart valves have been repaired through open-heart surgery. This still remains the standard referral pathway for the majority of patients with heart valve problems in the UK. While this approach is very successful and effective, there is an associated impact on the patient, who then requires a reasonable period of recovery afterwards.

Advances in surgical techniques and technology now mean that many valve repairs or replacements can be performed using keyhole surgery, including with the assistance of a surgical robot. These newer approaches are very effective and have shorter recovery times than traditional open-heart surgery. Indeed, even elderly patients are often able to get out of hospital within days of surgery.

I have some patients who have been able to play golf again just one month after heart surgery. Years ago, this would have been unthinkable; now it is eminently achievable. Of course, everybody is different and individual recovery from heart surgery will depend upon a number of factors. However, people can certainly expect to be able to get back to their normal routines and activities after surgery far more quickly than was previously possible.  

Many care providers offer what can be a fairly fragmented service for valve repairs. With this approach, it can be easy to feel you’re being passed between numerous different specialists and centres for your care. We appreciate the extra pressure and stress this can put on you, which is why at Circle, we are delighted to provide one continuous pathway.

This has been specifically designed to make things as simple and straightforward as possible for you. If it is appropriate, we will put you into our minimally invasive valvular pathway, with the initial work up and consultations at Circle. We will then communicate directly with any valve repair specialists and centres and make arrangements for your surgery with them on your behalf. 

A lot of healthcare networks will work only within their historical protocols or their resources; they will do things based on what they can deliver. Our approach is very different. We always start by asking what the best possible pathway would be for you, then we make that pathway a reality to ensure you receive personal, tailored care that is just right for you.

For any heart valve concerns, please contact my PA, ‘Tash’ (Natasha Jones), on 01761 422287 to schedule a consultation with me at Circle Bath. You will be able to select a time that is convenient to you (including evening appointments). When we meet, we will talk through your options to determine what would be best for you. With our advanced diagnostic equipment, pacing technologies and surgical techniques, we will ensure you receive the very best treatment without delay.   

I met Ali in the middle of an eventful ‘once-in-a-lifetime’ family holiday to the Orkneys! While a hospital visit was certainly not in our holiday plans, with the benefit of hindsight I am very grateful to have met Ali and his colleagues when I did.

I felt a bit strange on our initial flight over to the UK from Canada, but thought it was just a chest cold. During our holiday, we did a LOT of walking. I found I was far more tired than I should have been, often dropping quite far back from the rest of my family, especially when walking up hills (and there are a LOT of hills in the Orkneys!). As our holiday continued, I felt worse and worse, until eventually I told my wife I needed to go to hospital when we got back to Bath (our ‘base’ for our time in the UK).

At the hospital, my blood pressure was far higher than it should have been and the doctor examining me strongly advised me to see a specialist before I got a flight back to Canada.

I actually managed to get an appointment with Ali the day before our flight back to Canada. Ali was extremely interested in my ‘story’ and in the results from my various tests. He carried out an echocardiogram on my heart and told me straight away that I shouldn’t fly home. It turned out that I had three broken cords in my mitral valve. This is one of the valves in the heart, and it stops blood leaking back the wrong way. The broken cords meant that the valve wasn’t functioning as it should, causing what was basically congestive heart failure. This was a far more serious problem than the chest cold I thought I had up to that point.    

Talking with Ali, he explained that he could arrange for me to have surgery in the UK to repair the damaged valve. While this would mean extending my stay in the UK, it would ensure that I would be fit when I did fly home again. There were definite risks involved if I chose to put off the surgery. Talking through everything with Ali, and then my family, I decided to have the surgery before flying home.  

The surgery to repair the broken cords went well. As it was minimally invasive, all I have now are a few very small scars. A month after my surgery I was cleared to fly back to Canada. Since the surgery, I have been doing a lot of walking and exercise to keep fit and healthy.

While we ended up having a very different holiday to the one we had anticipated, I have to say that I really couldn’t have met better people to treat me than Ali and his colleagues. I am extremely grateful for their expert help and prompt treatment.

Fast track your treatment with Ali Khavandi

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020 3613 6779

Circle Bath Hospital, Foxcote Avenue, Peasedown St John, Bath BA2 8SQ

Good

Overall rating 24th April 2017