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Heart Valve Disease

The future of #heart #transplantation This is a ' Ghost Heart '. It has been decellularized, leaving only connective tissue. The organ can then be reseeded with a patient’s own cells to regenerate it so it can be transplanted without fear of tissue reject
What is Heart Valve Disease?

Your heart has four valves that keep blood flowing in the correct direction. With heart valve disease, one or more of the valves in your heart do not open or close properly, which can cause the blood flow through your heart to your body to be disrupted. Treatment depends on the heart valve affected and the type and severity of the disease. Sometimes heart valve disease requires surgery to repair or replace the malfunctioning valve.[1] Heart valve disease can develop before birth (congenital) or be acquired during one’s lifetime. Sometimes, the cause of valve disease is unknown.

Diagram Description automatically generated
Picture Credit/Attribution: “File: Diagram of the human heart (cropped).svg” by Wapcaplet is marked with CC BY-SA 3.0.

A heart valve is a one-way valve that allows blood to flow in one direction through the heart’s chambers. The four valves in a human heart determine the pathway of blood flow through the heart. A heart valve opens or closes according to differential blood pressure on each side.

How do the Valves work?
The heart consists of two atria (upper chambers) and two ventricles (lower chambers). Blood passes through a valve as it leaves each chamber of the heart. The valves prevent the backward flow of blood. They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The heart valves and their locations are[2]:

  • Tricuspid valve. Located between the right atrium and the right ventricle.
  • Pulmonary valve. Located between the right ventricle and the pulmonary artery.
  • Mitral valve. Located between the left atrium and the left ventricle.
  • Aortic valve. Located between the left ventricle and the aorta.

Heart valve disorders can arise from[3]:

  • Regurgitation (or leakage of the valve). When the valve(s) do not close completely, it causes blood to flow backwards through the valve and reduces forward blood flow, leading to volume overload in the heart.
  • Stenosis (or narrowing of the valve). When the valve(s) opening becomes narrowed, it limits the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force to move blood through the narrowed or stiff (stenotic) valve(s).

Tricuspid atresia is where the tricuspid heart valve hasn’t been formed properly. The tricuspid valve separates the right-sided collecting chamber (atrium) and pumping chamber (ventricle). Blood can’t flow properly between the heart chambers and causes the right pumping chamber to be underdeveloped[4].

Symptoms
Some people with heart valve disease might not have symptoms for many years. When signs and symptoms occur, they might include[5]:

  • Whooshing sound (heart murmur) when a doctor is listening to the heart with a stethoscope
  • Palpitations caused by irregular heartbeats
  • Low or high blood pressure, depending on which valve disease is present
  • Chest pain
  • Abdominal swelling or pain (more common with advanced tricuspid regurgitation)
  • Fatigue
  • Shortness of breath, particularly when active or lying down
  • Swelling (Oedema) of ankles, feet or legs or abdomen
  • Rapid weight gain (a weight gain of 2 or 3 pounds in a day is possible)
  • Dizziness
  • Fainting
  • Irregular heartbeat

Causes
The causes of heart valve damage vary depending on the type of disease and may include the following[6]:

  • being born with an abnormal valve or valves (congenital heart disease)
  • having had rheumatic fever
  • cardiomyopathy – a disease of the heart muscle
  • damage to the heart muscle from a heart attack
  • getting older
  • a previous infection with endocarditis
  • syphilis (a sexually-transmitted infection)
  • myxomatous degeneration (an inherited connective tissue disorder that weakens the heart valve tissue)
  • high blood pressure, high cholesterol, diabetes. 
  • rheumatic fever

Congenital Heart disease[7]
Congenital (that is, from birth) heart disease refers to a range of possible heart defects:

Aortic valve stenosis
Aortic valve stenosis is a serious type of congenital heart defect. The aortic valve that controls the flow of blood out of the main pumping chamber of the heart (the left ventricle) to the body’s main artery (the aorta) is narrowed. It affects the flow of oxygen-rich blood away from the heart towards the rest of the body and may result in the left ventricle muscle thickening because the pump has to work harder.

Coarctation of the aorta
Coarctation of the aorta (CoA) is where the main artery (the aorta) has a narrowing, which means that less blood can flow through it. CoA can occur by itself or in combination with other types of heart defects, such as a ventricular septal defect or a type of defect known as a patent ductus arteriosus. The narrowing can be severe and will often require treatment shortly after birth.

Ebstein’s anomaly
Ebstein’s anomaly is a rare form of congenital heart disease where the valve on the right side of the heart (the tricuspid valve), which separates the right atrium and right ventricle, doesn’t develop properly. This means that blood can flow the wrong way within the heart, and the right ventricle may be smaller and less effective than normal. Ebstein’s anomaly can occur alone, but it often occurs with an atrial septal defect.

Patent ductus arteriosus
As a baby develops in the womb, a blood vessel called the ductus arteriosus connects the pulmonary artery directly to the aorta. The ductus arteriosus diverts blood away from the lung (which isn’t working normally before birth) to the aorta. A patent ductus arteriosus is where this connection doesn’t close after birth as it should, meaning extra blood is pumped into the lungs, forcing the heart and lungs to work harder.

Pulmonary valve stenosis
Pulmonary valve stenosis is a defect where the pulmonary valve, which controls blood flow from the right heart pumping chamber (the right ventricle) to the lungs, is narrower than normal. This means the right heart pump has to work harder to push blood through the narrowed valve to get to the lungs.

Septal defects
A septal defect is where there’s an abnormality in the wall (septum) between the main chambers of the heart. There are two main types of septal defect:

  • Atrial septal defects. An atrial septal defect (ASD) is where there’s a hole between the two collecting chambers of the heart (the left and right atria). When there’s an ASD, extra blood flows through the defect into the right side of the heart, causing it to stretch and enlarge.
  • Ventricular septal defects. A ventricular septal defect (VSD) is a common congenital heart disease. It occurs when there’s a hole between the two pumping chambers of the heart (the left and right ventricles), causing extra blood to flow through the hole from the left to the right ventricle due to the pressure difference between them. The extra blood goes to the lungs, causing high pressure in the lungs and a stretch on the left-sided pumping chamber. Small holes often eventually close by themselves, but larger holes need to be closed surgically.

Single ventricle defects
A single ventricle defect is where only one of the pumping chambers (ventricles) develops properly. Without treatment, these defects can be fatal within a few weeks of birth. However, complex heart operations can now be carried out which improve longer-term survival but may leave a person with symptoms and a shortened life span. Two of the more common single ventricle defects are hypoplastic left heart syndrome and tricuspid atresia:

  • Hypoplastic left heart syndrome: Hypoplastic left heart syndrome (HLHS) is a rare type of congenital heart disease where the left side of the heart doesn’t develop properly and is too small. It results in insufficient oxygenated blood getting through to the body.
  • Tricuspid atresia is where the tricuspid heart valve hasn’t formed properly. The tricuspid valve separates the right-sided collecting chamber (atrium) and pumping chamber (ventricle). Blood can’t flow properly between the chambers, which causes the right pumping chamber to be underdeveloped.

Tetralogy of Fallot
Tetralogy of Fallot is a rare combination of several defects:

  • ventricular septal defect: a hole between the left and right ventricle
  • pulmonary valve stenosis: narrowing of the pulmonary valve
  • right ventricular hypertrophy: where the muscle of the right ventricle is thickened
  • overriding aorta: where the aorta isn’t in its usual position coming out of the heart

As a result of this combination of defects, oxygenated and non-oxygenated blood mixes, causing the overall amount of oxygen in the blood to be lower than normal. This may cause the baby to appear blue (known as cyanosis) at times.

Total anomalous pulmonary venous connection (TAPVC) occurs when the four veins that take oxygenated blood from the lungs to the left side of the heart aren’t connected in the normal way. Instead, they connect to the right side of the heart. Sometimes, only some of the four veins are connected abnormally, which is known as partial anomalous pulmonary venous connection and may be associated with an atrial septal defect. More rarely, the veins are also narrowed, which can be fatal within a month after birth.

Transposition of the great arteries
Transposition of the great arteries is serious but rare. It’s where the pulmonary and aortic valves and the arteries they’re connected to (the pulmonary lung artery and the aorta main body artery) are “swapped over” and are connected to the wrong pumping chamber. This leads to blood that’s low in oxygen being pumped around the body.

Truncus arteriosus
Truncus arteriosus is an uncommon type of congenital heart disease. It exists when the two main arteries (pulmonary artery and aorta) don’t develop properly and remain as a single vessel. This results in too much blood flowing to the lungs which, over time, can cause breathing difficulties and damage the blood vessels inside the lungs. Truncus arteriosus is usually fatal if it isn’t treated.

Heart valves can develop both regurgitation and stenosis at the same time. Also, more than one heart valve can be affected simultaneously. When heart valves fail to open and close properly, the effects on the heart can be serious, possibly hampering the heart’s ability to pump enough blood through the body. Heart valve problems are one cause of heart failure.

Mitral Valve problems[8]
The mitral valve is a small flap in the heart that stops blood from flowing the wrong way. Problems with it can affect how blood flows around the body. The main problems that affect the mitral valve are:

  • Mitral valve prolapse – the valve becomes too floppy and does not close tightly.
  • Mitral regurgitation – the valve leaks, and blood flows the wrong way.
  • Mitral stenosis – the valve does not open as wide as it should.

These conditions can be serious, but they’re often treatable. In some cases, mitral valve surgery may be needed.

Mitral valve prolapse
Many people with a mitral valve prolapse do not have symptoms, and it may only be spotted during a heart scan (echocardiogram) carried out for another reason. You probably will not need treatment if you do not have any symptoms. Your doctor may suggest:

  • making lifestyle changes, such as giving up smoking, caffeine and alcohol – things can make your heart work too hard
  • that you have regular check-ups to monitor your condition

If you have symptoms or your mitral valve is very floppy, your doctor may recommend:

  • medicine to relieve your symptoms, such as beta blockers for an irregular heartbeat
  • mitral valve surgery to repair or replace the mitral valve

Mitral valve prolapse is usually caused by problems with the tissues that join the mitral valve to the heart muscles. Some people with the condition are born with it, and it’s more common in people with connective tissue disorders, such as Marfan syndrome. Rarely, it can be caused by damage to the heart muscles themselves – for example, as the result of a heart attack.

Mitral regurgitation
Mitral regurgitation is where some blood flows the wrong way in the heart because the mitral valve does not close properly. Mitral valve regurgitation does not always have symptoms. If not treated, it can lead to:

You might not need treatment if you do not have any symptoms. Your doctor may just suggest having regular check-ups to monitor your condition. If you have symptoms or the problem with your valve is serious, your doctor may recommend:

  • medicines to relieve your symptoms – such as diuretics to reduce breathlessness and medication for atrial fibrillation
  • open-heart surgery – to repair or replace the mitral valve
  • keyhole surgery – a small clip is attached to the mitral valve to help it close; the clip is guided into the heart through a thin tube inserted into a vein in the groin

Mitral regurgitation happens if the mitral valve cannot close properly and is usually caused by either:

  • the mitral valve becoming too floppy (mitral valve prolapse)
  • the ring of muscle around the valve becoming too wide

These problems often develop with age – for example, because of “wear and tear” over time or damage caused by untreated high blood pressure. Mitral regurgitation can sometimes be caused by a problem such as:

Mitral stenosis
Mitral valve stenosis is where the mitral valve does not open as wide as it should, restricting the flow of blood through the heart. Mitral valve stenosis may not have any symptoms. Sometimes it can cause:

If not treated, it can lead to:

If you do not have any symptoms, you might not need treatment. Your doctor may just suggest having regular check-ups to monitor your condition. If you have symptoms or the problem with your valve is serious, your doctor may recommend:

  • medicines to relieve your symptoms – such as diuretics to reduce breathlessness and medication for atrial fibrillation
  • mitral valve surgery – to replace the valve or a procedure to stretch it with a small balloon (balloon valvuloplasty)

One of the main causes of mitral valve stenosis is rheumatic heart disease. This is where an infection causes the heart to become inflamed. Over time, it can cause the flaps of the mitral valve to become hard and thick.

Other causes include hard deposits that form around the valve with age or a problem with the heart from birth (congenital heart disease).

Mitral valve surgery[9]
Mitral valve surgery may be recommended if you have symptoms caused by a problem with your mitral valve or if the problem is quite serious. The most common mitral valve procedures are:

  • mitral valve repair
  • mitral valve replacement
  • balloon valvuloplasty – where the mitral valve is stretched with a small balloon

Picture Credit Attribution: “Heart Valve surgery at the Clinical Center” by History at NIH is marked with CC PDM 1.0.

Mitral valve repair
Mitral valve repair is an operation to make the flaps of the mitral valve stay closer together. This will help stop blood from flowing the wrong way through the valve. It’s mainly used to treat mitral valve prolapse or regurgitation if the problem is serious and causing symptoms. The operation is carried out under general anaesthetic, where you’re asleep. Your surgeon will usually access your heart through a single cut along the middle of your chest, but smaller cuts between your ribs are sometimes used. Afterwards, the flaps of the mitral valve are then partially sewn together.

The operation may be done as keyhole surgery, where a small clip is attached to the mitral valve to help it close. Most people experience a significant improvement in their symptoms after surgery, but speak to your surgeon about the possible complications.

Mitral valve replacement
Mitral valve replacement is an operation to replace your mitral valve with a mechanical valve or a valve made from animal tissue (a bioprosthetic valve). This is usually only done if you have mitral stenosis or mitral prolapse or regurgitation and are unable to have a valve repair. The operation is carried out under general anaesthetic, where you’re asleep. Your surgeon will usually replace the valve through a single cut along the middle of your chest.

Most people experience a significant improvement in their symptoms after surgery, but speak to your surgeon about the possible complications. The risk of serious problems is generally higher than with mitral valve repair. You’ll also need to take medicine to prevent blood clots for a long time after this operation. If you have a mechanical valve, you’ll need to take this medicine for life.

Balloon valvuloplasty
Balloon valvuloplasty, also called percutaneous mitral commissurotomy, is a procedure that can be used to widen the mitral valve if you have mitral stenosis. It’s usually done using local anaesthetic, where you remain awake but your skin is numbed. A small cut is made in your groin or neck, and a thin tube is passed along a blood vessel to your heart. The end of the catheter has a small balloon attached to it. This is inflated inside the narrowed valve to stretch it wider. The balloon is then deflated and removed along with the catheter.

This procedure is generally less effective than replacing the mitral valve, but recovery tends to be quicker, and it may be a better option if your valve is not too narrow or you’re at an increased risk of surgery complications (for example, if you’re pregnant or frail).

Aortic Valve replacement[10] 
An aortic valve replacement is used to treat conditions affecting the aortic valve. These are known as aortic valve diseases, the two main ones being:

  • aortic stenosis – where the valve is narrowed, restricting blood flow
  • aortic regurgitation – where the valve allows blood to leak back into the heart

These problems can be something you’re born with (congenital), or they can develop later in life.

Causes
Some of the main causes include:

  • senile aortic calcification – where calcium deposits form on the valve as you get older, preventing it from opening and closing properly.
  • bicuspid aortic valve – a problem present from birth in which the aortic valve has only two flaps instead of the usual three – which can cause problems as you get older
  • underlying conditions that can damage the aortic valve – including Marfan syndrome, Ehlers-Danlos syndrome, rheumatic fever, lupus, giant cell arteritis and endocarditis

Problems caused by Aortic Valve disease
If you have aortic valve disease, you may not experience any symptoms at first, but the condition can eventually, become more severe and cause:

  • chest pain brought on by physical activity (angina) – caused by your heart having to work harder
  • shortness of breath – at first, you may only notice this when you exercise, but later, you may experience this even when resting
  • dizziness or lightheadedness – caused by the obstruction of blood flow from your heart
  • loss of consciousness (fainting) – also a result of reduced blood flow

In particularly serious cases, aortic valve disease can lead to life-threatening problems such as heart failure.

When surgery is recommended
If you have an aortic valve disease but have no or only mild symptoms, you’ll probably just be monitored to check whether the condition is worsening.

If your symptoms become more severe, you’ll probably need surgery to replace the aortic valve. Without treatment, severe aortic valve disease is likely to worsen and may eventually be fatal.

A colorful butterfly with a black background Description automatically generated with low confidence

Picture Credit: Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). Heart valves are labelled (Bicuspid, Tricuspid, Aortic, Pulmonary).
Attribution: Henry Vandyke Carter, Public domain, via Wikimedia Commons
File URL: https://upload.wikimedia.org/wikipedia/commons/7/71/Gray1216.svg

The heart beats continuously, pumping the equivalent of more than 14,000 litres of blood every day through five main types of blood vessels: arteries, arterioles, capillaries, venules and veins. The heart’s main function is to pump blood around the body. Blood carries nutrients and waste products and is vital to life. One of the essential nutrients found in blood is oxygen.
Source: https://patient.info/news-and-features/anatomy-of-the-heart-and-blood-vessels

How is Heart Valve Disease diagnosed?
Your doctor will conduct a physical examination and listen for a heart murmur, a possible sign of a heart valve condition. Heart valves work by making sure that blood flows in only one direction through your heart. When a heart valve is damaged, it affects how blood and oxygen are pumped through your heart and body. If you aren’t having symptoms, your doctor can still pick up signs of possible problems with your heart if they listen to the rhythm of your heart. If your doctor hears a murmur (an unusual sound), they may refer you for further tests to see how your heart is working[11]. You might have several tests to diagnose your condition. The tests might include[12]:

  • Echocardiography. Sound waves directed at your heart from a wand-like device (transducer) produce video images of your heart in motion. This test assesses the structure of your heart, the heart valves and the blood flow through your heart. An echocardiogram (ECG) helps your doctor get a close look at the heart valves and how well they’re working. Doctors may also use a 3D echocardiogram. An ECG is often used to check for any clumps of bacteria that may have formed, and can help detect infected or damaged heart tissue.
  • Transesophageal Echocardiogram. In another type of echocardiogram called a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (oesophagus). This test helps your doctor get a closer look at the heart valves than is possible with a regular echocardiogram.
  • Electrocardiogram (ECG). This is a type of ultrasound scan: wires (electrodes) attached to pads on your skin measure electrical impulses from your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
  • Chest X-ray. A chest X-ray can help your doctor determine whether the heart is enlarged, which can indicate certain types of heart valve disease. A chest X-ray can also help doctors determine the condition of your lungs.
  • Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. It can determine the severity of your condition and assess the size and function of your lower heart chambers.
  • Exercise tests or stress tests. Different exercise tests help measure your activity tolerance and monitor your heart’s response to physical exertion. If you can’t exercise, you might be given medications that mimic the effect of exercise on your heart.
  • Cardiac catheterisation. This test isn’t often used to diagnose heart valve disease, but it may be used if other tests aren’t able to diagnose the condition or to determine its severity. A doctor threads a thin tube (catheter) through a blood vessel in your arm or groin, guides it to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.
  • Breathing tests – you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness; common tests include spirometry and a peak flow test.

Chest X-ray – to check whether your heart is larger than it should be, whether there’s fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms. A chest x-ray produces an image of your heart, lungs, airways, and ribs.

  • Angiogram – an angiogram is a special type of x-ray which uses contrast dye to look at your coronary arteries.
  • Blood tests. Blood tests are a common way for healthcare professionals to assess your health. 
  • Brain scans. Brain scans produce detailed images of the brain and can be used to detect and diagnose conditions.
  • Checking your pulse. You can tell if you have an irregular heartbeat by checking your pulse.
  • Genetic testing. Genetic testing can be used to find out whether you have a specific altered gene or a genetic fault.

Risk Factors
When considering the risk factors that can cause heart disease, the list is long and worrying. It includes[13]:

  • Age
  • Sex
  • Smoking
  • Physical inactivity,
  • Excessive alcohol consumption,
  • Unhealthy Diet
  • Obesity
  • Family history of cardiovascular disease
  • Hypertension (raised blood pressure)
  • Diabetes Mellitus (raised blood sugar)
  • Hyperlipidemia (raised blood cholesterol)
  • Undiagnosed celiac disease[14]
  • Psychosocial factors
  • Poverty and low educational status
  • Air pollution
  • Poor sleep
  • Genetics

Your risk for heart disease increases if your kidneys don’t function properly. Kidney disease is tied to high blood pressure and arterial disease. A cardiologist can discuss how your condition affects your heart and help you reduce your risk for heart disease[15].

Some of these risk factors, such as age, sex or family history/genetic predisposition, are immutable, but many important cardiovascular risk factors are modifiable by lifestyle change, social change, and drug treatment (such as prevention of hypertension, hyperlipidemia, and diabetes).[16]

Genetics
Cardiovascular disease in a person’s parents increases their risk three-fold,https://en.wikipedia.org/wiki/Cardiovascular_disease – cite_note-23 and genetics is an important risk factor for cardiovascular diseases[17]. More than 40 inherited cardiovascular diseases can be traced to a single disease-causing DNA variant, although these conditions are rare.[18]

Age
Age is the most important risk factor in developing cardiovascular or heart diseases, with an approximate tripling of risk with each decade of life[19]. Ageing is also associated with changes in the mechanical and structural properties of the vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and may subsequently lead to coronary artery disease[20].

Lifestyle Changes
The Heart.org website[21] has some useful information about lifestyle changes following a diagnosis of Heart Valve Disease. Briefly, it says that following recommendations about diet, exercise, and other habits can help alleviate heart failure symptoms, slow your disease’s progression and improve your everyday life. Most people with mild to moderate heart failure often can lead nearly normal lives. Making some of these lifestyle changes can be easier said than done. But working these changes into your daily routine can make a real difference in your quality of life.

Important lifestyle changes may include:

  • Becoming a non-smoker – people who quit smoking are more likely to have their heart failure symptoms improve.
  • Weigh yourself at the same time each day, preferably before breakfast and after urinating. Notify your GP if you gain three or more pounds in one day, five or more pounds in one week, or whatever amount you were told to report.
  • If you have heart failure, it’s common for your body to retain fluid. You may be prescribed diuretics (water pills) to help you get rid of extra water and sodium to reduce your heart’s workload. Talk with your doctor about how much liquid to drink every day.
  • If you drink alcohol, do so in moderation. This means no more than one to two drinks per day for men and one drink per day for women. Talk to your doctor about whether it’s permissible for you to drink alcohol.
  • Consume only a moderate amount of caffeine per day, no more than a cup or two of coffee.
  • Eat an overall healthy dietary pattern that emphasises a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and non-tropical vegetable oils. Also, limit saturated fat, trans fat, cholesterol, sodium, red meat, sweets and sugar-sweetened beverages.
  • If you’re not physically active, talk to your doctor about starting an exercise regimen. Schedule physical activity at the same time every day so it becomes a regular part of your lifestyle.
  • Managing stress by taking 15 to 20 minutes a day to sit quietly, breathe deeply and think of a peaceful scene. Or try a class in yoga or meditation, but check with your doctor first before undertaking a strenuous yoga class. When you get angry, count to 10 before responding to help reduce your stress.

Seeing your GP or a Heart Specialist
The Mayo Clinic says that if you have symptoms that might suggest heart valve disease, see your doctor. Your GP might recommend seeing a cardiologist if you have a heart murmur.

British Heart Foundation shop, Penzance

Picture Credit Attribution: “British Heart Foundation shop, Penzance” by HowardLake is marked with CC BY-SA 2.0.

The NHS say that if you have symptoms of heart failure, your GP should offer you some checks and a blood test to see how well your heart is working. If your blood test shows you might have heart failure, your GP should refer you to a specialist heart failure team, and you may be offered further tests.[22]

UK Patient has a Pioneering procedure to fix a leaking heart valve[23]
From a Press Release issued by Royal Brompton Hospital dated 9th August 2016:

“A cutting-edge procedure to repair leaking heart valves without the need for open-heart surgery was carried out at Royal Brompton Hospital in a UK first. The innovative technique uses a piece of equipment known as the Harpoon device to repair a leaking mitral valve through a small incision in the chest, replacing the need for major conventional surgery.

“Around one in 50 adults in Britain is thought to have mitral valve disease. Mitral regurgitation (MR) occurs when the mitral valve (which separates, and helps control blood flow through, the upper and lower left chambers of the heart) collapses and fails to close properly. As a result, blood flows backwards through the valve when the heart contracts, compromising the function of the heart. The condition can cause breathlessness, fatigue, dizziness, chest pain and, if left untreated, can lead to heart failure and death.

“Mr Neil Moat, consultant cardiac surgeon at Royal Brompton Hospital, performed the new technique for the first time in the UK as part of a new clinical trial, with the help of imaging colleague Dr Alison Duncan.

“Repairing a leaking mitral valve usually requires open-heart surgery, which involves making a large incision to the chest and dividing the breastbone. Patients require the support of cardiopulmonary bypass, commonly known as a heart-lung machine, so the operation can take place while the heart is not beating.

“The new procedure is carried out while the heart is still beating, eliminating the need for a heart-lung machine. With the patient under a general anaesthetic, a transoesophageal echocardiogram (TEE) – an ultrasound scan of the heart – is undertaken by inserting a tiny camera through the mouth into the oesophagus (gullet), providing a visual guide of the heart for the surgeon. A small incision is made in the left-hand side of the chest and the Harpoon device enters the heart’s lower left chamber until it reaches the collapsed part of the mitral valve. Once in place, the surgeon releases synthetic chords from the device which attach to the valve.

“Up to five chords are used and the tension on the chords is adjusted until the valve no longer leaks. The endings of the chords are then secured to the outside of the heart.

“Mr Moat said: We are excited about the impact this procedure could have for many patients with mitral valve disease. Conventional surgery is very effective but is quite invasive. This procedure is truly minimally invasive, not only in terms of the incision, but also in the avoidance of cardiopulmonary bypass and the need to stop the heart beating. The new method takes half as long to perform, is thought to halve the time patients spend in hospital and leads to shorter overall recovery times. It is like fixing broken strings of a parachute.’

“Sixty-three-year-old Jennie Keefe, from Tadworth in Surrey, was the first UK patient to take part in the trial. She was found to have a heart murmur in her 40s and several years later tests at her local hospital revealed she had severe MR. She explained: ‘In the last year or two I started to experience symptoms. I was very tired, breathless and couldn’t keep up with friends and family when we were out walking. My family and partner were worried because they noticed the difference in me.’

“Jennie was referred to Mr Moat and had the new procedure at the end of April. Follow-up tests a month later confirmed that her MR had gone. She said: ‘The day after I had the procedure my friends and family visited and said I looked better than I had in months. The team at Royal Brompton was brilliant and I was able to leave five days later. I’m privileged to be the first person in the UK to be offered this new technique. My recovery is going well and I’m improving every day, which has given me a more positive outlook. I’m self-employed so the shorter recovery time was really beneficial.’

“The early feasibility study is funded by Harpoon Medical, the company that manufactures the device.

“Royal Brompton is the first UK hospital to be part of the Mitral Trans-Apical Chordal Echo-guided Repair (TRACER) international early feasibility study.

End

Sources and Further Reading

The future of #heart #transplantation This is a ' Ghost Heart '. It has been decellularized, leaving only connective tissue. The organ can then be reseeded with a patient’s own cells to regenerate it so it can be transplanted without fear of tissue reject

Picture Credit: “The future of #heart #transplantation. This is a ‘ Ghost Heart ‘. It has been decellularized, leaving only connective tissue. The organ can then be reseeded with a patient’s own cells to regenerate it so it can be transplanted without fear of tissue reject” by 2ilorg is marked with CC BY 2.0.

Caution: No advice is implied or given in articles published by us. The information contained in this paper is provided for informational purposes only. There is no implied endorsement or promotion of any organisation by the writer. This guide is for general interest only and is compiled from the sources stated but has not been medically reviewed. It should never be used as a substitute for obtaining advice from your Doctor, a consultant Cardiologist or other qualified clinician/medical practitioner. If you have already been given dietary advice you should not make changes without first talking to your GP, consultant or dietitian. Any medications mentioned in this paper include names for US drugs. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible. The hyperlinks were valid at the date of publication.

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  2. Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-valve-diseases ↑
  3. Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-valve-diseases ↑
  4. Source: https://www.nhs.uk/conditions/congenital-heart-disease/types/ © Cown Copyright is acknowledged ↑
  5. Sources: https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/symptoms-causes/syc-20353727, and https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-valve-diseases ↑
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  7. Source: https://www.nhs.uk/conditions/mitral-valve-problems/ © Cown Copyright is acknowledged ↑
  8. Source: https://www.nhs.uk/conditions/mitral-valve-problems/ © Cown Copyright is acknowledged ↑
  9. Source: https://www.nhs.uk/conditions/mitral-valve-problems/ © Cown Copyright is acknowledged ↑
  10. Source: https://www.nhs.uk/conditions/aortic-valve-replacement/whyitsdone/ © Crown Copyright acknowledged ↑
  11. Source: https://www.bhf.org.uk/informationsupport/conditions/heart-valve-disease ↑
  12. Sources: https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/diagnosis-treatment/drc-20353732, https://www.rbht.nhs.uk/our-services/heart-valve-disease and https://www.bhf.org.uk/informationsupport/tests ↑
  13. Source: https://en.wikipedia.org/wiki/Cardiovascular_disease ↑
  14. Celiac disease is a chronic digestive and immune disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. ↑
  15. Source: https://www.nm.org/healthbeat/healthy-tips/ten-signs-its-time-to-see-a-cardiologist ↑
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  18. Source: Semsarian, Christopher; Ingles, Jodie; Ross, Samantha Barratt; Dunwoodie, Sally L.; Bagnall, Richard D.; Kovacic, Jason C. (2021-05-25). “Precision Medicine in Cardiovascular Disease: Genetics and Impact on Phenotypes: JACC Focus Seminar 1/5”. Journal of the American College of Cardiology. 77 (20): 2517–2530. doi:10.1016/j.jacc.2020.12.071. ISSN 0735-1097. PMID 34016265. S2CID 23507357 ↑
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  21. At: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure ↑
  22. Source: https://www.nhs.uk/conditions/heart-failure/diagnosis/ ↑
  23. Press Release dated 9th August 2016, at: https://www.rbht.nhs.uk/sites/nhs/files/2018-03/Harpoon%20device%20for%20mitral%20valve%20regurgitation.pdf Royal Brompton & Harefield NHS Foundation Trust is a national and international specialist heart and lung centre based in Chelsea and Harefield (in north-west London). Royal Brompton and Harefield hospitals are part of Guy’s and St Thomas’ NHS Foundation Trust. ↑

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Martin Pollins

Martin Pollins is a Chartered Accountant and MBA with wide experience in corporate finance and business management. He has served on the boards of several companies, including those listed on the London Stock Exchange, AIM and OFEX. He is the Chairman and Founder of OneSmartPlace and was a Council member of the Institute of Chartered Accountants in England and Wales from 1988 to 1996. He was managing partner of PRB Martin Pollins, based in Sussex, the first Accountancy firm to advertise on British television. He went on to create and launch the CharterGroup Partnership (the UK’s first Accountancy network) and then LawGroup UK (at the time, one of the largest networks of lawyers in the UK). In recent years, he helped to raise several £millions to fund British films such as The Da Vinci Code, Bridge of San Luis Rey, Head in the Clouds and Merchant of Venice with actors such as Charlize Theron, Robert De Niro, Al Pacino, F. Murray Abraham. Kathy Bates, Gabriel Byrne, Geraldine Chaplin, Tom Hanks, Ian McKellen, Audrey Tautou, Penélope Cruz, Steven Berkoff, Lynn Collins, Jeremy Irons, Joseph Fiennes and many more. He has written several business publications (see https://onesmartplace.com/resources/)

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