Congenital heart disease (CHD) is the most commonly observed birth defect and is a leading cause of infant death in the developed world. Royal Brompton Hospital is pioneering an alternative treatment with a 95 per cent success rate.
Many adults with CHD are born with a malformation of the pulmonary valve, which sits between the heart and lungs. Most have undergone open-heart surgery during childhood to restore blood flow to the lungs with a valve or conduit implantation.
These valves or conduits normally last 10 to 20 years before they need replacing due to wear, obstruction or loss of efficacy. Previously, because of this, most patients with CHD would often require a second and third open-heart surgery to replace the pulmonary valve.
Treating the pulmonary valve
There is an alternative option at Royal Brompton Hospital. In recent years, the congenital heart disease team have offered a state-of-the-art innovation in the treatment of CHD: Melody transcatheter pulmonary valve (TPV) therapy.
Melody TPV is specifically used to treat the narrowed or leaking pulmonary valve conduit. Dr Michael Rigby leads the clinical programme for this treatment and has implanted almost 100 patients with a 95 per cent success rate.
Adding further international experience, Professor Alain Fraissé joined Royal Brompton Hospital as director of paediatric cardiology in 2014. In an effort to enable more people to benefit from the Melody valve procedure, Professor Fraissé has been sharing this knowledge internationally as part of the visiting doctors programme.
Professor Fraissé has visited the Middle East a number of times where he performed the procedure, and provided supervision and technical advice to local consultants. He was the first to perform this procedure in a number of Middle Eastern and African countries.
Professor Fraissé said, “CHD is a major concern for patients around the world. Royal Brompton Hospital is one of the largest performers in Europe of the Melody valve operation and I am pleased to have the opportunity to share and showcase this revolutionary treatment.”
Prior to the procedure, patients are assessed for suitability via MRI and CT scans. This is to ensure the safety of the patient as in approximately 5 per cent of cases, the placement of the coronary artery poses too great a risk to carry out the procedure. In addition, some patients will require the implantation of a number of stents prior to Melody TPV therapy, to ensure that the blood vessels are supported.
A specially-designed heart valve is delivered through a catheter and requires only a small incision in the leg. The heart valve is made from a cow’s vein that has been attached to a wireframe. For the procedure, the valve is placed onto a catheter and guided through the vein to the heart where it will replace the old one.
The majority of patients are fit to leave hospital the day following the operation.
Dr Rigby adds, “This is a highly complex procedure. It is standard practice to work on each case with a team of valve specialists to ensure the best outcomes.”
“Royal Brompton and Harefield hospitals are the biggest valve implanters in the UK, and the fifth largest in Europe – it is through this level of experience we are able to offer the best care and outcomes for our patients.”
Furthermore, being the largest centre for CHD, the team provide care for the entire patient life. This has some key benefits – over the past 20 years, the surgeons at Royal Brompton Hospital have been planning ahead for their patients.
When a child has their first valve or conduit implantation, the surgeons ready their valves to ensure they are wide enough and best placed to enable less invasive treatments such as Melody TPV therapy or other future procedures. This negates the need for further open heart surgery which greatly reduces risk and time spent in hospital for recovery and is another element of Royal Brompton Hospital’s multidisciplinary approach.
Consultant paediatric cardiologist
Consultant paediatric cardiologist