An innovative therapy to restore Pulmonary Valve Function
Congenital heart disease (CHD) is the most commonly observed birth defect and a leading cause of infant death in the developed world. Royal Brompton Hospital is pioneering an alternative treatment with a 95% 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 10-20 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.
At RBH there is another alternative. For the past five years the congenital heart disease team have been offering Melody Transcatheter Pulmonary Valve (TPV) Therapy – a state-of-the-art innovation in the treatment of CHD. Melody TPV is specifically used to treat the narrowed or leaking pulmonary valve conduit. Dr Michael Rigby and Dr Anslem Uebing lead the clinical programme for this treatment and have implanted almost 100 patients with a 95% success rate.
Adding further international experience, Professor Alain Fraisse joined the RBH team as Director of Paediatric Cardiology in 2014. In an effort to enable more children to benefit from the Melody Valve procedure, Prof Fraisse has been sharing this knowledge internationally as part of The Visiting Doctors Programme.
In 2015 Professor Fraisse visited the Middle East a number of times where he performed the procedure, 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.
Prof. Fraisse 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 – in approximately 5% 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 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 operation, Dr Rigby adds “This is a highly complex procedure. It is standard practice for Dr Uebing and myself to work simultaneously on each case with a team of valve specialists to ensure the best outcomes. RB&HH are the biggest valve implanters in the UK, and the 5th 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 RBH 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 RBH’s multidisciplinary approach.
Professor Alain Fraisse, Consultant and Director, Paediatric Cardiology Service
Prof. Alain Fraisse holds expertise in interventional catheterisation in children and adults with congenital heart disease. Prof Fraisse is involved in extensive research work with currently over 120 published research papers in Medline.
Dr Michael Rigby, Consultant Paediatric, Cardiologist
Dr Michael Rigby has a specialist interest in interventional cardiac catheterisation in congenital heart disease in children and young adults. His areas of expertise lie in closure of atrial septal defects and ventricular septal defects, cutting balloon dilatation of pulmonary vein stenosis, and pulmonary valve implantation.
Dr Anselm Uebing, Consultant Adult and Paediatric Cardiologist
Dr Uebing leads the adult congenital interventional catheterisation programme which he launched at the Trust in 2010. He undertakes all types of congenital procedures and also supports the paediatric team, having been trained in both adult and children’s congenital cardiology.
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