Professor Ben Bridgewate

• What is Heart valve disease?
• What are the symptoms of Heart valve disease? Are their early signs for us to look out for?
• What treatments are available?
• Why do some of us not get the treatment we need?

PatientTalk.Org were luck enough to catch up with Professor Ben Bridgewater for an overview of the subject. Professor Bridgewater is the Heart Valve Voice Chair and Consultant Cardiac Surgeon at University Hospital of South Manchester and one of the planets leading experts on the topic of Heart valve disease.

PATIENTTALK.ORG -Professor Bridgewater,  what is Heart valve disease?

PROFESSOR BRIDGEWATER – So heart valve disease is a disorder in the valves of the heart, there’s four valves in the heart and they ensure that the blood flows one way and one way only around the body, a lot of people think that heart disease is about heart muscles and having heart attacks but also valves are really important to make sure that it functions well and those valves can become narrowed which means the heart has to work hard to pump blood through the narrowing or they can become leaky which means every time the heart pumps it pumps the blood round the wrong way of the body or it falls back into the heart and has to do it all over again, so either way it means that the heart struggles.

PATIENTTALK.ORG -What causes Heart valve disease?

PROFESSOR BRIDGEWATER – Well there’s different causes, the most common cause is just wear and tear, if people are around for a long time their heart valves are opening sixty to eighty times a minute all through their life the heart valves start to deteriorate so its unusual for people under the age of fifty its becomes more common and its really quite common for people when they get over their eighty’s but after the age of sixty it really starts to ramp up and become more common.

PATIENTTALK.ORG -So what is the main treatment for heart valve disease?

PROFESSOR BRIDGEWATER – Well the symptoms of heart valve disease is usually shortness of breath, chest tightness and feeling tired and often people put their symptoms down to the ageing process rather than heart valve disease parse but actually if there is a significant narrowing or a significant leaking of the valve there’s nothing that can be done with medications the only real treatments are valve procedures so those would usually be replacements of the aortic valve or repair or replacement of the mitral valve and both of those treatments are very effective.

PATIENTTALK.ORG -So the next question on this one was can you describe Heart Valve surgery, I don’t suppose you could answer that briefly?

PROFESSOR BRIDGEWATER – Heart valve surgery is typically open heart surgery where you use a bypass machine to isolate the heart from the rest of the body, the machine takes over the work from the heart and the lungs for a short period of time, you then isolate the heart and then have a look at valves and you remove them and replace them with a mechanical valve or a valve which is made of pig and cow tissues or occasionally with a Mitral valve you can repair it by keeping the body’s own tissues but putting a few stitches in to stop the valves leaking, That’s the classical treatments and those are very effective, there are new treatments which are coming in now which are either similar to the old treatments but through smaller incisions but now there are new treatments which are coming though catheter based approaches where rather than having open heart surgery at all you just have a catheter put in through the groin and those treatments can be very effective in some situations.

PATIENTTALK.ORG -Tell us what the prognosis is after the diagnoses?

PROFESSOR BRIDGEWATER – The prognosis after diagnoses is very good if the diseases is picked up early enough and treated appropriately but if its missed and people are referred to late into the disease  process the prognosis is not so good at all and unfortunately if its missed the heart can deteriorate such that these treatments aren’t appropriate, but if its picked up the early the procedures will return people back to an age matched healthy population the lifestyle will be the same an aged much healthy population and their life expectancy will be very good.

PATIENTTALK.ORG -Heart valve always is calling for a better diagnosis, why do you think it’s so poor at the moment?

PROFESSOR BRIDGEWATER – Heart Valve Voice is calling for better awareness about Heart valve disease, we know that in the UK about half of the number of procedures for aortic surgery’s as there are in France and France has a similar size population so we know it’s being under diagnosed and untreated in this country. We also know that there are big regional variations so there’s a postcode lottery of care, so we know those things and so we are calling for greater awareness, were calling for better diagnosis and earlier treatment for patients who are unlucky enough to suffer from heart valve disease.

PATIENTTALK.ORG -Do the rates of diagnosis differ for people with private health care?

PROFESSOR BRIDGEWATER – We have no information that the rates of diagnosis and treatments differ for people with private health care and it’s not something we would look to specifically but we have no evidence on that case at the moment.

PATIENTTALK.ORG -What other things can be done to improve the rates of diagnosis and treatments?

PROFESSOR BRIDGEWATER – For patients to get effective treatment they need to have the diagnosis made early and they need to be referred to people that have expertise in treating the disease, so that starts off with patients being aware particularly as they get older, if they are not feeling as well as they were, they need to see their GP and their GP should have a low index of suspicion for diagnosing heart valve disease, you can usually pick up a murmur by listening with a stethoscope , which I think is very important that the GPS do that. If they pick up a murmur they should be referring on for more detailed investigations which will often be an echo study, which is done in a quick study with a little bit of gel on the chest and a machine has a look at how they valves are working and that will give you a clear diagnosis, if that shows significant valve disease people need to be referred onto a specialist to see what treatment is best for them.

PATIENTTALK.ORG -What else Heart Valve Voice is calling for? You’ve released this white paper and there’s some other things in there that you would like to see happen?

PROFESSOR BRIDGEWATER – Heart Valve Voice is a group of patients, primary care doctors, secondary care doctors and surgeons and cardiologists like myself who treat the disease have come together and we launched the white paper yesterday at the houses of parliament. We think that it’s important that heart valve disease has a greater level of awareness right throughout the community, in patients and across health care professionals so that the diagnoses are made earlier and people are referred across. We think it’s very important that the elderly get more time with the GP’s so we are calling for longer consultations, 15 minute consultations for people over the age of seventy five, it can be quite often be difficult to unpick different symptoms in people as they become more elderly if they have multiple problems we are also asking for longer consultations for those types of patients, were asking for appropriate referrals pathways right through the disease so that people get the treatments effective and that decision should be made by multidisciplinary groups of  expertise in all of the various different treatment options and were asking for the same level of surgical treatments in the UK as we see in our European neighbours and if we can achieve those things we will do very well for the patients .