Heart Tests
Cardio-respiratory investigations are provided by a team of over 100 staff including Cardiac, Respiratory and Sleep Physiologists, Associate Practitioners and Assistant Technical Officers. The service includes a wide range of cardiac, respiratory and sleep investigations for adult and paediatric patients. We aim to deliver access to our tests within 6 weeks. One stop clinics are available for a range of services including interstitial lung disease, heart failure, valve disease, atrial fibrillation and inherited cardiac conditions. GP direct access is available for ambulatory monitoring, ECG, Cardiac Rhythm Management, Echocardiograms and Spirometry. The department runs a number of physiologist led services including implantable device follow up clinics, stress echocardiograms and tilt testing.
Last year the department performed approximately:
- 1,000 ambulatory blood pressure’s
- 250 bubble / contrast studies
- 6,000 ambulatory ECG’s
- 200 bronchial challenge tests
- 1,000 cardiopulmonary exercise tests
- 1,200 exercise tests
- 50,000 ECG’s
- 15,000 echocardiograms
- 100 fit to fly tests
- 3,000 full lung function tests
- 8,000 pacemaker / implantable defibrillator follow ups
- 1,200 stress echocardiograms
- 600 trans oesophageal echocardiograms
- 2,000 sleep studies
- 5,000 spirometry tests
- 200 tilt tests and
- 200 walk tests.
It may be possible to conduct some of the necessary tests on attendance at your outpatient appointment, detailed information about what you can expect for each of these is given below.
What is an ECG?
An electrocardiogram or ECG is a recording of the electrical activity of the heart.
Do I need to do anything before the test?
Wear top clothing that can be easily removed. Do not apply body oils or lotions and talcum powders as these prevent good contact between the skin and the ECG stickers.
What will happen during the test?
You will be asked to undress to the waist. ECG stickers are placed across the left side of your chest and one on each arm and leg. You will be asked to keep very still and relax whilst we take a recording.
Will it hurt?
The test is painless but your skin will have to be rubbed where we are going to put the stickers.
How long will the test take?
Usually between 10-20 minutes.
Can I bring someone with me?
Yes, but we would usually ask them to wait outside while you have the test.
What will the test tell?
An ECG records the electrical activity produced each time the heart beats and is used to measure the heart rate and rhythm. It can help diagnose heart disorders such as irregular heart rhythms, heart attacks and enlargement of the heart.
When will I get the results?
If you have been referred by your GP the results will be sent back to the surgery. If you have been sent during an out patient appointment you will be given the recording to take with you to clinic.
What is an echocardiogram?
An echocardiogram (Echo) is a cardiac ultrasound scan which uses ultrasound waves to produce an image of your heart.
Do I need to do anything before the test?
No. You may eat and drink as normal. You can also continue to take your medication.
What will happen during the test?
You will be asked to undress to the waist and lie on a couch. Gowns are provided. You do not have to lie flat if this is difficult and the test can be done with you sat in a wheelchair if necessary. ECG stickers are attached to your chest to monitor your heart beat. You will be asked to turn onto your side with your hand placed under your head. A small probe will then be placed on different parts of your chest with some gel to record the images. You may hear the sound of blood flow in your heart.
Will it hurt?
The test is painless. You will only feel the probe pressing on your chest.
How long will the test take?
Approximately 30-45 minutes.
Can I bring someone with me?
Yes, we would usually ask them to wait outside while you have the test.
What can the test tell?
An echocardiogram provides information about the structure and function of the heart as well as the condition of the heart muscle. It is useful if you have had a heart attack or heart failure. An echocardiogram is also commonly used to assess the heart valves and blood flow within the heart.
When will I get the results?
A written report will be sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment
What is ambulatory blood pressure monitoring?
This is a recording of your blood pressure at regular intervals over 24 hours.
Do I need to do anything before the fitting?
All patients need to wear a loose fitting top that can be put on over a blood pressure cuff.
What will happen during the fitting?
The BP cuff is fitted to your arm and attached to a recorder which is worn on a belt around your waist. The device will be set to record your BP every 30 minutes during the day and hourly during the night, or programmed for shift working patterns. It is recommended that you do not drive while you have the recorder fitted as you may not be insured. You will be given a diary sheet for details of any medication you are taking, symptoms and sleep times. You will also be given a set time to return the recorder the following day and it is important that you tell us before your appointment if you are unable to do this.
Will the recording hurt?
It can be uncomfortable when the cuff inflates just as it is when you have your blood pressure taken.
How long will the fitting take?
Approximately 20-30 minutes.
Can I bring someone with me?
Yes, we would usually ask them to wait outside while you have the fitting.
What will the test tell?
The test can confirm if you have high or low blood pressure or ensure the medication you are taking is working.
When will I get the results?
The results will be analysed and sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment. Please do not hesitate to ask the person performing the test any questions you may have.
What is an ambulatory ECG recording?
This is an ECG recording that can be from 1 to 7 days.
Do I need to do anything before the test?
Wear top clothing that can be easily removed. Do not apply body oils or lotions and talcum powders as these prevent good contact between the skin and the ECG stickers.
What will happen during the test?
A small recorder about the size of a mobile phone is attached to your chest with ECG stickers. The recorder is then clipped to your waistband, put in a pocket or worn around your neck. If you wear the recorder for longer than 24hrs you will be shown how to disconnect and reconnect it to allow you to bathe. You will be asked to complete a diary telling us of sleep times and any symptoms. It is important that while you are wearing your recorder you have as normal a day as possible. You will be given a set date and time to return the recorder. This is very important and if you are unable to bring back at this time please let us know before your appointment.
Will it hurt?
Your skin will have to be rubbed where we are going to put the stickers. This is to try and ensure we get a good quality recording.
How long will the fitting take?
Approximately 10-20 minutes.
Can I bring someone with me?
Yes, but we would usually ask them to wait outside while you have the test.
What will the test tell?
The recording can give us information about how fast or slow your heart rate is, if it is irregular and exactly what your heart is doing when you have your symptoms.
When will I get the results?
The results will be analysed and sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
What is a coronary angiogram?
A coronary angiogram is an x-ray test which obtains detailed pictures of the arteries that supply the heart with blood.
Why do the test?
The test is done to look for any narrowing of the coronary arteries. It can also provide vital information about the function of the pumping chambers and the valves within the heart. Results of the test will help the doctor decide on your treatment. Treatment may include tablets, coronary angioplasty or an operation (coronary artery bypass grafts).
The cardiology department
The angiogram will be done in the Cardiac Catheter Suite. You will be escorted to the Cardiac Catheter Suite by a member of the Catheter Suite Staff. You will notice a lot of equipment which will take x-ray and video pictures of your heart and coronary arteries. There will be several people in the room during your test including the doctor, nursing staff. the radiographer who takes the x-ray pictures, and the technician who measures and monitors your heart beat. The team are all skilled people who want your test to be as comfortable as possible.
The coronary angiogram
You will be awake throughout your angiogram.
The test will usually be done through the right groin (the femoral artery), but arteries in the left groin or wrist may be used. The skin will be cleaned and a sterile sheet will be put over the lower half of your body. It is important that you do not touch the top surface of the sterile sheet. The doctor will numb the area with a local anaesthetic. After the initial stinging you should only feel a dull pressure, but there may be some discomfort.
The catheter, which is a thin hollow tube, is inserted into the artery and manipulated into position. The dye, which will show on the x-ray picture is then injected into the heart and arteries. You will feel a hot flush as the dye is pumped around the body by the heart. The doctor will warn you when this is going to happen.
The x-ray machine is moved around you in order to get pictures of the heart from different angles and at times it may get very close to your face and body.
How long does it take?
About 30 – 40 minutes.
Will it hurt?
There are no nerve endings within the arteries or heart, so you should not feel any pain from the catheter. Sometimes a missed heartbeat, or palpitation is felt when the catheter is inserted into the heart, this is to be expected.
If you do have any discomfort or chest pain during the procedure, please tell the doctor.
Frequently it can be difficult to tell just by looking at an X-ray whether a narrowed section is causing a problem and requires treatment. The pressure wire is used regularly by all our operators and enables the measurement of blood flow either side of a narrowing in the artery. If flow is reduced this means treatment is recommended which can usually be done immediately. If flow is normal then we can confidently recommend that stents or even coronary surgery should not be recommended.
What is a bubble study?
A bubble study is a scan of the heart that uses a fluid with micro (very small) bubbles in it to assess the structure of the heart.
Do I need to do anything before the test?
No. You may eat and drink as normal. You can also continue to take your medication.
What will happen during the test?
You will need to undress to the waist and lie on a couch if possible, gowns are provided. ECG stickers are attached to your chest to monitor your heartbeat. You will be asked to turn onto your side with your hand placed under your head. A small probe will then be placed on different parts of your chest with some gel to obtain ultrasound images. You may hear the sound of blood flow in your heart. During the scan the fluid with micro bubbles will be injected into a small vein in your arm or hand. We may ask you to perform some breath holding for a short period of time during the scan.
Will it hurt?
The scan is painless. A small tube will be inserted into a vein in your arm or hand so that the fluid can be injected. You do not feel any adverse effects from the liquid. The tube will be removed before you leave the department.
How long will the test take?
Approximately 45 minutes.
Can I bring someone with me?
Yes, we would usually ask them to wait outside while you have the test.
What can the test tell?
A bubble study is commonly used to assess heart structure and to determine whether there are any holes in the heart.
When will I get the results?
A written report is sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
What is a CPX?
Cardiopulmonary exercise (CPX) is a method of looking at how your heart, lungs and muscles react to exercise.
Do I need to do anything before the test?
Wear loose fitting clothing and comfortable flat shoes. Do not eat 2 hours before the test, and do not drink liquids 1 hour before the test. If you smoke avoid smoking for at least 8 hours before the test. Do not eat or drink foods and liquids that contain caffeine 2 hours before the test.
What will happen during the test?
10 ECG stickers are fitted to your chest, a BP cuff is fitted to your arm, and an oxygen saturation probe is fitted to your finger. A soft nose clip is fitted and you will have to breathe through a face mask or mouth piece. Your heart rate and rhythm, BP, oxygen consumption and oxygen saturation will be monitored throughout the test. You will either cycle or walk on a treadmill, this will get faster and steeper every 3 minutes. You will be asked to do as much exercise as you are physically able.
Will it hurt?
You may also get your symptoms while you are having the test.
How long will the test take?
Approximately 60-90 minutes.
Can I bring someone with me?
Yes, but we would ask them to wait outside while you have the test.
What can the test tell?
By monitoring your breathing and heart function throughout the stress test it is possible to determine your exercise capacity.
When will I get the results?
A written report will be sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
What is an exercise tolerance test?
This is a test where we monitor your ECG and blood pressure while you walk on a treadmill.
Do I need to do anything before the test?
Wear top clothing that can be easily removed and comfortable shoes. You may be asked to stop some of your medication before the test but this will be clearly explained on your appointment letter.
What will happen during the test?
ECG stickers are placed on your chest and a blood pressure (BP) cuff is put on your arm. Gowns are provided. We may ask questions about your health and medication. You will walk on a treadmill which starts at a gentle walking pace and then gets a bit faster and steeper every 3 minutes. Your ECG and BP are monitored carefully throughout the test. When you have symptoms or are too tired to continue the treadmill is stopped.
Will it hurt?
Your skin will be rubbed to ensure we get a good quality recording. You may also get your symptoms whilst you are on the treadmill.
How long will the test take?
Approximately 40-60 minutes to complete the test. If you are attending a Rapid Access Chest Pain Clinic your may be in the hospital for up to 4 hours.
Can I bring someone with me?
Yes, but we would ask them to wait outside while you have the test.
What will the test tell?
The test indicates how much exercise you are able to do and if your symptoms are related to your heart.
When will I get the results?
The results will be analysed and sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
What is a stress echocardiogram?
A stress echocardiogram is a scan using of your heart at rest and when the heart rate is increased either with a drug or exercise.
Do I need to do anything before the test?
You may be asked to stop some of your medication before the test but this will be clearly explained on your appointment letter. Please drink plenty of fluids and avoid caffeine for 12 hours before the test.
What will happen during the test?
You will be weighed and prepared as for the echocardiogram. A small tube will be inserted into a vein in your arm and a drug will be given to increase your heart rate gradually, or you may be asked to walk on a treadmill. The scan will be repeated when your heart rate has increased and at the end of the test when your heart rate has returned to normal.
Will it hurt?
You may have a small injection but the scan is painless. The test may bring on chest pain / breathlessness but the test can be stopped at any time you wish.
How long will the test take?
Approximately 1 hour.
Can I bring someone with me?
Yes, but we would ask them to wait outside while you have the test.
What can the test tell?
A stress echocardiogram provides information about the function of the heart and the condition of the heart muscle. This is useful if you have had a heart attack, angina or heart failure. A stress echocardiogram is also commonly used to assess patients with chest pain / breathlessness.
When will I get the results?
A written report will be sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
What is a transoesophageal echocardiogram?
A transoesophageal echocardiogram (TOE) is a scan of the heart with a probe that is inserted into the oesophagus (gullet / food pipe).
Do I need to do anything before the test?
You must not eat anything for 6 hours before your appointment. You may drink small amounts of water and take any medication up to 4 hours before the test.
What will happen during the test?
A doctor will explain the procedure and you will need to sign a consent form. You will then be asked to undress to the waist and lie on a couch. Gowns are provided. Your heartbeat, BP and the oxygen level in your blood are monitored continuously. Oxygen will be given through a small tube in your nose. You may be sedated and/or have a spray to numb the back of your throat. A mouth guard will be used to protect your teeth (false teeth need to be removed). A probe will be placed in your mouth and passed down into your oesophagus (gullet / food pipe) to obtain images of you heart.
Will it hurt?
If you have been sedated you may find that you do not remember the procedure. It may be uncomfortable to swallow the probe and you may have a sore throat afterwards. You will be given a leaflet to advise you on when you may eat / drink normally following the test.
How long will the test take?
Approximately 1 hour.
Can I bring someone with me?
Yes, but we would ask them to wait outside while you have the test. If you have sedation you will need an escort to take you home and stay with you after the test.
What can the test tell?
A TOE is commonly used to assess the heart valves.
When will I get the results?
A written report is sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
Magnetic resonance imaging (MRI) is a scanning method to look inside the body without using x-rays. The scanner is a large cylindrical magnet which is open at both ends. It uses a strong magnetic field, radio frequency waves and a computer to build up very detailed images/pictures of the body. The images are then displayed on the computer screens in the scanning control room.
We acquire numerous images from several different angles of the heart and heart vessels. We can also see how the heart is functioning and how blood is moving.
Who is involved?
Radiographer Assistant: welcomes you, books you in, goes through the safety questionnaire. Prepares you for the scan including any injections.Radiographer: Prepares you for the scan and performs the scan. Is in constant contact with you through your headphones.Doctor: Sometimes evaluates the images as they are acquired whilst you are in the scanner, then analyses the images later in great detail before producing a report.
Do I need to prepare for the scan?
You will need to remove any metallic objects such as jewellery, keys, money etc before being scanned. You will also need to remove all clothes that have metal zips or fasteners. You may bring tracksuit bottoms, pyjamas or other clothes to change into, but you will have to wear a gown on your top half. Your outer clothes and valuables may be stored in the secure locker provided. As the scan can take some time you can bring a CD with you to listen to while having the scan done.
Most patients will need to have an injection of a contrast agent which can provide additional information about the heart and vessels. You should not feel any ill effects from the injection. If you are breast feeding, the contrast manufacturers advise you to stop breast feeding your child for at least 24 hours after having an injection of contrast.
When you arrive at the department you will be able to book in at the reception desk. Our radiographic assistant will then go through the patient MRI safety questionnaire with you. As the questionnaire is very important to us, we like to double check the answers with you. You will also be weighed and your height will be measured. You will then get changed into a gown ready to go to the scanner.
Once you are ready the assistant and/or Radiographer will escort you into either the preparation room or scanning room. Here we will explain what happens to you during the scan, and give you the chance to ask any questions that you may have. If you require contrast injection during the scan we will insert a small cannula into a vein.
Once in the scanning room you will be positioned on your back with a pillow under your head and a pad under your legs for comfort. ECG dots are then placed on your chest so we get an accurate reading of how your heart is beating. A special receiver aerial called a coil is then placed on your chest to pick up the signal from your heart. You will be asked to hold your breath when the pictures of your heart are taken to avoid them being blurred from movement. As the scanner makes a loud knocking sound we will give you a pair of ear defenders to wear throughout the scan. These not only reduce the noise of the scanner, but enable you to hear the radiographer talk to you. You can communicate with the radiographer during the scan and you will have an alarm buzzer to hold if you need any help. You can listen to a digital radio station of your choice throughout the scan or bring your own CD.
What is a tilt test?
A tilt test monitors your blood pressure and heart rate whilst lying and standing.
Do I need to do anything before the test?
On the day of the test you may have a light meal no later than 2 hours before your appointment time. It is best to wear a loose fitting top. You are advised not to drive immediately after this test and therefore you need to attend accompanied by a relative or friend. Take your medication as usual on the day of the test and bring a list of your medications when you attend for the test.
What will happen during the test?
We will take your medical history, measure your height and weight, and then you will lie on the tilt table. ECG stickers will be attached to your chest. A small probe will be attached to one finger to monitor your blood pressure accurately. A small plastic tube will be near to your nose in order to monitor your breathing. You will lie flat for about 10 minutes and then stand up for 20 minutes. If necessary you may be given a tablet under your tongue which contains a drug to open up your blood vessels. You will then stand for up to a further 15 minutes before being laid flat again.
Will it hurt?
The tilt test is painless however you may feel slightly lightheaded afterwards.
How long will the test take?
Approximately 60-90 minutes.
Can I bring someone with me?
Yes, we would usually ask them to wait outside while you have the test.
What can the test tell?
This investigation helps to determine whether your symptoms of fainting, dizzy spells or blackouts are due to blood pressure changes which occur with lying and standing.
When will I get the results?
A written report will be sent to the doctor who requested the test. Your doctor may either write to you or give you the results at your next appointment.
Heart Treatments
If you require a procedure to treat your condition and you would like more information, please see below.
Angioplasty, or percutaneous coronary intervention (PCI) is an X-ray guided procedure performed to reopen narrowed or blocked arteries using a catheter delivered from outside the body. A wire is carefully threaded through any narrowed areas and balloons (usually) with stents are used to reopen these sections of diseased arteries. Stents are mechanical frames used to keep the artery open once the balloon is removed. This procedure is performed using local anesthesia and in the majority can be performed using the radial artery in the forearm, which is safer and more convenient for patients.
PCI is performed for stable angina (predictable chest pain or breathlessness on exertion) or for unstable symptoms that come on at rest or in the context of a heart attack
Annually more than 2000 coronary angioplasties are performed in Leeds.
Leeds offers a 24/7 service for emergency coronary intervention for heart attacks in the West Yorkshire region and was one of the first centres in the UK to offer primary angioplasty for acute ST elevation myocardial infarction. Every year approximately 1100 patients are treated by emergency angioplasty.
Chronic total occlusions are complete blockages in coronary arteries. Treatment of these complete blockages is more difficult and sometimes requires complex techniques to reopen successfully. These techniques may include sending wires backwards from the other side of the blockage or occasionally deliberately tearing the internal lining of the artery to break through resistant narrowings. Historically the success rate of reopening CTOs successfully was approximately 50%. Leeds offers a CTO service led by Dr Jon Blaxill and patients who require these complex techniques or who have had failed procedures elsewhere are usually treated successfully.
These are stents that over resorb over a period of 2 to 3 years. The advantage of a dissolving stent is that once the stent has been fully resorbed this can leave the coronary artery to work normally and remodel or grow outwards rather than re-narrow inwards. Also late complications related to stents such as sudden blockage due to clot may be reduced
What is a pacemaker?
A pacemaker is a battery operated device, inserted into the body just below the collar bone. A wire or ‘electrode’ leads into the heart.
The most common pacemaker is designed to ‘sense’ the speed of your heart beat. If the rate falls below a certain level, the pacemaker ‘senses’ this and sends impulses along the electrode to stimulate or ‘pace’ the heart beat at a faster more appropriate rate until your own heart beat increases again.
There are many different types of pacemakers which are individually selected for your particular needs.
Why do I need a pacemaker?
There are many reasons why people may need a pacemaker. If your pulse falls to a slow rate you could feel dizzy, tired and sleepy. You may even have been experiencing blackouts which can lead to personal injury. Some people experience a fast erratic heart rate causing ‘palpitations’. You may also feel breathless. It is also possible not to experience any of the above but your doctor may still advise a pacemaker.
Please discuss your nurse / doctor which type of pacemaker you have and how it will help your symptoms.
Ablation is a procedure that uses energy (usually radiofrequency) to destroy or isolate sources of abnormal electrical impulses that can cause or maintain atrial fibrillation (AF), It is performed by placing catheters into the heart through a vein usually in the groin or occasionally the arm or neck, guided by x-ray. The term ablation means making small burns in the heart tissue in order to cause a small scar, which can no longer conduct abnormal impulses. Most healthy tissue is unharmed.
Left atrial ablation for AF
Paroxysmal AF often originates from the four pulmonary veins that drain blood from the lungs into the left atrium. With this procedure, catheters are placed in the heart and guided to the left atrium. Ablation is then performed around the pulmonary veins to prevent the abnormal electrical impulses from entering the left atrium and causing AF. The particular pattern of ablation performed varies from specialist to specialist. In patients with persistent AF, additional lines of ablation in the left atrium may be required. This type of ablation procedure is usually reserved for patients who have significant symptoms from their atrial fibrillation and have failed medication.
Before the procedure and pre-assessment:
If you are not on warfarin we will either refer you to the anticoagulation clinic or your GP to get it started.
You will be invited to attend a pre-admission clinic a few days before the ablation. Please ensure that you have not had anything to eat or drink from midnight.
We will fill in our pre-assessment form and take a note of your medication.
Your blood will be tested. In particular, we will check your INR levels to ensure that your blood is neither too thick nor thin for the procedure. Generally we will ask you to continue taking your usual dose of warfarin, however we may advise you to amend the dosage or stop warfarin before the procedure.
There will be opportunity to discuss the procedure with a Nurse Specialist and hopefully any questions you have will be answered.
You will also find out whether you need to avoid eating and drinking prior to admission and instructions will be provided regarding your current medications such as which to stop and for how long beforehand.
After seeing the nurse you may need to have an ultrasound scan of the heart called a transoesophageal echocardiogram. The purpose of this test is to view the heart in detail and ensure that there are no blood clots within the heart which could lead to stroke if an ablation procedure is performed.
How this is done
Your throat will be sprayed with a local anaesthetic to make it numb. You may then be given sedation into a vein. Following this you will be asked to swallow a probe into your gullet and stomach. The test takes about 30 minutes. Common side effects of the test include a sore throat and discomfort during the procedure. Although there is a risk of damaging your food pipe, this is very rare.
ICDs are implanted to protect from serious fast heart rhythm disturbances (arrhythmias).
The ICD is a small device containing a battery and computer; it differs from an ordinary pacemaker because it has the ability to deliver large electric shocks and can treat fast rhythm problems. It is usually implanted in the left chest wall under the collarbone and connects to the heart via 1, 2 or 3 leads or wires. Its job is to constantly monitor the heart rate. Should it detect a fast rhythm it can deliver electrical therapy to “reset” the heart back into a normal rhythm.
ICDs are mainly aimed at treating electrical problems in the heart, in general they will not alter other cardiac symptoms; for example chest pain or breathlessness.
Patients who are considered for this type of device have either experienced a serious arrhythmia or are likely to do so. Your nurse or doctor can explain how it applies to you.
This is the delivery of a small direct electrical current (a shock) to the heart in an attempt to interrupt the abnormal activity, this interruption allows the pacemaker of the heart to step in and a normal rhythm to take over. The small electrical shock is delivered by a specialised machine called a defibrillator. Two pads are placed on your chest and the defibrillator which has two paddles on it is placed over these pads and the electric shock is administered. You will be asleep during the procedure and therefore will not feel anything.
The procedure will take place in a small anaesthetic room attached to the ward. The nurse will give you a gown and ask you to remove any dentures. You will be taken to the anaesthetic room o yourbed or a trolley. You will have leads attached to your chestso that we can monitoryour heart. You will be asked to lie flat with one pillow under your head (if possible).
A venflon (a small needle) will be placed in the back of your hand to allow the anaesthetist to give you medication to put you to sleep.
A doctor and an anaesthetist will be with you at all times. You will be asked to breathe deeply through into an oxygen mask. You will be asleep for a short while during which time the procedure will take place.
Narrowing of the mitral valve is rare in the UK and is usually caused by rheumatic fever. Stretching the valve is often an effective therapy in young patients and may avoid or substantially delay the need for cardiac surgery. The technique is called percutaneous mitral valve commissurotomy (PTMC) and is performed by sending a special balloon through the top of the heart across the valve. This service is led by Dr Jim McLenachan and patients are referred from throughout Northern England.
Transcatheter aortic valve implantation allows the aortic valve to be replaced without the need for open-heart surgery, and is therefore a good option for patients in whom the risks of open-heart surgery are unacceptably high.
What does the procedure involve?
Transcatheter aortic valve implantation is usually performed under a general anaesthetic, though can be performed under local anaesthetic with sedation. Your doctors will tell you which approach they plan to use for you.
Tubes are then passed into the arteries and veins in your groin. Through one of these tubes the doctors pass a large balloon into the aortic valve and inflate the balloon to stretch open the narrowed valve. A long tube or ‘delivery sheath’ is then passed through the artery in the groin and up to the heart. The new aortic valve is contained within this tube. The valve is a ‘tissue valve’ made out of the lining of a pig’s heart and then sewn into a metal tubular frame.
The delivery sheath is passed across the aortic valve, and then pulled back to deliver the new valve. The metal tubular frame containing the valve expands of its own accord, pushing your old valve out of the way, and allowing the new valve to start working immediately.
After the procedure you will spend the first 48 hours on the coronary care unit, after which you will be transferred to the ward. You will be discharged home about 5 to 7 days after the procedure.
For information about cardiac surgery, please visit the Yorkshire Heart Centre webpage. For information about rehabilitation after surgery, please download the Take Heart ‘Rehabilitation After Heart Surgery (813 KB)‘ booklet