Heart specialist operates on same patient 25 years apart

A young woman born with a heart defect has had a pioneering procedure carried out by the same cardiologist who helped to save her life as a baby.

Samantha Blake, 27, from Haywards Heath in West Sussex, is one of the first people in the UK to have a new minimally invasive treatment using a replacement valve to fix a leaking heart valve at Guy’s and St Thomas’ NHS Foundation Trust, saving her from needing open heart surgery.

She was born with a condition which causes the heart to form abnormally and affects around one in 3,000 babies born in the UK.

Patients with Tetralogy of Fallot, which is one of the most common congenital heart defects, need to have major corrective surgery when they are babies. Samantha, a barrister’s clerk, was cared for and operated on by Professor Shakeel Qureshi, consultant cardiologist and specialist in congenital heart disease, and Professor David Anderson, consultant heart surgeon, at Guy’s Hospital when she was 17 months old.

The life-saving surgery leaves patients with a heart valve, the pulmonary valve, which does not close properly, causing blood to leak. Patients usually need an operation to mend the leaking valve in early adulthood.

Last autumn Samantha benefited from a new replacement valve, known as the Venus P-valve, which is fitted during a minimally invasive procedure. She was delighted that it was carried out by Professor Qureshi.

She said: “I felt in very safe hands with Professor Qureshi – he is like an old friend because he has looked after me since I was a newborn. It was a big relief having the new procedure because there was a chance I would have needed open heart surgery again without it. I’d always felt fortunate that I had no memories of my operation as a baby so it had been scary to think it might happen again as an adult.”

Until now, the other replacement valves available to fix the leakage were too small to fit most patients, meaning only 20% could have them implanted and the rest needed open heart surgery for a second time. The Venus P-valve, which is made from animal heart tissue and is mounted inside a metal stent (a tiny tube), is available in much larger sizes so is expected to be suitable for most patients born with Tetralogy of Fallot.

Professor Qureshi is the lead investigator in a clinical study assessing the new device. He said: “It is preferable for patients to avoid having open heart surgery more than once. They can be left with scarring inside the heart from the surgery they had as babies which may make it more challenging for surgeons to open the chest safely again, and there are higher risks of bleeding and infection compared with less invasive procedures.”

The valve is put into place using a catheter (a thin, flexible tube) which is inserted into a vein through a small incision made in the groin. The device is guided through the body using X-ray imaging until it reaches the damaged valve in the heart and is then deployed to replace the function of the leaky valve.

Professor Qureshi explained: “We know people who have had corrective surgery for Tetralogy of Fallot will need further treatment to stop their pulmonary valves leaking later in life, so patients have regular scans to check if it has started to affect the shape of their hearts and we intervene at that stage. Usually patients haven’t yet developed symptoms but they may experience breathlessness, tiredness and have a lower exercise tolerance.”

Samantha said: “As I child I never felt different to my friends and I could do the same as everyone else. But in 2015 I started to notice that it would take me longer to get my breath back when I walked up a flight of stairs and by last year I’d get quite breathless walking up a hill.

“I had regular scans to keep an eye on the leaking valve and last year it had got a lot worse. Leaving it wasn’t an option because it would have continued to deteriorate and eventually my heart wouldn’t have worked properly.

“My breathing returned to normal immediately after the procedure. I feel lucky to be one of the first people to have the new replacement valve, it’s like a weight has been lifted knowing that the leakage has been stopped now.”

Professor Qureshi added: “Around 100 people have had the valve implanted in the world so far and the majority have had good results. This is a very exciting development which could prevent many people across the world having major surgery.”

Visit NHS Choices to find out more about Tetralogy of Fallot.