ASD (atrial septal defect)

What is atrial septal defect (ASD)?

Atrial septal defect is a type of heart defect wherein blood flows between the atria, which are normally separated by a dividing wall (the interatrial septum). While in the womb, and just after birth, it is normal for blood to flow between the atria through the foramen ovale, a small passageway between the two.

There are different types of ASD, and they can form at various stages in foetal development, or on occasion, after birth (e.g in patent foramen ovale, where the foramen ovale does not close as it should).

The types can be broadly categorised into:

Secundum: the commonest type, occurring in the middle of the septum.

Primum: occurring in the lower part of the septum, and sometimes along with other congenital heart defects.

Sinus venosus: a rare type, occurring in the upper part of the septum.

Coronary sinus: a rare type, where part of the wall between the coronary sinus and the left atrium is missing.

What causes ASD?

Atrial septal defect is congenital. If the dividing wall (the septum) is absent or defective, then oxygen-rich blood in the left side of the heart can mix with the blood in the right side of the heart, which has depleted levels of oxygen. As a result, the blood which is found in the arteries and which supplies the brain, other organs, and tissues of the body, has lower levels of oxygen in it than is usual. The heart then pumps extra blood into the lung arteries, meaning the heart and lungs have to work harder, damaging the lung arteries in the process.

What are the symptoms of ASD?

If the defect is very small, then symptoms may not be present, and there may not be any medical complications related to the defect. Symptoms may present when the child has grown up to be an adult, and can occur around age 30 in some cases. Signs to watch for include:

Shortness of breath, particularly during exercise

Swelling in the legs, feet, or abdomen

Heart palpitations

Fatigue, or tiring easily

Heart murmur

Stroke

Can ASD be prevented?

As ASD is congenital, in most cases it cannot be prevented. However, certain factors increase the risk of its development, including drug use, smoking, and substance abuse during pregnancy, obesity, having diabetes, and having rubella during the first few months of pregnancy.

What is the treatment for ASD?

If the defect is small, then treatment may not be necessary. Monitoring to see how the defect progresses will be advised, to see if the hole closes on its own – which can happen. However, treatment may be necessary, and this may be recommended in the form of medication or surgery. Medication can be used to control or reduce symptoms which occur along with the defect, while surgery aims to repair the defect itself.

Which specialist treats ASD?

A cardiologist, or paediatric cardiologist generally monitors and treats atrial septal defect.

Mitraclip

The MitraClip (sometimes styled mitraclip or mitral clip) is a modern treatment for mitral valve regurgitation for patients who can’t undergo open-heart surgery. It is inserted via a catheter, which is fed through a vein to the heart, using echocardiography and fluoroscopy imaging to guide the surgeon. It is clipped onto the mitral valve, allowing it to close more completely, thus restoring normal blood flow.

Patent foramen ovale

What is it?

The patent foramen ovale (PFO), also known by its colloquial name of “hole in the heart”, is a cardiac defect consisting in a small hole in the cardiac muscle, located between the right and left upper chamber (atria) of the heart. PFO is normal in babies when they are still in the womb, because a baby’s lungs are not working yet and that small hole allows blood to circulate between the heart’s atria. It is also fundamental for blood oxygenation and for the correct functioning of the circulatory system. However, after birth or during the baby’s first year, the small hole should close.

What are the symptoms?

This condition is quite widespread - 30% of the adult population is affected from it. PFO can potentially become a severe condition, because it does not cause any immediate symptoms. There is a higher risk of complications for people who suffer from both cardiac and neurological disorders and for people who engage in underwater sports.

What causes PFO?

It’s not clear yet what causes PFO, although it may be possible for this condition to be associated with a genetic mutation. However, this theory has not been conclusively confirmed yet.

How can it be treated?

Currently, the condition is mostly diagnosed by doing a transcranial ecodoppler. PFO can be treated with surgery, which may be recommended if there are also other cardiac conditions (especially in children) or in case another concurrent cardiac disorder arises, if the blood stops flowing to the lungs or in case of recurring strokes (especially for adults).

There are two types of procedures to close the PFO:

Catheter procedure: a small device, which can expand, is inserted within your heart through a catheter. The device cover up the hole in between the atria. This is a percutaneous procedure, and is less invasive when compared to regular surgery.

Surgical closure: this is an “open heart procedure” and although it may be riskier than the percutaneous procedure, it is very helpful for people who are also suffering from other cardiac conditions.

Finally, people suffering from PFO and with a predisposition to blood clots formation also need to get started on medication to prevent or reduce the possibility of stroke.

Which doctor should I talk to?

The healthcare professionals who treat PFO are cardiologists and heart surgeons.

TAVI (transcatheter aortic valve implantation)

Transcatheter aortic valve implantation (TAVI) (known as transcatheter aortic valve replacement or TAVR in the USA) is a modern innovative surgical technique to replace the aortic valve. The aortic valve opens when the heart pumps blood, but if it cannot open or close properly the heart is put under strain. For patients who cannot undergo open-heart surgery, TAVI allows surgeons to implant a specially designed aortic valve using a catheter (a long, narrow tube), which is inserted via a large blood vessel (often in the groin).

Valvular heart disease

What is valvular heart disease?

Valvular heart disease includes any disease that affect the valves of the heart. These pathologies affect the aortic and mitral valve on the left side and the pulmonary and tricuspid valves on the right side of the heart. If they get worse and are not treated, they can affect the flow of blood through the heart and cause serious heart problems.

Valvular heart diseases can be classified into three groups according to their severity:

Mild valvular heart disease – a mild disorder that does not require treatment. A follow up with the cardiologist is sufficient.

Moderate valvular heart disease – requires comprehensive follow-up and in some cases the patient may require treatment.

Severe valvular heart disease – usually requires surgical treatment, in many cases to replace the affected valve.

What are the symptoms of valvular heart disease?

The symptoms will vary depending on the type of valvular heart disease but generally, the patient will experience shortness of breath, fatigue, swelling around the ankles and feet, chest pain and may even lose consciousness during physical exertion.

Causes of valvular heart disease

Valvular heart disease can be congenital or acquired. The main causes include:

Congenital heart disease – the patient was born with an abnormal valve.

Rheumatic fever

Cardiomyopathy – this disease of the heart muscle can damage the valves.

Heart attack – these can leave damage to the heart muscle and valves.

Previous infection with endocarditis

Ageing

Can valvular heart disease be prevented?

Many of valvular heart diseases cannot be avoided, but there are measures that can be taken to minimise the risk, such as regular heart check-ups, maintaining a healthy diet and doing regular physical activity to keep your heart healthy.

Treatment of valvular heart disease

The treatment will depend on the type of valve disease and the degree of severity. Many cases can be treated with medication, while more severe cases may require surgery to repair or replace the valve.

Mitral regurgitation

What is mitral valve regurgitation?

Mitral regurgitation is the most common heart valve disorder and occurs when the heart valve does not close properly meaning that there is a backflow of blood from the left ventricle to the left atrium. The leakage of blood backward through the mitral valve occurs every time that the left ventricle contracts.

What are the symptoms of mitral regurgitation?

For some people, there are no signs of mitral regurgitation or the symptoms develop gradually over time and may even take years to appear. These may include:

fatigue

abnormal heart murmur, which is heard through a stethoscope

dizziness

heart palpitations, such as fast heart rate sensations

difficulty breathing, especially after physical activity or when lying down

swollen feet or ankles

In some cases, the symptoms appear suddenly due to a heart attack or a rupture of the valve cords.

What are the causes of mitral valve regurgitation?

The heart has four valves – the mitral, tricuspid, pulmonary and aortic valves - that keep the blood flowing in the right direction. Each of the valves has flaps that open and close during each heartbeat. Sometimes the valves do not open or close properly, which disrupts the blood flow through the heart to the body. With a mitral valve regurgitation, the valve between the left chamber and the lower left chamber does not close fully, which causes blood to leak backwards into the left atrium. It is caused by problems that occur in the mitral valve, which are known as primary mitral valve regurgitation. Possible causes are:

coronary heart disease

arterial hypertension

displacement of the mitral valve

heart attack

rare diseases such as Marfan syndrome (a genetic disorder of the connective tissue)

rheumatic heart disease

swelling of the heart

How is mitral regurgitation prevented?

Implementing lifestyle changes such as eating healthily (fruits, vegetables, wholegrain and organic meat and fish) can help overall wellbeing. High blood pressure can make mitral regurgitation worse, so blood pressure lowering medicines may help. Limiting salt intake is recommended for those who have hypertension. The reduction of caffeine and alcohol lowers the risk of arrhythmias.

What is the treatment for mitral regurgitation?

There may be regular examinations and monitoring of mitral valve regurgitation but treatment depends on the severity of the individual case. If it is mild or moderate, then medical treatment may not be needed but the doctor will watch the condition regularly.

In more severe cases, mitral regurgitation surgery is required to repair the mitral valve. Sometimes a patient may need a replacement valve, which is made of pig, cow or human heart tissue. There are also man-made mechanical valves as an option.

Dr Michael Mullen

GMC: 3273049

Dr Michael Mullen is a consultant cardiologist based in London. He is recognised, internationally, for his expertise in the treatment of structural heart disease, with 20 years of experience in this field. His private practice is based at the Harley Street Clinic and Barts Heart Centre, where he is the clinical lead for structural heart intervention. His areas of clinical expertise include percutaneous aortic valve replacement, MitraClip repair of mitral regurgitation, device closure of patent foramen ovale (PFO) and atrial septal defect (ASD) and other bespoke interventions for structural heart abnormalities. He has played a key role in the development of many new technologies for the treatment of these conditions and their introduction into clinical practice in the UK, including TAVI, MitraClip and suture closure of patent foramen ovale. Dr Mullen has a broad research portfolio and is frequently invited to give lectures and live demonstrations at national and international conferences.

Professional experience
- Consultant Cardiologist, The Harley Street Clinic (HCA Healthcare) (present)
- Consultant Cardiologist, St Bartholomew's Hospital (present)
- Consultant Cardiologist, The Heart Hospital, University College London Hospitals (past)
- Director, cardiac catheter laboratories, Royal Brompton and Harefield NHS Trust (past)
Education
- Higher cardiology training in Sheffield, London and Toronto, Canada
- MB BS, University of Newcastle-upon-Tyne
- MD, University of London 2001
Professional membership
- The British Medical Association
- British Cardiac Intervention Society
- British Congenital Cardiac Association
- Royal College of Physicians of London
- British Cardiac Society
Teaching posts
- Reader University College London
- Honorary Senior Lecturer, Imperial College (past)
Publications and conferences
- IPC Milan - Live case operator and presentation on Suture Closure of PFO (Sept 2017)
- CSI Frankfurt - Live case transmission from Barts Heart Centre (June 2017)

ASD (atrial septal defect)
What is atrial septal defect (ASD)?

Atrial septal defect is a type of heart defect wherein blood flows between the atria, which are normally separated by a dividing wall (the interatrial septum). While in the womb, and just after birth, it is normal for blood to flow between the atria through the foramen ovale, a small passageway between the two.

There are different types of ASD, and they can form at various stages in foetal development, or on occasion, after birth (e.g in patent foramen ovale, where the foramen ovale does not close as it should).

The types can be broadly categorised into:
- Secundum: the commonest type, occurring in the middle of the septum.
- Primum: occurring in the lower part of the septum, and sometimes along with other congenital heart defects.
- Sinus venosus: a rare type, occurring in the upper part of the septum.
- Coronary sinus: a rare type, where part of the wall between the coronary sinus and the left atrium is missing.
What causes ASD?

Atrial septal defect is congenital. If the dividing wall (the septum) is absent or defective, then oxygen-rich blood in the left side of the heart can mix with the blood in the right side of the heart, which has depleted levels of oxygen. As a result, the blood which is found in the arteries and which supplies the brain, other organs, and tissues of the body, has lower levels of oxygen in it than is usual. The heart then pumps extra blood into the lung arteries, meaning the heart and lungs have to work harder, damaging the lung arteries in the process.

What are the symptoms of ASD?

If the defect is very small, then symptoms may not be present, and there may not be any medical complications related to the defect. Symptoms may present when the child has grown up to be an adult, and can occur around age 30 in some cases. Signs to watch for include:
- Shortness of breath, particularly during exercise
- Swelling in the legs, feet, or abdomen
- Heart palpitations
- Fatigue, or tiring easily
- Heart murmur
- Stroke
Can ASD be prevented?

As ASD is congenital, in most cases it cannot be prevented. However, certain factors increase the risk of its development, including drug use, smoking, and substance abuse during pregnancy, obesity, having diabetes, and having rubella during the first few months of pregnancy.

What is the treatment for ASD?

If the defect is small, then treatment may not be necessary. Monitoring to see how the defect progresses will be advised, to see if the hole closes on its own – which can happen. However, treatment may be necessary, and this may be recommended in the form of medication or surgery. Medication can be used to control or reduce symptoms which occur along with the defect, while surgery aims to repair the defect itself.

Which specialist treats ASD?

A cardiologist, or paediatric cardiologist generally monitors and treats atrial septal defect.
Congenital heart disease
What is a congenital heart disease?

A congenital heart disease happens when there is a malformation of the heart or nearby vessels of the newborn or foetus. Some of these heart diseases don’t develop until months or years later.

In these cases we speak of a congenital heart defect, such as an underdeveloped heart, narrow blood vessels, leaking heart valves, or holes in the septa.

There are different types of heart defects, some are mild and only pose a mild health risk to the child’s health, and others may require urgent surgery.

Heart disease can be classed as:
1. Heart diseases that obstruct the blood flow.
2. Cyanogenic congenital heart diseases, where the blood flows from the pulmonary to the systemic circulation, delivering non-oxygenated blood to organs and tissues.
3. Those that lead to short-circuits in the blood from systemic to pulmonary circulation. These include ventricular septal defect and atrial septal defects.
- Ventricular septal defect: where there is a hole in the link between both ventricles. This is the most common congenital heart disease. It may be asymptomatic and the hole may heal itself. If it continues to grow, it will pump too much blood into the lungs causing heart failure.
- Atrial septal defect: is a hole between the heart’s lower chambers that allow the blood to flow. The blood will flow from left to right, if there is too much blood in the right, the lungs will be pressed. Atrial septum defects don’t tend to cause problems, but they may sometimes cause hypertension, heart failure, and strokes.
- Tetralogy of Fallot: is a combination of different congenital abnormalities including; ventricular septal defect, pulmonary artery stenosis, and hypertrophy of the right ventricle. It prevents blood from reaching the lungs to oxygenate. This makes the baby turn blue. Surgical advances are making it easier to treat these issues.
- Long QT syndrome (LQTS): is a structural abnormality of the potassium and sodium channels of the heart. It can lead to arrhythmias that lead to syncope, seizures, and even sudden death.
- Short QT syndrome: is a genetic condition linked to atrial fibrillation. It has a shorter QT interval.
- Brugada syndrome: condition that causes an electrocardiographic abnormality. It is hereditary.
These heart diseases are all linked to sudden death syndrome.

Medical tests

Most congenital heart diseases can be detected by ultrasound before birth. These ultrasounds are routine procedures that monitor pregnancy progress as well as the mother and foetus health status.

There are some heart diseases that can only be detected after birth. If the heart disease is serious, this will be identified in the medical check-ups after birth.

Prognosis

As mentioned, there are different types of congenital heart diseases with varying seriousness. Some may be mild and spontaneously solve themselves while others may require immediate hospitalisation and surgery.

What causes it?

The causes for congenital heart disease remain unknown, although some risk factors have been identified:
- Hereditary causes: they could be part of some genetic or chromosomal syndromes such as Down’s syndrome, Marfan, Noonan, or Turner syndrome.
- Mother’s nutritional status: lacking iodine or folic acid, being overweight or having conditions such as diabetes are often related to foetal congenital anomalies according to the WHO (World Health Organization).
- Infections and toxic substances: consuming alcohol and smoking, some medications, and some conditions, such as rubella, can increase the chances of heart disease.
How can it be prevented?

There are primary preventive measures that can reduce the risk of heart diseases developing:
- Improve pregnancy diet with vitamins and minerals such as folic acid.
- Stop smoking and consuming alcoholic drinks when pregnant.
- Monitor blood sugar levels in pregnant ladies who have diabetes.
- Avoid exposure to toxic substances.
What is the treatment?
- Pharmaceutical treatment: this is used in the acute phase when the patient has had angina or a heart attack. This is for heart attacks where there is a blocked artery, which the medication aims to unclog. Medication used includes; acetylsalicylic acid (aspirin), antiplatelet medicines, anticoagulants, beta-blockers, nitroglycerin, thrombolytic or fibinolytic drugs, and painkillers.
- Surgical treatment: this is opted for in more serious cases or in cases where medications haven’t helped. The procedure used is artery surgery and could be; angioplasty or percutaneous revascularisation, coronary bypass surgery, or a bypass.
- Long-term treatment: this involves making changes to the patient’s lifestyle. Stop smoking, only consume alcohol in moderation, have a balanced diet, exercise regularly, keep an eye on risk factors, and relax.
What specialist should I see?

Babies and children with congenital heart issues are diagnosed and treated by a paediatric cardiologist. If surgery is needed, this will be performed by a cardiac or cardiovascular surgeon.
Heart valve surgery
What is valvular heart surgery?

Valvular heart surgery is a technique used to treat problems or conditions of the heart valves, such as valvular stenosis, which occurs when there is a narrowing or closure of the valve, or valve insufficiency, also known as valve regurgitation, which occurs when the valve doesn’t close properly.

This is an open-heart operation in which the chambers and vessels of the heart are opened. It is performed under general anaesthetic.

There are two ways of addressing this problem through traditional surgery: with a sternotomy, whereby an incision is made in the sternum, or by opening the blood vessel to repair the valve or replace it with a prosthetic valve.

Why is valvular heart surgery performed?

The heart has four valves: the aortic, mitral, tricuspid and pulmonary valves. The function of these four valves is to control the direction of blood flow through the heart.

The main diseases for which valvular heart surgery is indicated are aortic stenosis, mitral stenosis, aortic insufficiency, and mitral insufficiency.

Valvular procedures are aimed at repairing or replacing the mitral valve or aortic valve. Both valves are located in the left side of the heart, which is the part that has to work the hardest since it controls the flow of oxygenated blood from the lungs and carries it to the rest of the body.

What does valvular heart surgery involve?

A heart-lung bypass machine is used in valve replacement or repair operations. You’ll be given an anticoagulant to prevent the formation of blood clots.

After connecting you to the circulation machine, the heart is stopped and cooled. An incision will then be made in the heart or aorta, depending on which valve needs to be repaired. Once the process is complete, the heart is restarted and you are disconnected from the machine.

In some cases the operation may not be effective so another intervention will be required. You should also be aware that a biological valve may need to be replaced within fifteen to twenty years.

If you have a mechanical valve - which can also fail - you will have to take anticoagulants for the rest of your life. If bacteria penetrate the repaired or artificial valve, bacterial endocarditis can develop.

Preparing for valvular heart surgery

Most people who require valve surgery are admitted to hospital the day before the procedure, and in some cases on the day of the surgery itself. You will be asked to shower or have a bath beforehand, to avoid the presence of bacteria on the skin.

At the hospital, your skin will be disinfected with an antiseptic and, if necessary, the area where the incision will be made will be shaved.

You will need to fast before surgery, as this reduces the risk of complications from anaesthetic. If you have eaten or drank anything beforehand, you must inform the anaesthetist and the surgeon.

If you are a smoker, the doctor will ask you to stop smoking at least two weeks before the operation, as smoking can cause coagulation-related problems.

Post-operative care

This type of surgery usually requires a hospital stay of approximately one week. Complete healing may take several months, although the recovery period will vary depending on your health before the surgery.

Following the operation, continuous cardiological monitoring will be required, along with periodic check-ups. You should contact the specialist if you notice any unusual symptoms.

Your medication may need to be changed depending on the type of intervention.

If you have a dental problem or infection, you should contact your dentist and start taking the indicated antibiotics immediately.

Alternatives to valvular heart surgery

The alternative treatment to valve surgery is minimally-invasive percutaneous surgery. Advanced techniques such as videothoracoscopy are used, in which a micro camera is introduced into the thorax to facilitate surgery. Treatments include the HeartPort procedure and percutaneous aortic valve surgery:
- HeartPort: a small incision is made in the mammary fold and extracorporeal circulation is performed through the femoral artery and vein
- Percutaneous aortic valve surgery: this is performed through a catheter inserted into the femoral artery, through which a biological valve is then introduced.
Mitraclip

The MitraClip (sometimes styled mitraclip or mitral clip) is a modern treatment for mitral valve regurgitation for patients who can’t undergo open-heart surgery. It is inserted via a catheter, which is fed through a vein to the heart, using echocardiography and fluoroscopy imaging to guide the surgeon. It is clipped onto the mitral valve, allowing it to close more completely, thus restoring normal blood flow.
Mitral regurgitation
What is mitral valve regurgitation?

Mitral regurgitation is the most common heart valve disorder and occurs when the heart valve does not close properly meaning that there is a backflow of blood from the left ventricle to the left atrium. The leakage of blood backward through the mitral valve occurs every time that the left ventricle contracts.

What are the symptoms of mitral regurgitation?

For some people, there are no signs of mitral regurgitation or the symptoms develop gradually over time and may even take years to appear. These may include:
- fatigue
- abnormal heart murmur, which is heard through a stethoscope
- dizziness
- heart palpitations, such as fast heart rate sensations
- difficulty breathing, especially after physical activity or when lying down
- swollen feet or ankles
In some cases, the symptoms appear suddenly due to a heart attack or a rupture of the valve cords.

What are the causes of mitral valve regurgitation?

The heart has four valves – the mitral, tricuspid, pulmonary and aortic valves - that keep the blood flowing in the right direction. Each of the valves has flaps that open and close during each heartbeat. Sometimes the valves do not open or close properly, which disrupts the blood flow through the heart to the body. With a mitral valve regurgitation, the valve between the left chamber and the lower left chamber does not close fully, which causes blood to leak backwards into the left atrium. It is caused by problems that occur in the mitral valve, which are known as primary mitral valve regurgitation. Possible causes are:
- coronary heart disease
- arterial hypertension
- displacement of the mitral valve
- heart attack
- rare diseases such as Marfan syndrome (a genetic disorder of the connective tissue)
- rheumatic heart disease
- swelling of the heart
How is mitral regurgitation prevented?

Implementing lifestyle changes such as eating healthily (fruits, vegetables, wholegrain and organic meat and fish) can help overall wellbeing. High blood pressure can make mitral regurgitation worse, so blood pressure lowering medicines may help. Limiting salt intake is recommended for those who have hypertension. The reduction of caffeine and alcohol lowers the risk of arrhythmias.

What is the treatment for mitral regurgitation?

There may be regular examinations and monitoring of mitral valve regurgitation but treatment depends on the severity of the individual case. If it is mild or moderate, then medical treatment may not be needed but the doctor will watch the condition regularly.

In more severe cases, mitral regurgitation surgery is required to repair the mitral valve. Sometimes a patient may need a replacement valve, which is made of pig, cow or human heart tissue. There are also man-made mechanical valves as an option.
Patent foramen ovale
What is it?

The patent foramen ovale (PFO), also known by its colloquial name of “hole in the heart”, is a cardiac defect consisting in a small hole in the cardiac muscle, located between the right and left upper chamber (atria) of the heart. PFO is normal in babies when they are still in the womb, because a baby’s lungs are not working yet and that small hole allows blood to circulate between the heart’s atria. It is also fundamental for blood oxygenation and for the correct functioning of the circulatory system. However, after birth or during the baby’s first year, the small hole should close.

What are the symptoms?

This condition is quite widespread - 30% of the adult population is affected from it. PFO can potentially become a severe condition, because it does not cause any immediate symptoms. There is a higher risk of complications for people who suffer from both cardiac and neurological disorders and for people who engage in underwater sports.

What causes PFO?

It’s not clear yet what causes PFO, although it may be possible for this condition to be associated with a genetic mutation. However, this theory has not been conclusively confirmed yet.

How can it be treated?

Currently, the condition is mostly diagnosed by doing a transcranial ecodoppler. PFO can be treated with surgery, which may be recommended if there are also other cardiac conditions (especially in children) or in case another concurrent cardiac disorder arises, if the blood stops flowing to the lungs or in case of recurring strokes (especially for adults).

There are two types of procedures to close the PFO:
- Catheter procedure: a small device, which can expand, is inserted within your heart through a catheter. The device cover up the hole in between the atria. This is a percutaneous procedure, and is less invasive when compared to regular surgery.
- Surgical closure: this is an “open heart procedure” and although it may be riskier than the percutaneous procedure, it is very helpful for people who are also suffering from other cardiac conditions.
Finally, people suffering from PFO and with a predisposition to blood clots formation also need to get started on medication to prevent or reduce the possibility of stroke.

Which doctor should I talk to?

The healthcare professionals who treat PFO are cardiologists and heart surgeons.
Sports physical examination
What is a sports medical examination?

Sports medical check-ups are all those tests concerning the state of health of the athletes, fundamental to play sports in a safe way. It is recommended to carry it out annually or whenever you want to start a new sport, to know if you are physically prepared to practice it.

What happens during a sports medical examination?

A sports medical examination may be composed of a series of tests:
- History: analysis of medical history and personal and family history.
- Gait analysis: revision of the pelvis, spine, ankles, knees, etc.
- Cardiovascular evaluation: checking blood pressure by listening to your pulse and heart beat
- Electrocardiogram: obtains a graph of the electrical activity of the heart.
- Respiratory assessment: this may involve listening to your breathing and spirometry (measures lung capacity and volume).
- Body composition: calculation of bone, muscle and fat weight.
- Evaluation of aerobic endurance test: consisting of running on treadmill or athletic track.
Why is a sports medical examination carried out?

The objective of a sports medical examination is to confirm that someone is ready for a certain sports activity, and to anticipate any difficulties the person may have. Anyone can benefit from an examination, whether they play sport to a professional level or would just like to take up a new sport as a hobby.

Preparing for a sports medical examination

Before submitting to the test, it is recommended to take the following measures:
- Wear loose, comfortable clothes
- Avoid heavy exercise for 24 hours before the exam
- Eat light food, do not smoke, do not drink coffee, alcohol or stimulants on the day
Meaning of abnormal results of a sports medical examination

A sports medical examination may reveal issues such as:
- Poor gait or posture that could result in injury
- Problems with breathing function that may require further investigation
- Inherited heart conditions which need managing for you to play sport safely
After you are given the results of your exam you may be referred to another specialist, such as a cardiologist or physiotherapist, for further investigation and treatment.
TAVI (transcatheter aortic valve implantation)

Transcatheter aortic valve implantation (TAVI) (known as transcatheter aortic valve replacement or TAVR in the USA) is a modern innovative surgical technique to replace the aortic valve. The aortic valve opens when the heart pumps blood, but if it cannot open or close properly the heart is put under strain. For patients who cannot undergo open-heart surgery, TAVI allows surgeons to implant a specially designed aortic valve using a catheter (a long, narrow tube), which is inserted via a large blood vessel (often in the groin).
Valvular heart disease
What is valvular heart disease?

Valvular heart disease includes any disease that affect the valves of the heart. These pathologies affect the aortic and mitral valve on the left side and the pulmonary and tricuspid valves on the right side of the heart. If they get worse and are not treated, they can affect the flow of blood through the heart and cause serious heart problems.

Valvular heart diseases can be classified into three groups according to their severity:
- Mild valvular heart disease – a mild disorder that does not require treatment. A follow up with the cardiologist is sufficient.
- Moderate valvular heart disease – requires comprehensive follow-up and in some cases the patient may require treatment.
- Severe valvular heart disease – usually requires surgical treatment, in many cases to replace the affected valve.
What are the symptoms of valvular heart disease?

The symptoms will vary depending on the type of valvular heart disease but generally, the patient will experience shortness of breath, fatigue, swelling around the ankles and feet, chest pain and may even lose consciousness during physical exertion.

Causes of valvular heart disease

Valvular heart disease can be congenital or acquired. The main causes include:
- Congenital heart disease – the patient was born with an abnormal valve.
- Rheumatic fever
- Cardiomyopathy – this disease of the heart muscle can damage the valves.
- Heart attack – these can leave damage to the heart muscle and valves.
- Previous infection with endocarditis
- Ageing
Can valvular heart disease be prevented?

Many of valvular heart diseases cannot be avoided, but there are measures that can be taken to minimise the risk, such as regular heart check-ups, maintaining a healthy diet and doing regular physical activity to keep your heart healthy.

Treatment of valvular heart disease

The treatment will depend on the type of valve disease and the degree of severity. Many cases can be treated with medication, while more severe cases may require surgery to repair or replace the valve.

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Which patients is TAVI suitable for?

TAVI stands for transcatheter aortic valve implantation, a minimally invasive catheter-based procedure for patients with aortic stenosis. Aortic stenosis is a heart defect characterised by the narrowing of the aortic valve, which can cause chest pain (angina), dizziness, palpitations, breathlessness and loss of consciousness. Cardiologist Dr Michael Mullen tells us all about TAVI, the possible risks faced with the operation and the road to recovery.