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Heart Valve Clinic

 

This guideline applies to adults aged 16 years and over.



Introduction

This clinic is a single point of access for referrals for patients with a confirmed valve disorder.  Referrals should be made via e-RS by letter.

 

In scope:                       Severe valve disease


Not in scope:                Any mild or moderate valve disease (with the exception of moderate mitral stenosis)




Red Flag Features

Acutely unwell patients

Subacute endocarditis

Syncope

Angina

Dyspnoea


 

Investigations required prior to referral

  • ECG
  • Echocardiogram
  • FBC, U&Es, eGFR, pro-BNP
  • CXR where appropriate

 


Advice and Guidance

Please send advice and guidance requests via e-RS to Cardiology.




Referral:

Refer by letter via eRS to the Heart Valve clinic

  • Documented severe aortic stenosis or aortic regurgitation
  • Suspected severe aortic stenosis or aortic regurgitation on echocardiogram
  • Severe primary mitral regurgitation
  • Suspected severe primary mitral regurgitation on echocardiogram
  • Moderate and severe mitral stenosis
  • Severe primary tricuspid regurgitation

Referral to the Heart Valve Clinic is not required for the following conditions.  These should be referred to the General Cardiology Clinic instead.

  • All mild and moderate valve disease
  • Functional mitral regurgitation (occurs in the absence of organic mitral valve disease and is a result of LV dysfunction) – to be referred to general cardiology or heart function service in case of concomitant severe LV systolic impairment.
  • Functional tricuspid regurgitation (because of RV dysfunction due to lung or left-sided heart disease)
  • Pulmonic valve disease
  • Severe frailty/multiple comorbidities precluding any intervention.

 

Referral instructions

Referrals must include the investigations (carried out within 3 months of referral with the exception of blood tests) listed below. Referrals will not be accepted with just physical examination (including finding of murmurs):

  • ECG
  • Echocardiogram
  • FBC, U&Es, eGFR, pro-BNP (within last 6 months, or within 1 month for new symptoms)
  • CXR (where appropriate)
  • Copies of relevant correspondence from cardiothoracic surgery if available such as discharge summary, operation notes and details of the prosthetic valve.




Supporting Information

For professionals:  Overview | Heart valve disease presenting in adults: investigation and management | Guidance | NICE

For patients: Heart valve disease - BHF

 

References         Overview | Heart valve disease presenting in adults: investigation and management | Guidance | NICE

  

Page Review Information

 Review date

17/01/2025

Next review date

17/01/2027

Clinical editor

Dr Melanie Schick

Contributors

Dr Zeljko Baricevic, Consultant Cardiologist RCHT