The heart valve clinic at Royal Brompton Hospital is run by clinical nurse specialists in heart surgery with extensive experience in caring for patients with heart problems. In addition, our nurses completed specialist training in order to conduct this clinic.
The nurse specialists manage all aspects of the service and liaise with other relevant health professionals when necessary to ensure patients receive expert specialist care.
What is the purpose of this clinic?
Modern heart valve replacements can help patients back to a near-normal life. However, all replacement valves may have long-term complications, which can be treated effectively if detected early enough.
A specialist unit, such as the one at Royal Brompton Hospital, can offer expert echo assessment by specialists with extensive experience of examining native (original) and artificial valves. This is vital in detecting complications and early signs of degeneration of the heart valves and of the general condition of the heart.
Many patients have had tissue valve replacements, which can start to deteriorate after 15 to 20 years because they are biological. Early detection of this deterioration means we can offer patients the appropriate treatment at the right time.
By providing specialist follow-up visits in a dedicated clinic and through liaising closely with GPs and other health professionals, we offer patients the comprehensive service needed after heart valve surgery.
Read more about heart valves and how they work
Read more about our advanced nursing team in adult cardiac surgery
This clinic is run every Thursday morning. Most patients are seen once a year unless more regular reviews are needed. Patients who are clinically stable are offered a follow-up appointment every two years.
Patients are referred to the clinic by their cardiac surgeon.
The heart valve clinic is for patients who have had heart valve surgery at Royal Brompton Hospital and need long-term ongoing review. Patients do not have to live in London – patients travel from all over the country to continue their follow-up with us.
Plan to arrive early
We suggest that you arrive early on the day of your appointment to ensure that all the necessary tests are done before your consultation.
Please continue to take all your medication as usual on the day of your clinic appointment. It is important to remember to bring any medication you usually take during the day with you so you do not miss any doses.
It is also important that you bring a list of all the medication you are currently taking with you to your clinic appointment. We suggest bringing your most recent repeat prescription. This means your nurse can note the exact name and dose of all your prescribed medication.
If you are taking Warfarin, please bring the yellow anticoagulation record booklet to your appointment so your nurse can see how controlled the INR has been.
Read more about Warfarin and anticoagulant therapy
hen you arrive for your appointment, please go straight to reception in the outpatients department (Outpatients East, Fulham wing). If possible, we suggest that you arrive early to ensure there is enough time to complete all the tests before your clinic appointment.
Before your consultation with the clinical nurse specialist, we will carry out some tests to check the condition of your replacement valve and how well your heart is working. Tests may include:
Echocardiogram (echo) - an ultrasound scan to measure the size and function of your heart and to check how well your heart and heart valves are working.
Patients will usually have their echo in the specialist echo room located in the outpatients department. The echo department will confirm the exact time and location of your test a few weeks before your appointment. If you do not receive a confirmation letter within two weeks of your clinic appointment, please contact the echo team on 020 7351 8209.
Electrocardiograph (ECG) - a test using small electrodes attached to the arms, legs and chest that show the rhythm and electrical activity of the heart.
Patients will usually have their ECG immediately after their echo in the same department.
We may also carry out some tests after your consultation with the clinical nurse specialist. These may include:
Blood tests - to check full blood count, kidney and liver function, iron studies, clotting studies (including INR if patient is taking Warfarin), glucose, cholesterol and BNP levels.
The blood test department (phlebotomy) is also located in the outpatients department, Fulham Road. The nurse specialist will give patients a completed form to take to this department following the consultation.
Chest X-ray - to check your heart, lungs and chest wall. If an X-ray is needed, the nurse specialist can arrange for it to be taken immediately after the consultation.
Your clinical nurse specialist will discuss any change in your symptoms, medication and general health since your last follow-up appointment.
During a brief physical check-up, we will take your blood pressure, weight, heart rate, respiratory rate, listen to your heart and lungs, and check for any signs of heart failure.
We also provide advice to promote good heart health and help you live as healthy a life as possible.
After your consultation, the nurse will check your availability and give you the date for your next heart valve clinic.
What happens next?
Your nurse specialist will write a letter to your GP detailing your results, clinical examination, medications and any further actions needed, such as a change in medication. You will receive a copy of this letter.
The nurse specialist will discuss any issues or concerns that arise during the clinic with the clinical lead, Professor John Pepper, and any other relevant consultants such as cardiology or respiratory consultants.
Some patients may need further tests that will be arranged for another date, such an ECG holter monitor test to check irregular rhythms of the heart. Occasionally other tests such as CT scans or MRI scans may also be arranged. If these tests are needed, it will be discussed with each patient in more detail.
Patients who have had heart valve surgery are at an increased risk of a rare infection that can damage the heart, called endocarditis.
Bacteria that can cause endocarditis may enter the body in many ways. One way is through the gums where bacteria is often present. This is why it is very important to take care of your teeth and gums and visit a dentist every six months for a check-up to prevent any problems. You can download our patient information leaflet to read more about endocarditis (PDF, 103KB).
Due to the increased risk of endocarditis in our group of patients, our heart valve surgeons usually recommend the use of prophylactic (preventative) antibiotics before any invasive dental treatment. This would include extractions, scaling, endodontic treatment with local anaesthesia and restorations below the gingival margin.
It is important that patients discuss this advice with their dentist and GP before their dental treatment. If you have any questions about endocarditis or the use of antibiotics as preventative treatment, please contact the clinical nurse specialists or Professor Pepper’s office directly.
Heart valve clinic appointment
Appointments are usually made a year in advance. Therefore, it is understandable that some patients may need to reschedule their heart valve clinic appointment. You can do this by phoning the appointments telephone number on 020 7351 8011.
If you are booked for other appointments on the same day, such as for an echo or pacing appointment, it is important that you also notify those departments.
It is important that you also inform the echo department if you have rescheduled your heart valve clinic appointment. To make sure that your echo can also be rescheduled to coincide with your new appointment, please contact the echo department on 020 7351 8209.
If you have a pacing appointment, please also inform the pacing department on 020 7351 8647 to see if they can reschedule your appointment for the same day as your heart valve clinic.