Cardiac Valve

Patient Initiated Follow up, also known as PIFU, allows you to contact the Cardiac Valve service when you feel you need to get help with your condition or if you have a flare up of symptoms.

This means rather than having prearranged or regularly scheduled appointments, you can access help when you need it the most.

When you are put on to a PIFU pathway, you will be advised your practitioner that this pathway is suitable for you. Together, you will discuss how to access the service when you need it. You will be provided with information of signs and symptoms for your valve disease and when you should self-refer and contact the service.

You will have regular surveillance with echocardiograms. These images will be reviewed by a clinician, and a letter will then be sent to you with the results. You may be contacted to ensure that you have no symptoms or if you have any concerns.

If you require urgent medical attention, you should contact your GP, NHS 111 or attend A&E if you are really unwell. For medical problems that are not related to your cardiac valve disease, your GP remains your first point of contact.

Further information of signs and symptoms of individual valve disease are detailed below in this combined information leaflet.

The aortic valve is a structure in the heart that allows one way flow of blood out of the main pumping chamber of the heart (the left ventricle) into the main blood vessel leaving the heart (the aorta). When the heart muscle pumps, the aortic valve opens allowing blood to exit the heart. When the heart muscle relaxes, the valve closes preventing backflow of blood into the heart during this phase, functioning as a ‘one way’ heart valve.

In most people the aortic valve has 3 leaflets (tricuspid valve). About 1 in 50 people are born with an aortic valve with two leaflets (a bicuspid aortic valve.) This is due to abnormal development of the valve whilst growing in the womb and is known as a congenital abnormality. The condition is more common in men than women.

Most people with bicuspid aortic valve will not experience any symptoms and will be simply kept under surveillance.

Bicuspid aortic valves are more prone to early wear and tear (degeneration) than tri-leaflet valves. If the valve degenerates it can become narrowed (aortic stenosis) or leaky (aortic regurgitation). If the valve is leaky or narrowed, the doctor will hear an abnormal sound when they listen to your heart, known as a heart murmur.

Occasionally, people with bicuspid aortic valve will also have a narrowing (coarctation) or stretch (aneurysm) of the main blood vessel (aorta).

If your valve is not working properly (leaky or narrowed) then you may experience symptoms of breathlessness, chest pain, blackouts, dizziness or ankle swelling. You should report these to your Healthcare Professional.

Most people with bicuspid aortic valve will not need any treatment and will just be kept under regular surveillance.

In some people the valve will become narrowed or leaky. If this is the case, provided you have no symptoms, you will remain under surveillance but may be seen more frequently.

If the valve becomes severely narrowed or leaky, then you may be referred to a heart surgeon for a heart valve replacement.

If you have a stretch of the aorta (aneurysm), usually this will only require surveillance. Occasionally blood pressure tablets are also recommended. Rarely, the aorta becomes severely stretched and if this is the case then you will be referred to a heart surgeon for consideration of replacement of the aorta.

Aortic regurgitation is a condition where the one-way aortic valve doesn’t close tightly and therefore becomes leaky. Blood exits the heart when the heart muscle (left ventricle) pumps. When the heart relaxes, as the valve is leaky, blood is able to leak back into the heart.

The abnormal blood flow results in an abnormal sound when the heart is listened to with a stethoscope, known as a heart murmur. Aortic regurgitation is usually diagnosed following an echocardiogram.

Aortic regurgitation is a long term (chronic) condition. It can be graded into three categories; mild, moderate and severe.

Regardless of the severity of aortic regurgitation, if you have no symptoms then it is likely that the Heart Valve Team will keep you under review with a clinic visit and echocardiogram on a regular basis. Patients with aortic regurgitation are often followed up for many years without symptoms. Most patients with mild aortic regurgitation will not need follow up.

If the valve is severely leaky (severe aortic regurgitation) and you have symptoms then you may be referred for aortic valve replacement.

Due to the importance of symptoms in patients with aortic regurgitation, you must let your Healthcare Professional know if you develop symptoms whilst on the PIFU pathway.

• Increasing shortness of breath
• Severe or increasing ankle swelling
• Chest pain or tightness
• Rapid or irregular heartbeat (palpitations)
• Difficulty exercising (not being able to do as much for as long)

If you experience any of these symptoms you must contact the Cardiac Valve service by email.

Aortic stenosis is a condition where the aortic valve becomes thickened and is less able to open well. As a result, the blood flow across the valve is abnormal and means that a heart murmur can be heard when your heart is listened to by a stethoscope.

The most common cause of aortic stenosis is age-related wear and tear (degeneration) and as a result most people who have the condition are over 60. In people born with an abnormal ‘bicuspid’ valve, the valve can become thickened (stenosed) at a younger age, and people with a bicuspid valve can be affected at any stage in their lives.

Aortic stenosis is a long term (chronic) condition. It can be graded into three categories; mild, moderate and severe.

Regardless of the severity of aortic stenosis, if you have no symptoms then it is likely that the Heart Valve Team will keep you under review with a clinic visit and echocardiogram on a regular basis. Patients with aortic stenosis are often followed up for many years without symptoms.

If the valve is severely narrowed (severe aortic stenosis) and you have symptoms then you may be referred for aortic valve surgery, which can be performed as either open heart surgery or keyhole valve replacement.

Due to the importance of symptoms in patients with aortic stenosis, you must let your Healthcare Professional know if you develop symptoms whilst on the PIFU pathway.

• Increasing shortness of breath
• Severe or increasing ankle swelling
• Chest pain or tightness
• Blackouts/lightheadedness (especially on exertion)
• Rapid or irregular heartbeat (palpitations)
• Difficulty exercising (not being able to do as much for as long)

If you experience any of these symptoms you must contact the Cardiac Valve service by email. 

Mitral regurgitation is a condition where this one-way valve is not working correctly. Because the valve is unable to close tightly, a leak of blood occurs when the main pumping chamber of the heart (left ventricle) contracts, allowing blood to pass back across the valve back into the top heart chamber (left atrium).

Most people with mitral regurgitation will not require any treatment, just regular monitoring of their condition.

If your mitral valve is severely leaky and you develop symptoms, the heart becomes severely stretched or starts to pump less efficiently, you may be referred for heart valve surgery.

Due to the importance of symptoms in patients with mitral regurgitation, you must let your Healthcare Professional know if you develop symptoms whilst on the PIFU pathway.

• Increasing shortness of breath
• Severe or increasing ankle swelling
• Chest pain or tightness
• Rapid or irregular heartbeat (palpitations)
• Difficulty exercising (not being able to do as much for as long)
• Increasing tiredness

If you experience any of these symptoms you must contact the Cardiac Valve service by email.

Mitral valve stenosis is a condition where there is thickening of the mitral valve on the left side of the heart. This usually opens to let red oxygenated blood through the top chamber of the heart (the left atrium) into the bottom chamber of the heart (left ventricle). From there it is pumped around the body.

In mitral stenosis this valve becomes thickened (stenosed) and it is then more difficult for blood to pass between the top chamber (left atrium) and bottom chamber (left ventricle). This often leads to a build-up of pressure in the top chamber (left atrium) which backs up into the lungs and causes shortness of breath.

The top chamber (left atrium) often becomes very enlarged due to this pressure build-up. This commonly leads to an irregular heartbeat known as atrial fibrillation.

Most people with mitral stenosis will not require any treatment and will just require regular monitoring of their condition.

If your mitral valve is severely narrowed and you develop symptoms, you may be referred for intervention on your mitral valve.

Due to the importance of symptoms in patients with mitral regurgitation, you must let your Healthcare Professional know if you develop symptoms whilst on the PIFU pathway.

• Increasing shortness of breath
• Severe or increasing ankle swelling
• Rapid or irregular heartbeat (palpitations)

If you experience any of these symptoms you must contact the Cardiac Valve service by email.