World surgical first sees 66-year-old blocked heart valve cleared with a live wire up his leg 

Leaky heart valves can leave patients struggling for breath and lead to heart failure. Repair usually involves open heart surgery but Michael Hammond, 66, an architectural website editor from Hove in Sussex, underwent a world first procedure to treat it, as he tells CAROL DAVIS.

THE PATIENT

After a busy August bank holiday laying a new deck five years ago, I started to feel a strange fluttering in my heart, as though gerbils were running around my chest. It made me anxious. Until then, I’d always been so well. 

The next day I saw my GP, who sent me straight to hospital where they diagnosed atrial fibrillation — an abnormal heart rhythm. Doctors delivered an electric shock to jolt my heart back into a normal rhythm.

Two weeks later I had an echocardiogram — an ultrasound scan of the heart — which revealed a leaking mitral valve. 

This meant my heart wasn’t working efficiently as the cords attaching the valve to the heart wall had snapped and it was allowing oxygenated blood to slip backwards.

Leaky heart valves can leave patients struggling for breath and lead to heart failure [file]

I was stunned. I was still cycling everywhere and wasn’t experiencing breathlessness.

Doctors said I needed open heart surgery to repair the valve. I spent ten days in hospital and came out on Christmas Eve 2013. After that I had echocardiograms every three months to check my valve function.

Then, in summer 2015, I was devastated to learn that more cords had snapped. I couldn’t face more open heart surgery but the doctors agreed I could put off the procedure as my condition was stable. They’d just continue to monitor me.

Then my mother was also diagnosed with mitral valve failure, but at 86 she wasn’t fit enough for open heart surgery. Instead she had the more unusual option of keyhole surgery to fit a new valve and was in hospital just a few days.

I saw her cardiologist, Professor David Hildick-Smith, in September 2017 and asked if I could have the same procedure. 

He said he could fit a new valve through the veins, pushing back the flaps of the natural valve to fit a synthetic one inside it.

I had the procedure at the Royal Sussex County Hospital in Brighton in March. It was a much shorter operation than before and I was in hospital for just three days.

But while I’d kept very fit before the surgery, I struggled for breath afterwards. I couldn’t cycle and my legs felt like lead when I climbed the stairs.

Tests showed that one of the flaps of the new artificial valve was partly blocking another valve close by, leading to the aorta, the body’s main artery. It seemed the only solution was the one I’d tried to avoid: open heart surgery to insert a mechanical valve.

But then Professor Hildick-Smith told me about a new technique using a wire fed into the heart through the veins from the top of the thigh. An electric current is passed through the wire, which acts as a knife cutting through the faulty flap to split it in two so it doesn’t block the blood flow.

A trial is running in the U.S. using this technique prior to a new valve being implanted in order to get the flap of the old one out of the way and avoid a potential blockage, but it had never been done after the valve was in place. I was the first in the world to have this procedure.

Being part of pioneering medicine was exciting. I had the two-hour procedure in July. As soon as I woke, I could breathe more easily. I was in hospital for two days and back on my bike in a week. It was great to feel well again.

THE SPECIALIST

Professor David Hildick-Smith is consultant cardiologist at Brighton and Sussex University Hospitals NHS Trust.

Some 5,000 patients in Britain each year have mitral valve leaking severe enough to be operated on; another 10,000 have less extreme leaking, causing breathlessness and swelling.

It can be genetic and happens when the valve tissue becomes floppy, or the muscle at the base of the valve is flabby so the leaflets — the two flaps of the valve that open to let blood through and close to stop it slipping back — no longer close properly. This can happen after a heart attack, due to high blood pressure, or when the heart is enlarged as a result of something like a virus.

Patients become breathless because oxygenated blood is no longer being pumped properly, and the condition can lead to heart failure. Many do not survive five years after diagnosis.

Leaky heart valves can leave patients struggling for breath and lead to heart failure

We can offer medication but as the condition worsens, patients may need surgery. This is usually open heart surgery to repair the valve, involving a recovery of up to six weeks.

A minimally invasive option via the veins has a recovery time of just a few days, but in the UK only around 100 or so valves each year are replaced this way. It is a difficult procedure and is only offered to patients too unwell for open heart surgery.

It involves making an incision in the main vein in the groin, threading a catheter into it, puncturing the dividing wall of the heart to reach the upper left chamber, the atrium.

The mitral valve sits between this and the lower chamber, the ventricle, which pumps oxygenated blood to the body. The replacement valve, measuring 26mm by 18mm, goes up the catheter and is expanded into place using a balloon.

But as it means pushing aside the flaps of the patient’s diseased valve, these flaps can, in some cases, end up blocking the exit of blood from the left ventricle to the aorta.

The Lampoon technique cuts through such a blockage using an electrified wire. A study is now running in the U.S, splitting this flap before a new valve is implanted so it cannot cause a life-threatening blockage, but Michael’s case was the first time we split one after a new valve was implanted.

With ultrasound guidance. I slide a catheter into the vein in the groin, all the way to the mitral valve. I then feed the wire up through it into the heart, then down back to the other side of the groin until we have a complete wire track from one thigh to the other.

Catheters insulate the wire, leaving just the section across the mitral flap exposed. Using a diathermy probe, I electrify the wire, pulling it rather like a cheese wire across the flap causing the blockage, slicing it almost completely in two. As it cuts, the electrified wire heats and seals the wound and blood flow becomes normal.

We turn many people down for valve replacement through the veins because of the blockage risk, but if we knew we could remove an obstruction afterwards, we could offer it to maybe 50 per cent of patients.

– The procedure costs the NHS around £4,000.