Maria Aroni, Director of the 4th Clinic of Cardiac Surgery/ Valvular Heart Disease
Nektarios Pilatis, Director of the 5th Clinic of Cardiology / Valvular Heart Disease
Stavros Kounas, Director of the 5th Clinic of Cardiology / Valvular Heart Disease
Valvular heart diseases are a common health problem for a significant part of the Greek population. The most common cases involve a congenitally defective valve (such as a bicuspid aortic valve or a myxomatous degeneration of the mitral valve). In the past, the lack of medical care in children and adolescents often led to rheumatic heart disease. Now, cases of rheumatic fever are becoming more and more rare as early diagnosis and treatment of rheumatic fever prevents diseases of this nature. On the contrary, the improvement of public health and the increase of the average life expectancy have led to an age where the progressive wear and degeneration of the valves is the main cause of valve diseases. In any event, each patient with valvular heart disease is unique, and his medical treatment requires knowledge, specialization and experience.
The specialized team for the treatment of valvular heart diseases, which operates at the Henry Dunant Hospital Center, the largest private hospital in the Balkans in the center of Athens, offers targeted, personalized treatment. This team of experienced specialists in the diagnosis and treatment of valvular heart disease patients aims at making the Henry Dunant Hospital Center a center of excellence in valvular heart diseases in accordance with the standards of the respective specialized centers of Europe and the U.S.A.
DIAGNOSTIC /IMAGING CARDIOLOGY Patients who come to the Center first undergo a series of diagnostic tests for a detailed diagnosis of their disease. Cardiologists specializing in cardiovascular imaging, such as Stavros Kounas and his colleagues, perform transthoracic and transesophageal echocardiograms (echocardiograms) in order to determine the affected valve, to measure the strength of the myocardium and to assess the general condition of the patient taking into account his medical history. Stress tests are often used to measure the patient’s endurance in daily activities and to reveal any symptoms. In some cases, additional information may be required through CT or MRI scan of the heart, aiming at a complete and clear study of the valve disease. The results are analyzed by a team of cardiologists and heart surgeons to develop an individualized treatment plan for each case. In mild or moderate valvular disease, for which no intervention is required, we recommend systematic follow up by the cardiologists of the team at regular intervals. The patient is informed about the nature and peculiarities of his heart disease and a proposed treatment plan is discussed with him.
INTERVENTIONAL CARDIOLOGY Interventional cardiologists, such as Nektarios Pilatis and his associates, with experience in catheter (non-surgical) interventions, perform diagnostic coronary angiograms, percutaneous coronary interventions (PCI) or transcatheter heart valve interventions such as Transcatheter Aortic Valve Implantation -TAVI. TAVI intervention is very demanding and is performed in patients at high surgical risk, i.e. mainly in elderly patients with concomitant serious medical problems. It is performed through the femoral artery, ie through the artery of the leg, and a new valve is implanted into the old aortic valve, through a catheter. It requires detailed planning from the beginning to the end of the operation.
Our team has the knowledge and experience to analyze in detail all the tests that need to be done before the operation, such as CT angiography, coronary angiography and echocardiography, to plan each step, from the ultrasound- and radio-guided localisation of the puncture point of the artery, to the implanting of the valve in such a way that it is properly oriented as to the old valve and implanted at the correct height, so as to avoid the need for pacemaker implantation and paravalvular regurgitation as much as possible, and to facilitate the access to the coronary vessels for a possible future angioplasty intervention. In other words, we apply all modern techniques for a successful operation, using the appropriate valve for each patient based on the particularities of each patient and his own valve.
CARDIAC SURGERY The specialized cardiac surgery team led by Maria Aroni, with a large range of valvuloplasty operations in Greece, undertakes the surgical repair of valve diseases in properly selected patients. Mitral vavluloplasty (or mitral valve repair) is desirable for all patients, especially for young patients to avoid lifelong anticoagulation with Sintrom, which requires mechanical valve replacement and is associated with a risk of stroke and hemorrhage. Mitral valve repair is indicated in case of severe valvular regurgitation before heart function is reduced, especially in young persons with many decades of expected survival. It is also especially important for young women to be able to conceive without taking anticoagulants which can harm the fetus.
Aortic valvuloplasty and tricuspid valve repair in case of regurgitation are equally important. An intervention is recommended based on the recently published guidelines in Europe and the U.S.A.. The surgical results recorded are excellent, as documented in the last decade in the United States. The fact remains, however, that valve surgeries are more complex than simple Bypass surgeries, so the need for them to be performed in a specialized Excellence Center is even more urgent. Diligent attention at all stages of the operation is a prerequisite for the most successful outcome of these operations. There must be detailed preoperative screening, intraoperative assessment of the cardiac function, and immediate extubation (awakening) of the patient in the operating room to avoid respiratory infections, which are especially dangerous in the elderly, as well as prompt mobilization of the patient within 24 hours after surgery to avoid respiratory infections which may be very serious.
The specialized team set up by the 4th Clinic of Cardiac Surgery and the 5th Clinic of Cardiology/ Valvular Heart Disease operating at the Henry Dunant Hospital Center offers the necessary comprehensive diagnosis, monitoring and treatment of valvular heart diseases. The excellent infrastructure, the advanced technological equipment and the experience of the medical staff promise a modern, effective, and human-centered approach of each patient. Let it be noted that the Henry Dunant Hospital Center belongs to the selected group of 600 hospitals in the world that have won the Gold Seal of Approval of the Joint Commission International, which reflects the Hospital’s commitment to provide safe, quality and effective patient care.