You have been referred to the structural heart disease service at Royal Brompton and Harefield hospitals by your cardiologist. You will have a number of tests while you are at the hospital so your condition can be diagnosed. 

What is structural heart disease?

Structural heart disease is an umbrella term for a number of defects which affect the valves and chambers of the heart and the aorta. Some defects are present at birth (congenital) while others form later in life. 

These defects can include:

• a hole between the atria (atrial septal defect)
• a hole between the ventricles (ventricular septal defect)
• an abnormal connection between an artery and a vein (fistula)
• damage to the lining of the aorta causing a bulge (pseudoaneurysm).

The symptoms of structural heart disease will vary depending on the patient and the type of defect they have. Some patients may have no symptoms at all, however symptoms can appear suddenly and become quickly more serious. 

Some common symptoms include:

• fainting (syncope)
• heart palpitations
• shortness of breath
• stroke
• high blood pressure
• swelling of the feet, ankles, hands or abdomen.

What will happen when I come to the hospital?

You may have an initial appointment at an outpatients clinic first. You will then be admitted to Royal Brompton or Harefield hospital for a few days so that all necessary tests can be carried out to find out if you have some form of structural heart disease. You will have one or all of the following tests:

• a standard echocardiogram (transthoracic echo) 
• a transesophageal echocardiogram (TOE) under local or general anaesthetic
• a lung function test.
• an ECG
• a magnetic resonance angiogram (MRA) scan
• A computerised tomography (CT) scan
• blood tests.

Once you have had these tests, a consultant will discuss the results with you and recommend treatment options.

Treatment

The treatments offered will vary depending on the type and severity of the condition. Some patients may need no immediate treatment but will be monitored by the hospital and will be brought in for a magnetic resonance imaging (MRI) scan once a year, to check that the condition hasn’t deteriorated. 

In some cases, drugs may be the best treatment option. If this is the case, your consultant will discuss this with you and will liaise with your cardiologist to make sure that you are taking the correct medication.

In many cases, some kind of intervention will be necessary to treat the condition. This could be done through cardiac catheterisation, which means a small tube will be passed through a blood vessel in your groin or arm which is then navigated to the heart. This is a minimally invasive procedure and will require only a short stay in hospital.

If you need a valve in your heart replaced you may have a transcatheter valve (TCV) procedure, which is a type of cardiac catheterisation which uses a balloon on the end of the catheter to put the replacement valve to the right place. 

Another treatment option is cardiac surgery to correct the problem. If you do need surgery, you will need to stay in hospital for longer so you can recover before you go home. It will take about three months to fully recover from your surgery.