Training in valve disease

MD in Medicine, Romania.  Over 25 years work experience in Echocardiography with extensive experience in valve disease assessment and management. Led and supported scientist-led valve clinics for over 10 years.

Specialist valve activity

I was an active member of the multidisciplinary clinical and surgical decision processes at the Heart Hospital (UCLH) 2002-2014. I set -up and led the valve clinic services, including valve stress echo, at Harefield Hospital 2014- 2017.   I have run a scientist-led valve clinic at GSTT since Dec 2018.  The clinic sees 20 new and 30 follow-up patients each week.  The unit performs 250 TAVI, 5 transcatheter periprosthetic leak closures, 10 balloon valvotomies and 40 transcatheter mitral valve procedures each year.  There are 100 valve stress echocardiograms and 400 valve CT each year. 

Patients seen
Moderate and severe native valve disease, post-endocarditis and post intervention, Mitral prolapse and bicuspid aortic valves

Patients not seen
Mild valve disease 

Process 

  • Scientist-led sessions of patients with severe/ moderate-severe disease (2 sessions/ week) are run in parallel to valve consultant clinics.
  • Scientist-led sessions of patients with mild/moderate disease run independently
  • Nurse-led sessions 
  • One independent session for routine F/U, and a 2nd session in parallel to scientist-led and consultant clinics
  • Murmur clinic that is integrated with the valve clinic (1-2 sessions/ week). New GP referrals for patients with asymptomatic murmurs are reviewed (clinical history, clinical assessment, and echo) and triaged to one of the valve clinics.
  • Highly specialist physiologist supports the consultants valve clinics by performing advanced echo scans linked with clinics
  • Valve stress echo activity is currently integrated within the departmental stress echo service. We plan to start a dedicated valve stress echo clinic (1-2 sessions/week) in May 2022.
  • Phone consultations clinics led by clinical scientists, nurses, and consultants

Escalation protocol: 

  • Emergency direct referral to a valve consultant (same day) or review in the valve team weekly review session
  • Weekly or direct referral to the joint clinical-surgical weekly MDT for critical and symptomatic patients
  • Same day direct access to ECG, Echo, ETT, PPM checks, BNP, and routine bloods
  • Close collaborative links for urgent referral to CMR, CT, stress echo

Training
Weekly valves and IE MDT (attend and chair on a rota), local, national, and international courses and meetings. A few examples: BSE Echo- Oct 2021; Tricuspid Valve Interventions EBAC webinar – Sep 2021; CSI CATHLAB LIVE, EBAC webinars – Jul 2021; ASE 2021 Scientific Sessions: A Virtual Experience – June 2021; Intervention on the mitral valve: When and how; RSM – Apr 2021; LAA Occlusion Summit, EBAC webinars, Mar 2021; Principles of stress echo Physiologist-led stress echo, Bracco – Mar 2021; Multidisciplinary Approach to the Contemporary Management of Heart Failure, The Cleveland Clinic Foundation Center for Continuing Education- Feb 2021; Best of Imaging 2020, EACVI – Dec 2020; PCR valves e- Course, EBAC – Nov 2020; BHVS Annual meeting, Focus on mitral valve prolapse and tricuspid valve disease – Nov 2020; BSE Echo- Oct 2020

CPD
40-50 CPD/year; Examples: Regular attendance to BSE, EACVI, BHVS, Eurovalve congress, London PCR, multiple MV, TV interventional webinars

Research 

  • MV disjunction trial, Dr Julia Grapsa, GSTT
  • Comparison of right heart remodelling in tricuspid interventions (triclip) versus tricuspid repair in haemodynamically significant tricuspid regurgitation, Dr Julia Grapsa, GSTT
  • EVAREST trial, Prof Leeson, Oxford
  • PROTEUS trial, PI for GSTT, NHSx funding, Ultromics 
  • UNITY AI research programme, Prof Darrell Francis, Imperial college 
  • Pulmonary artery aneurysm in pulmonary valve stenosis, Dr Alexandra Frigiola, GSTT
  • TAVI UK, national trial, multicentre randomised controlled trial, The Heart Hospital and Harefield Hospitals
  • Sapient 3 TAVI trial, Dr M Mullen, The Heart Hospital, UCLH
  • TAVI Direct flow valve, international study, Yale Echo Lab, Dr M Mullen, The Heart Hospital, UCLH

Publications
Grapsa J, Nikolou E, Bilkhu R, Kafil TS, Demetrescu C, et al. Multimodality imaging in transcatheter mitral interventions; Front. Cardiovasc. Med., 23 February 2021

Chambers JB, Parkin D, Rimington H, Subbiah S, Campbell B, Demetrescu C, Hayes A, Rajani R, Specialist valve clinic in a cardiac centre: 10-year experience; Open Heart 2020;7: e001262.

Demir FA, Konstantinos C. Theodoropoulos MD, Can Zhou, Demetrescu C, Monaghan MJ. When right heart valves are open 24/7; Turk Kardiyol Dern Ars. 2019 Mar;47(2):156.

Valve Societies
British Heart Valve Society, ESC valve council

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