Two years later, Kirsten attends her first appointment at the Scottish Adult Congenital Cardiac Service for a full assessment and review. The doctor reviews Kirsten’s ECG, exercise test (CPET), echo and MRI scan. Her exercise test shows a decrease in her exercise capacity since she was last reviewed and her echo demonstrates that her right ventricle had increased in size, due to the pulmonary regurgitation, and is now severely dilated, with some mild right ventricular dysfunction. Kirsten reports that she has been feeling more breathless during the last few months and is occasionally troubled with palpitations.
The doctor explains to Kirsten that she might need surgery on her pulmonary valve but that, in the first instance, her case will be discussed at a multidisciplinary team meeting.
Pulse point
Symptoms that are important for patients to look out for include palpitations, arrhythmias, chest pain and increasing shortness of breath. In particular, they should report any change from how they have previously been.
Indications for surgery: Guidelines vary depending on the cardiac lesion. Whether a patient requires surgery is based on symptoms, deterioration in their exercise capacity measured using CPET and any deterioration noted on imaging, such as echo or MRI. (See ESC Clinical Practice Guidelines.)
