Structural Heart Defects Structural Heart Defects Overview

Structural heart defects
overview
A NICE pathway brings together all NICE guidance, quality
standards and materials to support implementation on a specific
topic area. The pathways are interactive and designed to be used
online. This pdf version gives you a single pathway diagram and
uses numbering to link the boxes in the diagram to the associated
recommendations.
To view the online version of this pathway visit:
http://pathways.nice.org.uk/pathways/structural-heart-defects
Pathway last updated: 08 July 2015. To see details of any updates to this pathway since its launch,
visit: About this Pathway. For information on the NICE guidance used to create this path, see:
Sources.
Copyright NICE 2015. All rights reserved
NICEPathways
Pathways
Structural heart defects overview
Structural heart defects pathway

Copyright NICE 2015.
NICE Pathways
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NICE Pathways
Structural heart defects
No additional information
Pulmonary artery, valve and vein defects
NICE has published interventional procedures guidance on the following procedures with
normal arrangements for clinical governance, consent and audit:
percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction
endovascular closure of patent ductus arteriosus
radiofrequency valvotomy for pulmonary atresia
balloon dilatation of systemic to pulmonary arterial shunts in children
balloon dilatation with or without stenting for pulmonary artery or non-valvar right ventricular
outflow tract obstruction in children
balloon dilatation of pulmonary valve stenosis.
special arrangements for clinical governance, consent and audit or research:
telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with
congenital heart defects
percutaneous fetal balloon valvuloplasty for pulmonary atresia with intact ventricular septum
balloon angioplasty of pulmonary vein stenosis in infants.
Defects of the aorta and aortic valve
Self-monitoring coagulation status using point-of-care coagulometers where vitamin K

anticoagulants are prescribed for patients who have had aortic valve replacement
These recommendations are from atrial fibrillation and heart valve disease: self-monitoring
coagulation status using point-of-care coagulometers (the CoaguChek XS system and the
INRatio2 PT/INR monitor) (NICE diagnostics guidance 14).
The CoaguChek XS system is recommended for self-monitoring coagulation status in adults
and children on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve
disease if:

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NICE Pathways
the person prefers this form of testing and

the person or their carer is both physically and cognitively able to self-monitor effectively.
The InRatio2 PT/INR monitor is recommended for self-monitoring coagulation status in adults
and children on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve
disease if:
the person prefers this form of testing and
the person or their carer is both physically and cognitively able to self-monitor effectively.
Although there is greater uncertainty of clinical benefit for the InRatio2 PT/INR monitor than for
the CoaguChek XS system, the evidence indicates that the precision and accuracy of both
monitors are comparable to laboratory-based INR testing.
Patients and carers should be trained in the effective use of the CoaguChek XS system or the
INRatio2 PT/INR monitor and clinicians involved in their care should regularly review their ability
to self-monitor.
Equipment for self-monitoring should be regularly checked using reliable quality control
procedures, and by testing patients' equipment against a healthcare professional's
coagulometer which is checked in line with an external quality assurance scheme. Ensure
accurate patient records are kept and shared appropriately.
For people who may have difficulty with or who are unable to self-monitor, such as children or
people with disabilities, their carers should be considered to help with self-monitoring.
Interventional procedures
transcatheter valve-in-valve implantation for aortic bioprosthetic valve dysfunction
endovascular closure of patent ductus arteriosus
endovascular atrial septostomy
balloon valvuloplasty for aortic valve stenosis in adults and children
balloon angioplasty with or without stenting for coarctation or recoarctation of aorta in adults
and children.

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NICE Pathways
NICE has published interventional procedures guidance on transcatheter aortic valve

implantation for aortic stenosis with normal or special arrangements (see guidance for
details).
external aortic root support in Marfan syndrome
percutaneous fetal balloon valvuloplasty for aortic stenosis.
NICE has published interventional procedures guidance on sutureless aortic valve replacement
for aortic stenosis with special arrangements or only in the context of research (see guidance
for details).
Quality standards
The following quality statement is relevant to this part of the pathway.
6.
Self-monitoring of anticoagulation: developmental
Resources
The following implementation tools are relevant to this part of the pathway.
External aortic root support in Marfan syndrome: clinical audit tool
Atrial fibrillation and heart valve disease: costing statement
Septal defects
percutaneous closure of patent foramen ovale to prevent recurrent cerebral embolic events
transcatheter endovascular closure of perimembranous ventricular septal defect
endovascular closure of atrial septal defect.

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NICE Pathways
percutaneous closure of patent foramen ovale for the secondary prevention of recurrent
paradoxical embolism in divers
percutaneous closure of patent foramen ovale for recurrent migraine.
Mitral valve defects
thoracoscopically assisted mitral valve surgery
non-surgical reduction of the myocardial septum.
NICE has published interventional procedures guidance on percutaneous mitral valve
annuloplasty, which should only be used in the context of research.
NICE has published interventional procedures guidance on percutaneous mitral valve leaflet
repair for mitral regurgitation, which should only be used with special arrangements or in the
context of research (see guidance for details).
Hypoplastic left heart syndrome
NICE has published interventional procedures guidance on hybrid procedure for interim
management of hypoplastic left heart syndrome in neonates with special arrangements for
clinical governance, consent and audit or research.
NICE pathway on prophylaxis against infective endocarditis
See prophylaxis-against-infective-endocarditis
NICE pathway on patient experience in adult NHS services
See patient-experience-in-adult-nhs-services

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NICE Pathways
Sources
Telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with
congenital heart defects (2014) NICE interventional procedure guidance 505
Transcatheter valve-in-valve implantation for aortic bioprosthetic valve dysfunction (2014) NICE
interventional procedure guidance 504
Percutaneous closure of patent foramen ovale to prevent recurrent cerebral embolic events
(2013) NICE interventional procedure guidance 472
Sutureless aortic valve replacement for aortic stenosis (2013) NICE interventional procedure
guidance 456
Percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction (2013)
NICE interventional procedure guidance 436
Transcatheter aortic valve implantation for aortic stenosis (2012) NICE interventional procedure
guidance 421
External aortic root support in Marfan syndrome (2011) NICE interventional procedure guidance
394
Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent
paradoxical embolism in divers (2010) NICE interventional procedure guidance 371
Percutaneous closure of patent foramen ovale for recurrent migraine (2010) NICE interventional
procedure guidance 370
Percutaneous mitral valve annuloplasty (2010) NICE interventional procedure guidance 352
Transcatheter endovascular closure of perimembranous ventricular septal defect (2010) NICE
interventional procedure guidance 336
Percutaneous mitral valve leaflet repair for mitral regurgitation (2009) NICE interventional
Hybrid procedure for interim management of hypoplastic left heart syndrome in neonates (2007)
NICE interventional procedure guidance 246
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NICE Pathways
Thoracoscopically assisted mitral valve surgery (2007) NICE interventional procedure guidance
245
Percutaneous fetal balloon valvuloplasty for pulmonary atresia with intact ventricular septum
(2006) NICE interventional procedure guidance 176
Percutaneous fetal balloon valvuloplasty for aortic stenosis (2006) NICE interventional
Endovascular closure of patent ductus arteriosus (2004) NICE interventional procedure
guidance 97
Endovascular closure of atrial septal defect (2004) NICE interventional procedure guidance 96
Radiofrequency valvotomy for pulmonary atresia (2004) NICE interventional procedure
guidance 95
Endovascular atrial septostomy (2004) NICE interventional procedure guidance 86
Balloon valvuloplasty for aortic valve stenosis in adults and children (2004) NICE interventional
Balloon dilatation of systemic to pulmonary arterial shunts in children (2004) NICE interventional
Balloon dilatation with or without stenting for pulmonary artery or non-valvar right ventricular
outflow tract obstruction in children (2004) NICE interventional procedure guidance 76
Balloon angioplasty of pulmonary vein stenosis in infants (2004) NICE interventional procedure
guidance 75
Balloon angioplasty with or without stenting for coarctation or recoarctation of aorta in adults
and children (2004) NICE interventional procedure guidance 74
Balloon dilatation of pulmonary valve stenosis (2004) NICE interventional procedure guidance
67
Non-surgical reduction of the myocardial septum (2004) NICE interventional procedure
guidance 40
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NICE Pathways
Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care
coagulometers (the CoaguChek XS system and the INRatio2 PT/INR monitor) (2014) NICE
diagnostics guidance 14
Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.
Copyright
Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.
Contact NICE
National Institute for Health and Care Excellence
Level 1A, City Tower
Piccadilly Plaza
Manchester
M1 4BT
www.nice.org.uk
nice@nice.org.uk
0845 003 7781

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Structural heart defects overview