Scarborough Health Network (SHN) has launched a new Structural Heart Disease Clinic, providing heart valve disease patients in the eastern Greater Toronto Area (GTA) and surrounding communities with access to highly-specialized cardiac care closer to home. 

Located at SHN’s regional cardiac care centre at Centenary Hospital, the Structural Heart Disease Clinic supports patients suffering from aortic stenosis – one of the most common and serious heart valve disease problems – throughout their journey of care, including:

  • Consultation and specialized diagnostic testing;
  • Valve repair treatment, known as a trans-catheter aortic valve implantation (TAVI), which is performed by an SHN cardiologist at a cardiac facility at Sunnybrook Health Sciences Centre;
  • Post-procedure care and recovery (at Centenary); and 
  • Ongoing follow-up care.

Leading the clinic is a multidisciplinary team with extensive expertise in interventions, imaging, and clinical cardiology.  This includes Dr. Ram Vijayaraghavan ( Medical Director of SHN’s Cardiac Catheterization Lab), CT imaging cardiologists Dr. Paul Galiwango, Dr. Nisha D’Mello, Dr Natalie Ho, Diagnostic radiologists, Dr. James Woo, Dr. Nancy Jiang and nurse practitioner Janet Traverse. 

Dr. Nancy Jiang, Dr. Paul Galiwango and Dr. James Woo with the TAVI CT scanner

Aortic stenosis is the narrowing of the heart valve that opens and closes to let blood pump out of the lower left heart chamber and into the aorta, which is the main artery that carries blood to rest of the body. While aortic stenosis may be caused by birth defect or infection, it generally affects older people due to ageing and the build-up of calcium deposits over time. As the valve becomes narrower and unable to work properly, there is reduced or blocked blood flow from the heart to the aorta and throughout the body. This can bring about symptoms such as chest pain, rapid heartbeat, trouble breathing, feeling dizzy, swollen ankles or feet, difficulty sleeping or doing normal physical activities, and could possibly lead to heart failure.

Previously, patients in Scarborough and the GTA East would have to go out of region for care. Now, through SHN’s Structural Heart Disease Clinic, they have access to several diagnostic investigations to assess the state of their aortic valve and root, aortic arch, abdominal aorta, iliac and femoral vessels, and determine options for treatment. Specialized testing is done to view inside the body and map out the aorta and blood vessels – including a computerized tomography (CT) scan of the heart and possible repeat aortograms (a kind of catheterization procedure).

In November, the clinic team achieved an incredible milestone, performing SHN’s first TAVI CT scan, which helps cardiologists with determining suitability and planning for a TAVI valve replacement procedure. This diagnostic imaging test requires an advanced CT machine with sophisticated software in order to get images of high enough quality to obtain accurate measurements and mapping.

Cardiologist Dr. Paul Galiwango praised the team and new clinic, which made this diagnostic procedure possible more locally for patients.

“At SHN, we’re lucky to have a state-of-the-art CT scanner that can do cardiac imaging, and have invested in the right software and technology to be able to perform TAVI scans,” explained Dr. Galiwango. 

“Historically, this type of scanning has not been available in our region. But now with our structural heart program, we are doing the workups here at Centenary, including echocardiograms and the TAVI CT scans.”

For Dr. Galiwango, CT scans are a critical part of this treatment and care journey – without it, the TAVI procedure itself would not be possible.

“It helps us to determine if the patient is a candidate for TAVI, and also plan the procedure in terms of the type and size of valve implant, and what the safest access route will be to get to the heart.”

Dr. Paul Galiwango and Dr. Ram Vijayaraghavan

Then through a partnership between SHN and Sunnybrook Health Sciences Centre, patients under consideration for TAVI will have their case reviewed by a joint team. Appropriate patients will be booked for their TAVI intervention procedure, which happens at Sunnybrook a few weeks after their CT scan at Centenary.

The TAVI procedure is performed by Medical Director of SHN’s Cardiac Catheterization Lab Dr. Ram Vijayaraghavan, who is an interventional cardiologist and has trained with his counterpart physicians at Sunnybrook Hospital. 

“Our incredible partnership with Sunnybrook on training and performing TAVI procedures speaks to SHN’s commitment to enhancing our expertise and better meeting the needs of patients in Scarborough and the GTA East. Together, we’re giving patients their lives back,” said Dr. Ram Vijayaraghavan.

“There was a time when patients living with valve disorders faced two difficult options: deteriorating heart health or high-risk surgery. But that’s changing. TAVI is now the most common way to treat aortic stenosis. It’s a minimally-invasive procedure as opposed to the alternative open heart surgery, and the recovery for TAVI is much shorter. People are going home the next day and feeling better within a couple of days.”

To date, the Structural Heart Disease Clinic has cared for over 80 patients – accelerating their assessment, diagnosis, and treatment, and supporting their care journey closer to home. Looking ahead, SHN will continue to develop, hone, and expand both local expertise in advanced cardiac imaging and our cardiologists who have the skillset to do TAVIs at partner hospitals, like Sunnybrook – with an aim of ultimately being able to do these procedures on-site at our regional cardiac centre. 

To learn more about SHN’s Structural Heart Disease Clinic and referring aortic valve disease patients (including via an Ocean e-referral), please click here.