Heart valve disease: ‘We want to prevent it.’
Heart valve diseases are becoming easier to treat, but there is still much to discover about the cause and progression of these diseases. That is the focus of Professor Nina Ajmone Marsan and her team. The ambition? Personalised care.
What is the core message of your inaugural lecture, and why did you choose this?
‘We’ve made great progress in treating heart valve diseases, and can now repair or replace valves with less invasive procedures. But we still don’t fully understand why these diseases develop or why their progression can differ so much between patients. This requires collaboration among cardiologists, geneticists, biologists, engineers and other specialists.
A better understanding of the underlying mechanisms would enable us to recognise disease earlier, determine more accurately who would benefit from an intervention and hopefully in the future also develop medication that slows the disease’s progression.’
What main research lines do you and your team focus on?
‘We study heart valve diseases from different perspectives. Using advanced imaging, we aim to detect valve disease earlier, assess its severity more accurately, and identify the right treatment for the right patient. We don’t just want to intervene when the disease becomes severe. We want to understand how to slow its progression or even prevent it.
‘We’re also investigating what causes valve diseases: for example, genetic predisposition, inflammation, calcification or changes in the heart muscle. We also study patients whose disease progression differs from what we would expect. These exceptions can teach us a great deal. Our goal is to better predict individual risk and offer more personalised treatment.’
What role do teaching and patient care play in your vision of this field?
‘For me, research, teaching and patient care are closely connected. In clinical care, you see which questions really matter to patients. In research, you try to find answers to those questions. And through teaching, you pass this knowledge on to the next generation of doctors and researchers.
‘Valve disease requires collaboration between different specialists. That’s why I think it’s important to teach young colleagues not only knowledge and technical skills, but also how to make good decisions, how to guide patients carefully and how decide together on the best treatment plan.’
‘Juist uitzonderingen kunnen ons veel leren. Ons doel is om de risico’s van de individuele patiënt beter te voorspellen en behandelingen persoonlijker te maken.’
What stands out most from the past few years?
‘How quickly the field has changed. When I started out, many patients with severe valve disease were too frail for surgery. Now, we can use a catheter to replace or repair a heart valve in many of these patients, often through a small incision in the groin. It’s incredible. Cardiovascular imaging is becoming increasingly important too, both in diagnosis and in planning and supporting treatment. What I’ve also realised is that technical progress alone is not enough. We also need a much better understanding of the disease mechanisms themselves.’
Looking ahead, where do you hope the field will be in 10 to 15 years?
‘I hope that by then we’ll not only be better at treating valve disease, but also at preventing or slowing its progression. I also hope that we’ll have a much clearer understanding of why the disease develops in each patient and how quickly it’s likely to progress. My ambition is to move from general treatments to truly personalised care.
‘I also hope that all specialists involved will continue to work together to advance the field of heart valve disease, and that we pass on this culture of collaboration, curiosity and careful decision-making to the next generation.’
Nina Ajmone Marsan’s inaugural lecture ‘Klepziekten van het hart: heden, vooruitgang en toekomst’ (‘Heart valves:present, progress and future’) will take place on 3 July (14:00-15:00 hrs.) and will be streamed live by Leiden University.