Valvular pathology

Valvular Heart Disease in medico-legal claims.

Expert witness reports on delayed diagnosis of aortic stenosis, mitral regurgitation and valve replacement complications, addressing both breach and causation.

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  • Aortic stenosis negligence
  • Mitral regurgitation expert
  • Valve replacement delay
  • TAVI complications
what we cover

The condition and the legal questions it raises.

Valvular heart disease covers structural abnormalities of the aortic, mitral, tricuspid or pulmonary valves, often presenting with progressive symptoms of heart failure, syncope or sudden cardiac death. Timely diagnosis and intervention — whether surgical replacement or transcatheter techniques — can alter the natural history.

Most instructions arise where symptoms were misattributed, echocardiographic findings overlooked, or referral for valve intervention delayed. The decisions are tested against the current NICE and ESC guidance for valvular heart disease.

  • Breach questions address whether symptoms of dyspnoea, chest pain or syncope were adequately investigated with echocardiography, whether valve severity grading met thresholds for intervention, and whether cardiology referral was timely.
  • Causation questions turn on whether earlier intervention — surgical valve replacement or TAVI — would, on the balance of probabilities, have prevented the subsequent cardiac event, heart failure admission or sudden death.
  • Procedural complications — stroke, paravalvular leak or device embolisation following TAVI or surgical replacement — are assessed against the standard of care expected in high-volume centres.
  • Apportionment arises where pre-existing valve disease contributed to the outcome alongside the alleged breach, with material contribution analysis central to the report.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether symptoms of dyspnoea, angina or syncope were adequately investigated with transthoracic echocardiography in line with current guidance.
  • Whether valve severity grading — aortic valve area, mean gradient, regurgitant fraction — met the thresholds for intervention.
  • Whether referral for valve intervention — surgical replacement or TAVI — was made within a reasonable timeframe once severity thresholds were met.
  • Whether, on the balance of probabilities, earlier valve intervention would have prevented the cardiac event, heart failure admission or sudden death.
  • Whether procedural complications — stroke, paravalvular leak, device embolisation — fell below the standard expected in high-volume centres.
Out of scope

Not covered without separate instruction

  • Interventional technique during TAVI or balloon valvuloplasty, which sits with interventional cardiology instruction.
  • Cardiothoracic surgical decisions where surgical valve replacement was considered, addressed via cardiac surgery instruction.
  • Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
  • Quantum, life expectancy and care needs, addressed through dedicated reports where the case progresses to that stage.
Common cases

Common scenarios we report on.

These patterns recur in valvular heart disease claims, most turning on primary care or general cardiology decisions.

  • Primary care · Misattribution

    Symptoms of aortic stenosis attributed to ageing

    Patient presented with exertional dyspnoea and syncope; symptoms were attributed to ageing without echocardiography. Severe aortic stenosis was diagnosed only after hospital admission with heart failure. The report addresses whether the symptoms met thresholds for investigation and whether timely valve replacement would have altered the outcome.

    Often paired with: Breach of Duty Causation

  • Cardiology · Delayed referral

    Moderate mitral regurgitation — delayed surgical referral

    Echocardiogram demonstrated moderate mitral regurgitation with preserved left ventricular function; the patient was not referred for surgical assessment until progression to severe regurgitation with left ventricular impairment. The report examines whether referral thresholds were met and whether earlier intervention would have prevented irreversible ventricular damage.

    Often paired with: Breach of Duty Causation

  • TAVI · Procedural complications

    Stroke following TAVI procedure

    Patient underwent TAVI for severe aortic stenosis and suffered an embolic stroke within 24 hours of the procedure. The report addresses whether pre-procedural imaging and risk stratification met the standard expected in high-volume centres, and whether post-procedural anticoagulation was appropriate.

    Often paired with: Screening & Merits Breach of Duty

  • Valve replacement · Delay

    Valve replacement delayed in symptomatic severe aortic stenosis

    Patient with severe symptomatic aortic stenosis was referred for valve replacement, but surgery was delayed due to waiting-list pressures; the patient suffered sudden cardiac death while awaiting intervention. The report tests whether the delay fell below the standard of care and whether earlier surgery would have prevented the fatal event.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with causation often the central battleground.

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Send a short note on the alleged failings with the records bundle. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.

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