New minimally invasive treatment gives young adult with congenital heart condition an improved quality of life

Singapore, 14 November 2025 – 24-year-old Catherine, born with Down syndrome and Tetralogy of Fallot (TOF), a rare congenital heart condition, has regained her quality of life after undergoing a novel Venus P™ valve implantation at the National Heart Centre Singapore (NHCS). She is one of six patients in Singapore who has successfully received this minimally invasive pulmonary valve replacement, which spares her from an open-heart surgery.

Before the procedure, Catherine’s heart had begun to weaken from severe valve leakage, a common complication in adults who had TOF repaired as children. If left untreated, this could lead to irreversible heart damage and life-threatening complications¹.

Thanks to the Venus P™ valve, inserted via a small incision in her leg to restore normal blood flow, Catherine’s heart function was restored without having to undergo major surgery. She was discharged within days and resumed normal daily activities in just a week, compared to months of recovery expected from traditional open-heart surgery.

"The Venus P™ valve allows us to restore normal blood flow through a minimally invasive procedure, dramatically reducing recovery time,” said Assistant Professor Foo Jie Sheng, Senior Consultant, Department of Cardiology and Director, Adult Congenital Heart Disease (ACHD) programme, NHCS. “Catherine’s recovery shows how far congenital heart care has come. It’s deeply rewarding to see such outcomes for patients who have faced many challenges since birth.”

A Breakthrough for More Patients with Repaired Heart Defects

TOF affects about one in 3,600 live births and is the most common form of cyanotic congenital heart disease (“Blue Baby Syndrome”). Patients with TOF have multiple heart defects, including a narrowed pulmonary valve and a hole between the heart's pumping chambers. These defects usually require early open-heart surgical repair which Catherine underwent as a baby. NHCS currently cares for over 500 adults with repaired TOF.

Until recently, only about 30 percent of patients could benefit from existing percutaneous valve implants, as many had heart chambers that became too large or irregularly shaped after TOF surgeries. The Venus P™ valve now fits this wider group, possibly providing a life-changing alternative for the remaining 70 percent², who would otherwise need open-heart surgery.

Smarter Imaging, Earlier Intervention

Catherine’s successful treatment builds on NHCS’s research using advanced 4D flow imaging and artificial intelligence (AI) to improve diagnosis and treatment timing.

The INITIATE³ and PROPAGATE⁴ studies, led by NHCS and National Heart Research Institute (NHRIS), leverage 4D flow Cardiac Magnetic Resonance (CMR), a gold standard for assessing right heart size and function, to track blood flow dynamics in detail. Using AI, researchers can now detect early signs of heart strain and changes in heart function before symptoms appear and determine how early intervention can prevent deterioration.

“4D flow imaging allows us to see how blood moves through the heart in unprecedented ways,” said Associate Professor Zhong Liang, Co-Director and Core Technical Lead of CardioVascular Systems Imaging and Artificial Intelligence (CVS.AI), and Principal Investigator and Senior Clinician-Innovator at NHRIS, NHCS. “It enables timely and tailored interventions that help preserve both heart function and quality of life.”

NHCS is now working to integrate AI-enabled 4D flow analysis into routine care, ensuring patients receive more precise and proactive treatment.

Transforming Lifelong Care for Congenital Heart Patients

With advances in surgery and imaging, more children with congenital heart disease are surviving into adulthood, but many require re-intervention as they age.

“Through research and innovation in imaging and minimally invasive therapies, we aim to improve both the longevity and quality of life for our patients,” said Professor Yeo Khung Keong, Chief Executive Officer, NHCS.

References:

1. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart. 2014 Feb;100(3):247-53. doi: 10.1136/heartjnl-2013-304958.
2. Range of ventricular dimensions and function by steady-state free precession cine MRI in repaired tetralogy of Fallot: right ventricular outflow tract patch vs. conduit repair. J Magn Reson Imaging. 2007 Oct;26(4):934-40. doi: 10.1002/jmri.21094
3. INITAITE (INtegrated computational modelIng of right hearT mechanics and blood flow dynamics In congenitAl hearT diseasE) is a collaboration between NHCS, Duke-NUS Medical School, National University Hospital and KK Women’s and Children’s Hospital.
4. PROPAGATE (Progression of Right Ventricular MOrphology, Physiology, Anatomy and Exercise Capacity – LonGitudinal Assessment with Trial Expansion)is a collaboration between NHCS, DUKE-NUS Medical School, National University Hospital and KK Women’s and Children’s Hospital.

About the National Heart Centre Singapore

The National Heart Centre Singapore (NHCS) is a leading national and regional referral centre for cardiovascular diseases, offering 185 beds and a comprehensive range of cardiac care services from preventive to rehabilitative. Ranked #12 as the World’s Best Cardiology Hospital by Newsweek 2025, NHCS’s clinical outcomes are consistently recognised at the international level, meeting or exceeding global standards. It is also the only facility in Singapore providing heart and lung transplantation programme.

As an academic medical centre, NHCS is committed to training healthcare professionals and advancing cardiovascular health through cutting-edge translational research in collaboration with local and international collaborators.

For more information, please visit: www.nhcs.com.sg

Factsheet

There are now many children with congenital heart disease who are surviving into adulthood. Many of these patients have undergone surgery in childhood to repair their underlying heart defects but most of the surgery is only palliative and not curative. Further surgery is often required later in life to correct the underlying cardiac abnormalities. Many of the problems involve the right pumping chamber of the heart and current methods to evaluate the right heart is often inadequate to predict the timing for surgery before the right heart function deteriorates irreversibly. Although advances have been made in cardiac imaging, accurate assessment of the right heart chamber in terms of its structure, function and physiology remains challenging.

INITIATE is a collaboration between the National Heart Centre Singapore (NHCS), Duke-NUS Medical School, National University Hospital and KK Women and Children Hospital. It is a biomedical engineering-driven platform for 4D flow cardiovascular magnetic resonance imaging (CMR) for clinical, research and industrial applications. 4D flow CMR is the most comprehensive 3D non-invasive imaging to assess right heart function and morphology and hemodynamic of pulmonary artery.

The system consists of several modules which can perform different advanced computational analyses on 4D flow CMR images and provide detailed reports on patients’ conditions and their risk of heart failure and further intervention (for example, percutaneous pulmonary valve implantation). The analysis report the following parameters that determine the risk of impaired cardiopulmonary function and further intervention:

• Right ventricular volumes and function
• Right ventricular remodelling
• Pulmonary artery morphology, hemodynamic and function
• Pulmonary artery dilation and turbulent flow

The key benefits include reduced variability in reporting using AI, shorter processing time, greater detail in reporting and being specific to Asian population.

PROPOGATE is a longitudinal follow up study together with INITIATE’s collaborators.

There are three aims in PROPOGATE which will be completed over three years:

Specific Aim #1 (Primary aim): define trajectories in serial progression of RV structure, function and hemodynamics as well as CPET-assessed exercise capacity in RV pressure or volume overload states exemplified by PAH and rTOF, respectively, in association with the primary composite clinical outcome of time to first occurrence of all-cause death, hospitalization for right ventricular failure or ventricular tachyarrhythmia, or pulmonary valve intervention.

Specific Aim #2 (Secondary aim): quantify intra-blood RV kinetic energy and RV-PA coupling using artificial intelligence (AI)-enabled analysis of 4D flow CMR measurements of blood flow within the heart and pulmonary artery; and investigate their utility for predicting progression of RV remodeling, exercise function and clinical outcomes.

Specific Aim #3 (Exploratory aim): characterize metabolomic profiling in RV pressure- and volume-overloaded patients, in relation to RV morphological, functional, and hemodynamic alterations, specifically, RV failure and RV-PA coupling dysfunction.

After successful evaluation and validation, PROPOGATE will be incorporated into AI-enabled clinics at NHCS as part of clinical workflow in managing cardiovascular disease.