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Urology
Recommended by 3 specialists
23 years of experience
Benign Prostatic Enlargement, General Urology, Urological Oncology

Christian Brown is a Consultant Urologist and works as part of the prostate robotic teams at King's and Guy's Trusts. Christian trained at King's College Hospital, University College Hospital, The Royal Marsden and The Royal College of Surgeons, in addition to other hospitals across the South East of England.

Christian Brown offers both general and specialist urological care. His general practice involves the assessment and care of general urological conditions including those of the kidney, bladder, prostate and male genitalia. He specialises in laparoscopic and robotic surgery including robotic-assisted radical prostatectomy (RARP) and has performed over 1250 cases to date.

Christian Brown is a lecturer on various postgraduate courses within the University of London and in Europe. He has taught practical surgical skills to trainees and consultants both in the UK and overseas.


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Urology
Recommended by 4 specialists
13 years of experience
General Urology, Benign Prostatic Enlargement, Andrology + 7 more

Rajesh Nair, FRCS (Urol.), FEBU, MSc. (Urol) is a Consultant Urological Surgeon appointed in 2017 at Guy’s and St. Thomas’. Nair has a sub-specialist interest in open, laparoscopic and robot-assisted surgery with a particular focus with bladder, kidney, prostate and testis cancer issues as well as reconstructive urological surgery.

Nair has done fellowship training in robotics, uro-oncology and reconstructive urology at St. George’s Hospital, Guy’s Hospital, London and the Royal Melbourne Hospital and Peter MacCallum Cancer Centre in Australia.

He specialises in Blood in the Urine, Urinary Tract Symptoms, Bladder Cancer, Kidney Cancer, Prostate Cancer, Testis Cancer, Upper Tract Urothelial Cancer, Urinary Tract Reconstruction, Minimally Invasive Surgery (Robotic and Laparoscopic), Open Surgery, Blue-light Cystoscopy and Intravesical Bladder Treatment Strategies in Bladder Cancer, Continent and Incontinent Urinary Diversion, Bladder and Kidney Preservation for Cancer, Upper Tract Urothelial Cancer Diagnostics and Treatment, PUJ Obstruction, Robotic Pyeloplasty, Prostatitis, Testicular Pain. 


Diseases, Medical Tests and Treatments

  • Minimally Invasive Surgery (Robotic and Laparoscopic) & Open Surgery in Bladder Cancer
  • Kidney Cancer
  • Prostate Cancer
  • Testis Cancer
  • Upper Tract Urothelial Cancer and Complex Urinary Tract Reconstruction
  • Haematuria (Blood in Urine)
  • Bladder and Kidney Preservation for Bladder and Kidney Cancer
  • Surgery for Benign (Non-Cancerous) Prostate Hyperplasia (Enlargement) 
  • Blue-light Cystoscopy and Intravesical Bladder Treatment Strategies for Bladder Cancer
  • Continent and Incontinent Urinary Diversion (Neobladder, Mitrofanoff, Ileal Conduit)
  • Upper Tract Urothelial Cancer Diagnostics and Treatment
  • PUJ Obstruction and Robotic Pyeloplasty
  • Penile Surgery
  • Scrotal Surgery
  • Acute or Chronic Prostatitis (Prostate Inflammation)

 

 

  • Kidney cancer
  • Bladder cancer
  • Non-cancerous and cancerous prostate disease
  • Testis cancer
  • Upper tract urothelial cancer
  • Urinary tract reconstruction
  • Minimally invasive surgery (robotic and laparoscopic) and open surgery

 

 

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Obstetrics & Gynaecology
Recommended by 2 specialists
23 years of experience
Laparoscopic (Key-Hole) Surgery, Gynaecology

Mr. Tsepov is an internationally recognised expert endometriosis surgeon performing laparoscopic surgery and robotic surgery using DaVinci Xi surgical robot. Mr. Tsepov is a certified robotic DaVinci Xi console surgeon by The Intuitive Surgical. He and his multidisciplinary endometriosis team perform robotic surgery at The Princess Grace Hospital, HCA Healthcare UK. In his clinical practice, Denis widely uses traditional methods of diagnostics and treatment, as well as latest innovative approaches and techniques recommended by National Institute of Clinical Excellence (NICE), British Society of Gynaecological Endoscopy (BSGE), European Society of Gynaecological Endoscopy (ESGE) and Royal College of Obstetricians and Gynaecologists (RCOG).

At The Harley Street Clinic, Mr Tsepov has established and is currently leading a Multidisciplinary Endometriosis Clinic which has been accredited as an endometriosis referral centre by The British Society Of Gynaecological Endoscopy (BSGE)

The centre offers full range of investigations, treatment and post-treatment support for patients with severe endometriosis and complex gynaecological surgical problems. This work involves complex gynaecological laparoscopic surgery, often performed together with designated colorectal and urology surgeons given the complex surgical nature of severe endometriosis.

The Harley Street Clinic Endometriosis Centre Philosophy:

Individualised treatment strategy and involvement of patients in decision making

Multidisciplinary team approach and constant support of our patients.

Excisional nerve sparing endoscopic / robotic endometriosis surgery of any complexity

Center's multidisciplinary team offers top surgical expertise in excisional nerve sparing, radical and fertility preserving treatment options of severe infiltrating endometriosis. Our aim is to avoid multiple surgical operations for deep endometriosis and clear the disease in a single surgical procedure. We use principles of conservative radicality and nerve sparing and our target is to remove the disease and cause minimal collateral damage to other pelvic organs, nerves and blood vessels.

Ongoing Care and Patient Support

Harley Street Clinic Endometriosis Centre is a coordinated multidisciplinary network. It offers comprehensive and personalised approach to endometriosis from all aspects.

This is the the clinic where gynaecology endometriosis surgeons, specialist endometriosis nurse, colorectal (bowel) surgeon, urologist, anaesthetists, chronic pain specialists, gastroenterologists, and consultant radiologist, specialising in endometriosis work together and always discuss the treatment of patients with severe endometriosis on multidisciplinary team meetings (MDM)

Apart from the core medical specialists our patients will have access to clinical psychologist, complimentary medicine specialist and psycho-sexual councillor. We work in close partnership with fertility team in Lister Hospital for those patients who have difficulty getting pregnant with endometriosis. We support our patients in all aspects of endometriosis care before, during and after surgery. Our aim is to improve reproductive health of our patients and enhance their quality of life.

Bowel Endometriosis

For suspected deep infiltrating endometriosis of the bowel clinic offers offer extensive pre-operative assessment including special MRI scan to asssess the extent of the disease before surgery. If deep infiltrating endometriosis of the bowel is confirmed by the MRI we offer surgical treatment options which may include bowel shaving, disciod stapler bowel resection or, for large or multiple bowel endometriosis nodules - economical segmental bowel resection. All these procedures are performed laparoscopically. Our surgical audit data shows excellent results in improving patients quality of life, pain levels and sexual function. Our serious complications rate for bowel endometriosis surgery is very low and we take enourmous efforts to maintain patients well being before, during and after surgery.

Urinary Tract Endometriosis

Our multidisciplinary team has vast experience in surgical treatment of deep infiltrating endometriosis of the bladder and ureters. If bladder endometriosis is confirmed by the MRI we offer excisional treatment which may include full thicknes bladder nodules excision, bladder reconstruction and ureteric re-implantation. All these procedures are performed laparoscopically. After surgery we offer bladder physiotherapy support to enhance post surgical recovery and speed up patients return to normality.

Diaphragmatic Endometriosis

We offer excisional treatment for confirmed diaphragmatic endometriosis. These operations are performed by a joint surgical team involving gynaecology, upper GI and thoracic surgeons. Procedures are performed endoscopically.

Mr. Tsepov widely participates in major European and Global meetings dedicated to complex gynaecological surgery and endometriosis as faculty member and invited speaker. Mr. Tsepov has received Surgical Video Competition Award by British Society of Gynaecological Endoscopy in Edinburgh UK in 2018 and Silver Video Surgery Award by British Society of Gynaecological Endoscopy in Newport, UK in 2019. He has also performed live surgery broadcasts to a number of International congresses dedicated to deep infiltrating endometriosis.

Mr Tsepov is a passionate supporter of preventive and evidence-based medicine. His other areas of expertise include diagnosis and treatment of pelvic pain syndrome, uterine fibroids, ovarian cysts, menstrual disorders, polycystic ovarian syndrome, pelvic inflammatory disease, endocrine gynaecological disorders, early pregnancy problems, ectopic pregnancy, selection of the best contraception etc.

In his clinical practice, Denis widely uses traditional methods of diagnostics and treatment, as well as latest innovative approaches and techniques recommended by National Institute of Clinical Excellence (NICE), British Society of Gynaecological Endoscopy (BSGE), European Society of Gynaecological Endoscopy (ESGE) and Royal College of Obstetricians and Gynaecologists (RCOG).

Mr Denis Tsepov graduated from St. Petersburg State Medical University in Russia in 1997 and completed higher specialist training in the United Kingdom. Mr Tsepov is a member of the Royal College of Obstetricians and Gynaecologists of the United Kingdom (RCOG).

Mr. Tsepov has completed advanced special skills module in Gynaecological Oncology together with Labour Ward ATSM in 2010 and on UK specialist register.

In addition to his UK training he has learned and excelled advanced surgical techniques for excisional treatment of severe endometriosis in leading European Endometriosis Centres in Bordeaux and Rouen, (France) , Bologna and Negrar (Italy) and Moscow (Russian Federation)

Outside his clinic Mr. Tsepov is a passionate hiker and enjoys long walks on the British and French Countryside and also fishing trips to nothern Finland and Russia.

Diseases, Medical Tests and Treatments

  • Excision of severe deep infiltrating endometriosis
  • Excision of recto-vaginal deep endometriosis
  • Excision of bowel deep endometriosis
  • Rectal shaving, disc bowel resection, segmental bowel resection
  • Urinary tract deep endometriosis
  • Excisional nerve sparing surgery for deep endometriosis
  • Complex endoscopic gynaecological surgery
  • General and surgical gynaecology
  • Laparoscopic hysterectomy
  • Laparoscopic myomectomy
  • Hysteroscopy and hysteroscopic surgery
  • Office Hysteroscopy
  • Menstrual disorders
  • Gynaecological endocrinology
  • Menopause
  • Robotic surgery service
  • Deep endometriosis of the bowel and recto-vaginal space
  • Rectal shaving, discoid bowel resection, segmental bowel resection
  • Nerve sparing excisional surgery for endometriosis
  • Deep endometriosis of the urinary tract
  • Ureteric re-implantation, bladder excision and reconstruction.
  • Adenomyosis
  • Chronic pelvic pain
  • Uterine fibroids
  • Complex gynaecological surgery
  • Multidisciplinary surgery
  • The Harley Street BSGE Endometriosis Centre
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Neurosurgery
31 years of experience
Spinal Surgery

Mr Thomas is a consultant neurosurgeon who offers private care for brain and spinal problems across London. Following his qualification in 1988 he followed general surgical training and trained in neurosurgery. He became a consultant neurosurgeon at the age of 33 and has a broad clinial practice which includes sub speciality interests such as complex spine surgery, anterior and lateral skull base surgery and endoscopic pituitary and skull base surgery. 

He also runs a national multi-disciplinary clinic dedicated to neurofibromatosis and von Hieel Lindau disease. He is a valued panel member on international workshops on endoscopic pituitary surgery

For the last 15 years, Mr Thomas has visited Sri Lanka to lecture and perform operations with local neurosurgeons at the National Hospital and Sri Jayawardenapura Hospital in Colombo on a charitable basis.

 

 


Diseases, Medical Tests and Treatments
  • Spinal surgery
  • Sciatica
  • Back pain
  • Cervical spine surgery
  • Cervical myelopathy
  • Brachalgia
  • Discectomy
  • Endoscopic Minimally Invasive Spine Surgery
  • Epidural for back pain
  • Lumbar laminectomy
  • Lumbar microdiscectomy
  • Minimally Invasive Spinal Surgery 
  • Neurosurgery
  • Craniotomy Brain Surgery
  • Gamma knife surgery
  • Laminectomy
  • Facet joint pain

There are many more procedures not listed - if you have a query please call the practice on 02070348709

 

  • Pituitary
  • Acoustic neuroma
  • Spine
  • Skull base surgery
  • Neurofibromatosis
  • Vestibular Schwannoma
  • von Hippel Lindau disease
  • Minimally Invasive Spine Surgery
  • Sciatica
  • Brachalgia
  • Neck pain
  • Back pain

 

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Neurosurgery
Recommended by 1 specialist
41 years of experience
Spinal Surgery

Mr Gullan is the most senior neurosurgeon in London neurosurgery partnership and works with other to deliver a high level of neurosurgical care. 

He has obtained his membership of the Royal College of Physicians and a fellowship of the royal college of surgeons. He has developed a large practice in spinal and neurovascular training and has established a reputation for being at the forefront of many surgical techniques. 

He presented the first use of posterior instrumented stabilisation for malignant disease affecting the spinal column and was the first neurosurgeon worldwide to pilot both the use of intervertebral fusion cages for cervical disc surgery and introduce posterior lumbar interbody fusion to neurosurgeons in the UK.

Mr Gullan enjoys teaching, especially operative techniques and clinical decision making, to young neurosurgeons. 

 

 

 


Diseases, Medical Tests and Treatments

  • Craniotomy Brain Surgery
  • Laminectomy
  • Neurosurgery
  • Spinal surgery
  • Discectomy
  • Spinal surgery
  • Sciatica
  • Back pain
  • Cervical spine surgery
  • Cervical myelopathy
  • Brachalgia
  • Discectomy
  • Endoscopic Minimally Invasive Spine Surgery
  • Epidural for back pain
  • Lumbar laminectomy
  • Lumbar microdiscectomy
  • Minimally Invasive Spinal Surgery 
  • Neurosurgery
  • Craniotomy Brain Surgery
  • Gamma knife surgery
  • Laminectomy
  • Facet joint pain

 

  • Brain Tumours
  • Spinal surgery
  • Complex spinal surgery
  • Degenerative spinal disease
  • Metastatic spinal cord compression 
  • Spinal tumours
  • Neuro-oncology

 

 

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Neurosurgery
27 years of experience
Spinal Surgery, Neuro-Oncology, Paediatric (Pediatric) Neurosurgery

Mr Sanjeev Bassi, born in London and educated at Ilford County Grammar School for Boys and Victoria University of Manchester, is a consultant adult and paediatric neurosurgeon who treats patients with brain and spinal problems.

After gaining the Fellowship of the Royal College of Surgeons, Mr Bassi trained in neurosurgery in Nottingham and obtained his fellowship at the Necker Hospital in Paris and the Montefiore Hospital in New York. He then worked as a paediatric neurosurgical fellow at the Radcliffe Infirmary in Oxford and then as a consultant in adult and paediatric neurosurgery at King's College Hospital and the Evelina Children’ Hospital, St Thomas Hospital.

He has a full adult and paediatric practice for both cranial and spinal surgery. He provides treatment for sciatica, back pain, neck pain, brain tumours, hydrocephalus, brain haemorrhage, spinal tumours, cerebral palsy, implantation of skeletal muscle relaxant pumps, neuroendoscopy. He also treats premature children and is involved in antenatal diagnosis and counselling of parents of babies with spinal and brain problems which have been diagnosed by foetal MRI before birth.

He is one of the two leading paediatric neurosurgeons at Kings and performs 25%-30% of all paediatric neurosurgical operations occurring in the South of England. He also specialises in general neurosurgery for adults and paediatric diseases which progress into adulthood. He furthermore deals with degenerative spinal problems, including brachalgia, sciatica, spinal cord tumours and all brain tumours.

Having trained extensively in the applications of neuro-endoscopy in neurosurgery, he teaches and lectures internationally on third ventriculostomy, endoscopic treatment of craniopharingiomas and endoscopic applications in pineal tumours. In addition to this, he runs a course on hydrocephalus and endoscopy at the Royal College of Surgeons of England.

It is important that HCA is transparent about our relationship with those doctors who provide us with clinical guidance on delivering the best possible care to patients and operating our hospitals safely and efficiently. We set out here some of the ways in which we work together and the amount we pay this doctor for such services.

 


Diseases, Medical Tests and Treatments

  • Shunts
  • Cerebellar tonsillectomy 
  • Foraminotomy
  • Radio frequency ablation 
  • Anterior cervical discectomy and fusion
  • Cervical disc replacement

 

 

 

  • Adult and Paediatric Neurosurgery
  • Hydrocephalus
  • Endoscopy
  • Third ventriculostomy
  • Spina bifida
  • Paediatric and adult brain tumours
  • Cerebral palsy and intrathecal skeletal muscle relaxant pumps (including Baclofen)
  • Antenatal counselling
  • Brain haemorrhage
  • Prematurity
  • Spinal tumours
  • Sciatica
  • Brachalgia
  • Back pain
  • Neck pain
  • Carpal tunnel
  • Syringomyelia
  • Chiari malformation
  • Craniosynostosis 
  • Flat head symdrome
  • Spinal dysraphism
  • Tarlov cysts
  • Trigeminal neuralgia
  • Headaches
  • Posterior fossa tumour
  • Dermal sinus
  • Selective dorsal rhizotomy
  • Colloid cyst

 

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Oncology
24 years of experience
Clinical Oncology, Medical Oncology

Professor Heather Payne is a Consultant Clinical Oncologist, specialising in urological and prostate cancer at University College London Hospitals NHS Trust and she also sees patients privately, including at The Harley Street Clinic and The Prostate Centre.

Professor Payne trained at St Mary’s Hospital and after qualifying, spent time in general medicine in London and Haiti.

On her returned to London, she trained as a Clinical Oncologist, and also developed an interest in urological oncology.

In addition to her clinical work, she is also actively involved in research, and she has pioneered a program of high-dose rate brachytherapy for prostate cancer. Current research interests include hormone therapy, sensitisation of hormones and radiotherapy, predictive indices for bowel toxicity with radiotherapy, proton beam therapy for prostate cancer, chemotherapy and assisting men with decision making and prostate cancer.

Professor Payne is principal investigator in a number of international and national studies and has been published in peer-reviewed journals. She is Chair of the British Uro-oncology Group and Oncology Lead for the National Prostate Cancer Audit. She also serves on the Prostate Cancer Advisory Group for the UK.

Diseases, Medical Tests and Treatments

  • External Beam Radiotherapy
  • Intensity Modulated Radiotherapy/Rapid Arc
  • Low Does Brachytherapy
  • Hormone Treatment
  • Prostate Cancer
  • Novel Hormone Therapy
  • External beam radiotherapy
  • Chemotherapy
  • Brachytherapy

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Urology
21 years of experience
Benign Prostatic Enlargement, Urological Oncology, General Urology

Ben is a consultant urological surgeon with a special interest in the minimally invasive treatments of prostatic diseases. He is the Guy’s & St Thomas’ MDM urological cancer and clinical robotics lead, a UK robotic surgery mentor and robotic fellowship director. He trained at Guy’s and St Thomas’ Hospitals, The Royal Marsden Hospital and with Professor Tony Costello at the Royal Melbourne Hospital, where he was awarded the prestigious Rowan Nicks Fellowship from the Royal Australasian College of Surgeons. He is currently the British Association of Urology (BAUS) Oncology Section Chairman and in 2019 will be awarded the BAUS Golden Cystoscope for contributions to British urology within 10 years of consultant appointment.

He has learnt both laparoscopic and robotic surgical approaches and performed the first randomised trial of telerobotics between Guy’s and Johns Hopkins Hospitals, in 2002. This formed part of his Master of Surgery thesis on robotic surgery and telemedicine. Ben is associate editor of the BJUI, with over 230 peer-reviewed publications, 3 books, and 25 book chapters on minimally invasive and robotic urological techniques.

He has performed over 1000 robotic radical prostatectomies and over 1100 robotic upper tract procedures including 560 robotic partial nephrectomies and also performs holmium laser prostatectomy (HoLEP) with an experience of over 900 cases. He has also helped to develop both the robotic cystectomy and robotic partial nephrectomy programmes at Guy’s Hospital and is the highest volume surgeon for both robotic partial nephrectomy and upper tract robotics in the UK. His current research interests are in robotic surgery training, trans-perineal template biopsy techniques, active surveillance of low risk prostate cancer, sentinel node techniques and haptic probe development in robotic surgery.

Ben is a Trustee of The Urology Foundation Charity, for whom he regularly lectures, and is fortunate to have a very supportive surgical wife and three energetic boys


Diseases, Medical Tests and Treatments

  • Robotic Prostatectomy
  • Kidney Cancer
  • Laparoscopic Nephrectomy
  • Robotic assisted Partial Nephrectomy
  • Holmium Laser Enucleation of the Prostate (HoLEP)
  • Malignant and benign prostate disease
  • Robotic laparoscopic prostatectomy
  • Robotic partial nephrectomy
  • Pyeloplasty
  • Minimally invasive urological procedures
  • HoLEP (laser prostate surgery)
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Neurosurgery
Recommended by 1 specialist
26 years of experience
Neuro-Oncology, Functional Neurosurgery, Spinal Surgery

Professor Ashkan is a leading neurosurgeon at King’s College Hospital, London and one of the handful of neurosurgeons in the UK to be awarded a Professorship. Professor Ashkan underwent dual postgraduate training in medicine and surgery, obtaining Membership of the Royal College of Physicians in 1997 and the Fellowship of the Royal Colleges of Surgeons of England and Glasgow (FRCS) in 1998. Thereafter, he underwent higher specialist training in general neurosurgery in London, being awarded the Fellowship of the Royal College of Surgeons in Neurosurgery (FRCS SN) in 2002. His subspecialist training in stereotactic and functional neurosurgery included a Fellowship in France with Professor Benabid, generally considered as the founder of modern deep brain stimulation surgery, which led to a MD degree in 2006. He was appointed as a Consultant Neurosurgeon at King’s College Hospital in January 2007 and subsequently was promoted to the position of Professor.

In addition to his expertise in degenerative spine disease, which includes the management of back and neck pain, arm pain and sciatica together with peripheral nerve disorders such as carpal tunnel syndrome, Professor Ashkan’s main interests are neuromodulation surgery and brain tumours. This includes deep brain stimulation, spinal cord stimulation and occipital nerve stimulation for movement disorders, pain, headaches and image guided minimally invasive and stereotactic surgery for brain tumours including awake craniotomies and brain mapping.  He is also one of the few UK surgeons trained in Gamma and Cyberknife radiosurgery. 

He is the UK Lead for Genomics England programme for brain tumour, President of the British Society for Stereotactic and Functional Neurosurgery, Chairman of the Neurosurgery Section of the International Parkinson and Movement Disorder Society, King’s Lead for Neuro-Oncology, Chair of King’s Neuroscience Clinical Trial Unit and Deputy Lead for King’s Neuroscience Research Advisory Committee. 

Professor Ashkan has published over 400 peer review papers, abstracts and book chapters and is an Associate Editor or reviewer for several journals.

In his spare time Professor Ashkan has completed a degree and diploma in music and enjoys playing the piano. 


Diseases, Medical Tests and Treatments

Visualase, Deep Brain Stimulation, Spinal Cord Stimulation, Occipital Nerve Stimulation, DCVax Immunotherapy, Awake Craniotomy, Surgery for Brain Tumours, Visualase, Gamma-knife and Cyberknife Radiosurgery, Lumbar and Cervical Laminectomy and Discectomy.

Parkinson's disease, Essential Tremor, Brain Tumours, Spine Disease, Back Pain, Sciatica.

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Cardiology
47 years of experience
Heart Muscle Disease/Cardiomyopathy, Interventional Cardiology

Dr. Rodney Foale is a Consultant Cardiologist at The Harley Street Clinic and The Wellington Hospital. His main clinical interests are general adult cardiology, arrhythmia, hypertension and percutaneous interventional treatment of coronary artery disease. He specialises in angioplasty - a procedure that can open up a blocked blood vessel in the arteries using a tiny stent.

Dr. Rodney Foale was an Honours graduate from the University of Melbourne, Australia in 1971. He completed further training at St Vincent's Hospital, Melbourne, before travelling to India to work in rural Madras and Kashmir. After a training programme based in the UK at the Hammersmith and Royal London Hospitals, he took up the Registrar's post at the National Heart Hospital. He then spent two years at Massachusetts General Hospital in Boston, USA before returning to his Senior Registrar's post at the Hammersmith Hospital in London. In 1985 he was appointed as Consultant Cardiologist at St. Mary's Hospital, London. He then became the Clinical Director of Surgery, which incorporates Cardiovascular Medicine and Intensive Care. He is also the Co-Director of the International Centre for Circulatory Health (ICCH) which supports research at St Mary's Hospital-Imperial College.


Diseases, Medical Tests and Treatments

  • Angioplasty 
  • Coronary Angiography
  • CT Coronary Angiogram
  • Defobrillator Implantation 
  • ECG (electrocardiogram) 
  • ECG monitor (24 hours)
  • Coronary Artery Disease 
  • High Blood Pressure 
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