HELP! Need you suggestions before seeing my surgeon on Friday

[Eva]

My apologies for this lengthy thread!

On March 4th I had my 6-month echo at my cardio's office...three months ago it was done at UCLA Main lab. Unable to see me the day of the echo, my cardio called me that evening telling me the echo is perfect!! I asked about valves, he said I had a miral leak! He tried to convince it was OK. Next morning I requested a copy which was faxed to me. The M-Mode measurements are all within the normal range, except for Left atrium which is 46 mm, which was 43mm three months.

Quoting parts of the report:

Ventricular/Atrial function: LV ejection fraction estimated at 50%. The normal mitral valve inflow Doppler tracing is consistent with normal diastolic functions: E Wave 1.3 m/sec ; A 0.9 m/sec; MVDT 253 m/sec [it was 187 3 mnths ago]

Valvular Function: The mechanical SJ mitral valve is appears to be functioning normally. There is mild mitral regurgitation. There is trace-to-mild tricupspild regurgitation.

Conclusion: There is normal left ventricular size and low to normal systolic function. There is normal vavular function including mechanical aortic valve and mechanical mitral valve. There is no pulmonary hypertension.

UNQUOTE

[I feel report somehow contradicts itself or I do not know how to interpret it].
There was NO other mention about aortic valve...NO mention of pulmonic regurgitation which showed three months ago...NO mention of peak gradient, mean gradient, etc. ]

My cardio explained the left atrium size depends on where the technician took the measurement from. I argued that all technicians should take measurement from a specific point! His response when I asked there is no info about AV was that there was no need to write details when the results are OK!!

When cardio listened to my heart he said it was crisp and no murmur! if there is a leak, there should be a murmur ??? right ???

The morning I received the fax, I called my surgeon’s office and shared my concerns with the secretary. She said she would ask for the echo CD and ask Dr. Shemin to look at it, and if he did not approve of it, I would repeat the test. Not hearing from her, I called her this pm...she said she did not show the CD to Shemin as my cardio assured her the echo is OK and I am fine. I questioned if it is normal for a mechanical valve to leak, how come the aortic valve did not show any leak?! how come the left atrium is large than last time? how come others with mechanical valves do not have a leak? etc. She jotted down my concerns recommended I mention all this to Dr. Shemin when I see him on Friday, since he definitely has some time for me then.

So, what do you think?! any arguments to present in case he thinks echo was OK! In case he did not see the echo yet? In case ??? Should I insist on repeating the echo?

He may simply ask me to have it repeated and then I would feel bad for having trouble you and taken your time, which is why I was hesitant to post this before. Inside me I feel the technician was not experienced enough. She was too fast in making the measurements and too fast in moving from one spot to another ... all other technicians had to push hard to get a clear image! I did not say anything at the time as I did not want not to prejudge her.

Many thanks in advance

 

[ALCapshaw2]

I've 'heard' that a small amount of 'leakage' is inherent in some valve designs to allow the leaflets to be 'washed' during the diastolic part of the cycle. You may want to ask about that theory.

Since the accuracy of Echocardiogram Measurements is highly dependent on Technician skill and diligence, you may want to express your concern / observations to your Cardiologist and Surgeon.

You may also want to obtain a Copy of the CD or Tape and take it with you when you see your Surgeon so that you can look at the recording together.

Note that the Medical Modifier is typically interpreted as "something may be beginning to show here... we should monitor it for signs of progression (but NOT intervene at this time)"

The hierarchy for Medical Modifiers is:
NO/None, Trace, Mild, Moderate, Severe, Critical
and hyphenated combinations of succeeding levels.

Mild = "Wait and Watch"

'AL Capshaw'

 

[Lynlw]

I was wonderring why you are seeing your surgeon, is there a problem? I'm not a doc, but everything looks pretty good, as for the measurements they aren't exact on echoes and alot has to do with the fact the heart is beating and moving.

 

[Eva]

I've 'heard' that a small amount of 'leakage' is inherent in some valve designs to allow the leaflets to be 'washed' during the diastolic part of the cycle. You may want to ask about that theory. Thanks, Al, This is interesting and I shall ask. If my cardio had mentioned it to me this way, I would have accepted his answer!

Since the accuracy of Echocardiogram Measurements is highly dependent on Technician skill and diligence, you may want to express your concern / observations to your Cardiologist and Surgeon. I definitely will do
...........
Note that the Medical Modifier is typically interpreted as "something may be beginning to show here... we should monitor it for signs of progression (but NOT intervene at this time)"

The hierarchy for Medical Modifiers is:
NO/None, Trace, Mild, Moderate, Severe, Critical
and hyphenated combinations of succeeding levels.

Mild = "Wait and Watch"

'AL Capshaw'

Thanks, Al, for the prompt response. I shall take note of the Medical Modifier interpretation.

 

[zipper2]

Eva,i have no insight ,but wanna wish you the best for your
appt. on Friday,i also see both my cardio and surgeon on 25th
for a follow up WED.
Keep you in my thoughts and prayers,sure it will all go fine for you.

zipper2 (DEB)

 

[Eva]

Eva,i have no insight ,but wanna wish you the best for your
appt. on Friday,i also see both my cardio and surgeon on 25th
for a follow up WED.
Keep you in my thoughts and prayers,sure it will all go fine for you.

zipper2 (DEB)

Thanks, Deb, for your good wishes. I in trun send to you my positive vibes and prayers wishing you well all the time for many years to come.

 

[njean]

Eva, I'm so glad you finally posted your concerns & hopefully more people will come along & give you their thoughts. Perhaps tomorrow since your post was just a few minutes ago.

I have heard that mild leakage is NOT really that abnormal in newly implanted valves. Now the leakage on the mitral mechanical valve that I had shortly after my 1st OHS in 75', occurred due to the sutures working themselves loose. But this happened because of all the emotional upheaval that I was going thru at the time, i.e., my marriage breaking up, moving all my furniture & personal belongings back to my mom's house & on & on....

Now in my telephone conversations with you, you mentioned that you have not been feeling quite right so perhaps it is a good idea that they do another Echo just to see how it compares with the one done a few weeks ago. And insist on having it done at the hospital or at another medical facility rather than at your cardio's office which is where they did the last one.

And another thing I just thought about, you know for years & years, 27 years to be exact, I had the fortune of having the same, wonderful cardiologist up until he retired. And all those years, I never asked for a copy of my Echo --- it never even crossed my mind to ask for one. And, for at least 18 of those years, I had an Echo every 2 years. And my cardio always said the same, "your valves look & sound just fine" & so life went on. And too, I felt good so I never gave it much thought. Perhaps I had leakages too & never even knew about it!

I feel you will be just fine my friend and if it takes another Echo to give you reassurance, then request it & don't back down!!!

Praying for you!

 

[CThrock]

Eva,
I will keep you in my thoughts and prayers on Friday. My understanding with the Echos is they are not concrete and if they really see a problem they will do a TEE or cath. I was also told that some of the leakage is good. I had Echos every 6 months for about a year then they went to once a year. My last one was'nt a good report so they are doing them every 6 to 8 months to keep an eye on my tricuspid valve.
Try not to get to overwhelmed with the Echos. Do what you think you have to do my friend. I personally would wait and have another Echo in 6 months, but that me.
Hope that helps maybe I'll give you a call.

Crystal

 

[Eva]

..........the mitral mechanical valve that I had shortly after my 1st OHS in 75', occurred due to the sutures working themselves loose. But this happened because of all the emotional upheaval that I was going thru at the time, i.e., my marriage breaking up, moving all my furniture & personal belongings back to my mom's house & on & on....

Now in my telephone conversations with you, you mentioned that you have not been feeling quite right so perhaps it is a good idea that they do another Echo just to see how it compares with the one done a few weeks ago. And insist on having it done at the hospital or at another medical facility rather than at your cardio's office which is where they did the last one.

And another thing I just thought about, you know for years & years, 27 years to be exact, I had the fortune of having the same, wonderful cardiologist up until he retired. And all those years, I never asked for a copy of my Echo --- it never even crossed my mind to ask for one. And, for at least 18 of those years, I had an Echo every 2 years. And my cardio always said the same, "your valves look & sound just fine" & so life went on. And too, I felt good so I never gave it much thought. Perhaps I had leakages too & never even knew about it!

I feel you will be just fine my friend and if it takes another Echo to give you reassurance, then request it & don't back down!!!

Praying for you!

Norma,

Thanks for responding. You made me remember that a couple of times I completely forgot I had OHS and I moved/lifted up furniture in the guest room and stopped right away!! I wonder now.

Thanks for encouraging me on insisting on having another echo. I am not as much worried if I have the regurgitation...I just want to know facts!

My prayers to you too.

 

[Eva]

Eva,
I will keep you in my thoughts and prayers on Friday. My understanding with the Echos is they are not concrete and if they really see a problem they will do a TEE or cath. I was also told that some of the leakage is good. .......

Try not to get to overwhelmed with the Echos. Do what you think you have to do my friend. I personally would wait and have another Echo in 6 months, but that me.
Hope that helps maybe I'll give you a call.

Crystal

Thanks, Crystal, for your advice and prayers. I hope this is normal, but if not, I will just accept it and live the moment counting my blessings.

You are in my prayers too.

 

[Eva]

I was wonderring why you are seeing your surgeon, is there a problem? I'm not a doc, but everything looks pretty good, as for the measurements they aren't exact on echoes and alot has to do with the fact the heart is beating and moving.

Thanks, Lyn, for your encouragement. I am seeing the surgeon as it is my 6-month check up with him and at the same time to discuss the facts/theories about possibility of mechanical valves regurgitation.

 

[Nupur]

Eva, I don't have any experience with the leakage of mech valves, but I wanted to say I hope you get the answers and it puts your mind at rest. I know how terrible it is to live with the fear that something is wrong, and you certainly have always encouraged me to seek answers : ) Hope all goes well with your appointment.

 

[WayneGM]

Some leakage of a "normal" valve is normal. A mild or trace leak wouldn't necessarily have a murmur. Best wishes and good luck with your visit.

 

[Eva]

Eva, I don't have any experience with the leakage of mech valves, but I wanted to say I hope you get the answers and it puts your mind at rest. I know how terrible it is to live with the fear that something is wrong, and you certainly have always encouraged me to seek answers : ) Hope all goes well with your appointment.

Thanks, Nupur. I hope you get your peace of mind soon too. Wish you well always.

 

[Eva]

Some leakage of a "normal" valuve is normal. A mild or trace leak wouldn't necessarily have a murmur. Best wisheas and good luck with your visit.

Mmmm! OK. thanks, Wayne, for the explanation and your good wishes.

 

[Bina]

Trivial/trace regurge is more common than we think.
Our hearts have to deal with new valves, varying pressures, and new meds....it's no surprise that echo readings will reflect this.
Don't worry, Eva.

 

[Eva]

Trivial/trace regurge is more common than we think.
Our hearts have to deal with new valves, varying pressures, and new meds....it's no surprise that echo readings will reflect this.
Don't worry, Eva.

Thanks, Bina. I am not as worried as much as just wanting to know what is really going on?! whether to insist on another echo at the previous lab or if this is not normal what the cause of it, if there is any!

As I said before, tomorrow will take care of itself.

 

[WayneGM]

I forgot to mention, when I had my last echo my Cardio said that the mild/trace leak from my repaired mitral valve was less than many normal healthy valves leak. I'm sure the mild leak is nothing to worry about, but it's good that you're going to get it checked to be sure. It's always better to be safe than sorry. I'll be thinking of you tomorrow.

 

[abbanabba]

The M-Mode measurements are all within the normal range, except for Left atrium which is 46 mm, which was 43mm three months.

What are the "normal" parameters the echo cites for the left atrium? Are you outside of these? If so by how much? A 3mm difference could certainly depend on where the tech measured, or at what stage of the beat it was measured. How does this current measurement stand next to previous echos (beyond the last one you are comparing to)?

MVDT 253 m/sec [it was 187 3 mnths ago]

This is more of a significant change, but again, is it still within "normal" parameters? This might be worth questioning your cardio about.

Valvular Function: The mechanical SJ mitral valve is appears to be functioning normally. There is mild mitral regurgitation. There is trace-to-mild tricupspild regurgitation.

Conclusion: There is normal left ventricular size and low to normal systolic function. There is normal vavular function including mechanical aortic valve and mechanical mitral valve. There is no pulmonary hypertension.

As others have stated, mild/trace regurgitation is not uncommon with valves and at this level you won't necessarily pick up any murmer until they become more pronounced. It may be that mild regurgitation is the normal for your valve and that is the way it will remain. It may be less common in mechanical valves (I'm no expert on them), but so long as the level of regurgitation remains trivial it really shouldn't be cause for concern.

There was NO other mention about aortic valve...NO mention of pulmonic regurgitation which showed three months ago...NO mention of peak gradient, mean gradient, etc.

What was the level of pulmonic regurgitation you had earlier? If it was only mild/trace then perhaps they didn't pick it up this time. If the regurg was moderate or worse then I would be concerned if it was missed, but anything less than that really shouldn't give you anything to worry about.

So, what do you think?! any arguments to present in case he thinks echo was OK! In case he did not see the echo yet? In case ??? Should I insist on repeating the echo?[/

Do you want it repeated because there are slight variations from the last, or because you feel your health has declined and the numbers support this and you're worried this isn't being recognised? If you are only concerned about the variations, which may be nothing more than the difference in techs (or even how the machines are calibrated) I'm not sure your cardio would see much value in that. You might find waiting 6-12 months a better option as there would be a better chance of finding anything significant. Having one so soon again is unlikely to show much difference.

If, however, you are feeling poorly and are worried about your health, then I would definitely discuss this with your doctors, but even then they may suggest waiting at least 3 months to repeat the test - again, to allow that little bit of time to see if any changes are as a result of your heart, or merely tech interpretations.

Either way I hope it sets your mind at ease.


A : )

 

[Eva]

I forgot to mention, when I had my last echo my Cardio said that the mild/trace leak from my repaired mitral valve was less than many normal healthy valves leak. I'm sure the mild leak is nothing to worry about, but it's good that you're going to get it checked to be sure. It's always better to be safe than sorry. I'll be thinking of you tomorrow.

Thanks, Wayne again for now and all the times you responded to my threads. I will let you all know tomorrow.

What are the "normal" parameters the echo cites for the left atrium? Are you outside of these?The high normal is 43mm If so by how much? A 3mm difference could certainly depend on where the tech measured,This is what my cardio said and he drew a sketch to show me!! or at what stage of the beat it was measured. How does this current measurement stand next to previous echos (beyond the last one you are comparing to)? It was 43mm before surgery.

This is more of a significant change, but again, is it still within "normal" parameters? This might be worth questioning your cardio about. Thanks...this is what I needed to know...what questions to stress on tomorrow

.......(I'm no expert on them), but so long as the level of regurgitation remains trivial it really shouldn't be cause for concern. I hope so too.

What was the level of pulmonic regurgitation you had earlier? If it was only mild/trace then perhaps they didn't pick it up this time. You are absolutely right...it was trival/trace. If the regurg was moderate or worse then I would be concerned if it was missed, but anything less than that really shouldn't give you anything to worry about.

Do you want it repeated because there are slight variations from the last, or because you feel your health has declined and the numbers support this and you're worried this isn't being recognised? If you are only concerned about the variations, which may be nothing more than the difference in techs (or even how the machines are calibrated) I'm not sure your cardio would see much value in that. You might find waiting 6-12 months a better option as there would be a better chance of finding anything significant. Having one so soon again is unlikely to show much difference.

If, however, you are feeling poorly and are worried about your health, then I would definitely discuss this with your doctors, but even then they may suggest waiting at least 3 months to repeat the test - again, to allow that little bit of time to see if any changes are as a result of your heart, or merely tech interpretations.

Either way I hope it sets your mind at ease.


A : )

Thanks, Anna, very good points and I agree with your thoughts...I wish my cardio told me what you said above...I am the type who needs reasoning to convince me!

Many Thanks again