15-Week Post-Op Echo and Life Update

Hi all!

I just had a follow-up with my cardiologist and at my suggestion he ordered an echo to evaluate any post-surgical changes (I had a mechanical AVR w/ aneurysm repair on June 25th, 2024). For background, 28M very active and asymptomatic prior to surgery.

Disclaimer before I share- I realize that echocardiograms- especially TTE can vary widely depending on who is interpreting/it's not an absolute gold standard for function- but I thought the numbers were interesting. (Bolded are the biggest takeaways for me).

Pre-Surgery (April 2024)
1. Low normal global left ventricular systolic function. Ejection Fraction is estimated at 50-55 %.
2. Normal left ventricular diastolic function. Normal left ventricular cavity size.
3. LV wall thickness is within normal limits.
4. Normal right ventricular systolic function. Normal right ventricular size
5. Probable bicuspid AV. There is probably adequate aortic valve cusp separation. There is no aortic stenosis. Mild to moderate, eccentric aortic valve regurgitation.
6. Normal mitral valve appearance and function. Mitral stenosis is absent. There is no mitral regurgitation.
7. Tricuspid Valve: Normal appearance of the tricuspid leaflets. TR envelope inadequate to estimate RVSP
8. Pulmonic Valve: Pulmonic valve not well visualized. There is no pulmonic stenosis. There is no pulmonic regurgitation.

Right Before Surgery (June 25th, 2024)
1. Mildly decreased left ventricular systolic function estimated at 40-50%
2. Mild Left Ventricular hypokinesis
3. Bicuspid aortic valve with bileaflet prolapse. Mild-moderate eccentric regurgitation
4. Ascending Aorta 4.8cm, Aortic Root 5.1cm

Post-Surgery (October 9th, 2024)
1. Normal global and regional left ventricular systolic function. Ejection Fraction is estimated at 60 %. Normal left ventricular diastolic function. Normal left ventricular cavity size. LV wall thickness is within normal limits.
2. Mitral Valve: Normal appearance of the mitral valve leaflets. There is no mitral regurgitation.
3. Aortic Valve: Mechanical AV prosthesis with. The valve is well seated with no rocking or dehiscence no visible regurgitation or perivalvular leak, normal mean systolic gradient of 7 mmHg.
4. Tricuspid Valve: Grossly normal appearing tricuspid valve. Trace tricuspid regurgitation.
5. Pulmonic Valve: Normal appearance and function of the pulmonic valve.

Takeaways:

• Interesting to see the (estimated) rapid decrease in my EF from 50-55% to 40-50% over the course of 2-months (likely due to the aortic regurgitation) for further reference, my echo in 2022 had an EF of 60%. Also interesting to see the remodeling and recovery of my EF up to 60% 15-weeks post-op.
• The hypokinesis of my LV pre-op and immediately post-op was concerning but appears to have resolved or not be significant at this time.
• Biggest takeaway is that my mechanical valve is seated and working well- not that I would expect different- but that's why I picked it- durability and longevity given my age.
• I am back to lifting (light) weights and running ~1 mile without stopping 4-5 times a week. Any more distance than a mile and I start to feel more fatigued, so I am progressively adjusting my time and distance and keeping a slower than normal pace (for me) at 12 min/mile.
• Day-to-day occupational roles as a physical therapist are going well- no issues lifting patients or being on my feet all day.
• I truly think the sternal plating that my surgeon did assist in my return to work/working out. I feel as if my sternum is very secure and while I don't have a comparison to a normal closing technique, I think if your surgeon is experienced and your anatomy/surgery is a fit, it's worth it to look into and consider.
• Still having occasional PACs where my heart feels like it has an extra beat after my normal heartbeat. Cardiologist said not to be concerned- it's normal and not anything to fix/worry about. Just something to live with.
• Given the OK to wean off my beta blocker (currently on metoprolol tartrate 25mg 2x a day) to 1/2 a dose (12.5mg 2x a day) for a few weeks and if that goes well, off completely. If my BP goes back up above 130/80, he discussed using another agent to manage that was not a beta blocker.
• Around week 9-10, I started to have days where I didn't really worry/think about my surgery or heart. This is still the case to this day where, for the most part, aside from my daily warfarin dose/monitoring I really don't consider the surgery or management. Settling back into a routine.
• The INR clinic I use through my cardiologist is useless in my opinion. I am not approved for a home INR machine yet- so I get weekly blood draws and call that number into the clinic. They always offer the same advice and pushback on any of my self-prescribed formula based dose changes. So I make these changes anyway to keep myself in range- and tell the clinic that I am "totally following their dose recommendations." Also received pushback when I wanted to test weekly instead of every 2-3 weeks.
• On the topic of advocating for yourself- my cardiologist was not going to order an echo to evaluate any postsurgical changes until I brought it up myself to which he "totally agreed." If you want a test run/think it's warranted, don't be afraid to speak up- the results gave me peace of mind and I now don't have to get one for 3-years unless I become symptomatic.

Thanks for taking the time to read my thoughts! Overall, I have zero regrets about choosing the mechanical valve- as for me it made the most sense and has no limitations on what I was used to doing before surgery-- a no brainer as far as my health and wellbeing was concerned.

Here's to a lifetime of good reports .

Glad to hear that your post surgical echo showed good results. Thanks for sharing.

ncw3642 said:

Here's to a lifetime of good reports .

Click to expand...

Raises a glass to that.

My coumadin clinic have me going in every 4 weeks for lab draws. I bought a meter off ebay and test weekly. My clinic is aware of my meter and will let me go 4-6 weeks (8 if we're traveling). They make the adjustments to my dosage, but I do make minor adjustments, if needed, without their knowledge. I really like my clinic and I don't want to go for a monitoring program with medicare. For the most part, they listen to my suggestions now. But in the beginning, I had to call my cardiologist for help. Now, they like that I test weekly. I've been told they wish more patients were as knowledgeable and take Warfarin seriously as I do. LOL Thanks to everyone's knowledge on here!

Here's to a lifetime of good reports!

Beach77 said:

I've been told they wish more patients were as knowledgeable and take Warfarin seriously as I do

Click to expand...

don't we all!!

That all sounds really positive - my favourite part is the peace of mind you have gained from having this knowledge about your condition.

I got my mechanical aortic valve at 27yo, I've had it 19 years now and it has caused me no problems in that time.

I had my tricuspid valve replaced a fortnight ago, my doctors were more than happy to hand my warfarin management back to me once I was out of ICU and mentally capable. I got my partner to bring my testing kit in to hospital for me and managed my own testing and dosing, although I got my nurses to dispense the actual tablets so I knew I was taking the right amount. Meanwhile, I overheard staff discussing another patient who was refusing to take warfarin at all. I guess that's the two extremes of the patient spectrum when it comes to warfarin! Hopefully you can switch to self-testing before too long.

All the best for your continued return to health.

All heading in the right direction. Congratulations and keep going

ncw3642 said:

Hi all!

I just had a follow-up with my cardiologist and at my suggestion he ordered an echo to evaluate any post-surgical changes (I had a mechanical AVR w/ aneurysm repair on June 25th, 2024). For background, 28M very active and asymptomatic prior to surgery.

Disclaimer before I share- I realize that echocardiograms- especially TTE can vary widely depending on who is interpreting/it's not an absolute gold standard for function- but I thought the numbers were interesting. (Bolded are the biggest takeaways for me).

Pre-Surgery (April 2024)
1. Low normal global left ventricular systolic function. Ejection Fraction is estimated at 50-55 %.
2. Normal left ventricular diastolic function. Normal left ventricular cavity size.
3. LV wall thickness is within normal limits.
4. Normal right ventricular systolic function. Normal right ventricular size
5. Probable bicuspid AV. There is probably adequate aortic valve cusp separation. There is no aortic stenosis. Mild to moderate, eccentric aortic valve regurgitation.
6. Normal mitral valve appearance and function. Mitral stenosis is absent. There is no mitral regurgitation.
7. Tricuspid Valve: Normal appearance of the tricuspid leaflets. TR envelope inadequate to estimate RVSP
8. Pulmonic Valve: Pulmonic valve not well visualized. There is no pulmonic stenosis. There is no pulmonic regurgitation.

Right Before Surgery (June 25th, 2024)
1. Mildly decreased left ventricular systolic function estimated at 40-50%
2. Mild Left Ventricular hypokinesis
3. Bicuspid aortic valve with bileaflet prolapse. Mild-moderate eccentric regurgitation
4. Ascending Aorta 4.8cm, Aortic Root 5.1cm

Post-Surgery (October 9th, 2024)
1. Normal global and regional left ventricular systolic function. Ejection Fraction is estimated at 60 %. Normal left ventricular diastolic function. Normal left ventricular cavity size. LV wall thickness is within normal limits.
2. Mitral Valve: Normal appearance of the mitral valve leaflets. There is no mitral regurgitation.
3. Aortic Valve: Mechanical AV prosthesis with. The valve is well seated with no rocking or dehiscence no visible regurgitation or perivalvular leak, normal mean systolic gradient of 7 mmHg.
4. Tricuspid Valve: Grossly normal appearing tricuspid valve. Trace tricuspid regurgitation.
5. Pulmonic Valve: Normal appearance and function of the pulmonic valve.

Takeaways:

• Interesting to see the (estimated) rapid decrease in my EF from 50-55% to 40-50% over the course of 2-months (likely due to the aortic regurgitation) for further reference, my echo in 2022 had an EF of 60%. Also interesting to see the remodeling and recovery of my EF up to 60% 15-weeks post-op.
• The hypokinesis of my LV pre-op and immediately post-op was concerning but appears to have resolved or not be significant at this time.
• Biggest takeaway is that my mechanical valve is seated and working well- not that I would expect different- but that's why I picked it- durability and longevity given my age.
• I am back to lifting (light) weights and running ~1 mile without stopping 4-5 times a week. Any more distance than a mile and I start to feel more fatigued, so I am progressively adjusting my time and distance and keeping a slower than normal pace (for me) at 12 min/mile.
• Day-to-day occupational roles as a physical therapist are going well- no issues lifting patients or being on my feet all day.
• I truly think the sternal plating that my surgeon did assist in my return to work/working out. I feel as if my sternum is very secure and while I don't have a comparison to a normal closing technique, I think if your surgeon is experienced and your anatomy/surgery is a fit, it's worth it to look into and consider.
• Still having occasional PACs where my heart feels like it has an extra beat after my normal heartbeat. Cardiologist said not to be concerned- it's normal and not anything to fix/worry about. Just something to live with.
• Given the OK to wean off my beta blocker (currently on metoprolol tartrate 25mg 2x a day) to 1/2 a dose (12.5mg 2x a day) for a few weeks and if that goes well, off completely. If my BP goes back up above 130/80, he discussed using another agent to manage that was not a beta blocker.
• Around week 9-10, I started to have days where I didn't really worry/think about my surgery or heart. This is still the case to this day where, for the most part, aside from my daily warfarin dose/monitoring I really don't consider the surgery or management. Settling back into a routine.
• The INR clinic I use through my cardiologist is useless in my opinion. I am not approved for a home INR machine yet- so I get weekly blood draws and call that number into the clinic. They always offer the same advice and pushback on any of my self-prescribed formula based dose changes. So I make these changes anyway to keep myself in range- and tell the clinic that I am "totally following their dose recommendations." Also received pushback when I wanted to test weekly instead of every 2-3 weeks.
• On the topic of advocating for yourself- my cardiologist was not going to order an echo to evaluate any postsurgical changes until I brought it up myself to which he "totally agreed." If you want a test run/think it's warranted, don't be afraid to speak up- the results gave me peace of mind and I now don't have to get one for 3-years unless I become symptomatic.

Thanks for taking the time to read my thoughts! Overall, I have zero regrets about choosing the mechanical valve- as for me it made the most sense and has no limitations on what I was used to doing before surgery-- a no brainer as far as my health and wellbeing was concerned.

Here's to a lifetime of good reports .

Click to expand...

I appreciate you sharing this! I had AVR with artificial valve August 20th. and have had a good recovery but can tell my heart is de-conditioned. If I run/walk on the same day as a cardiac rehab session, I am worn out! My INR has been all over the charts and likely be more stable when I am approved for a home testing machine.

Beach77 said:

I don't want to go for a monitoring program with medicare

Click to expand...

Please help me understand: what is the problem with "a monitoring program with medicare"?

My traditional Medicare insurance gave me a free Coaguchek XS meter through my Coagulation clinic, and they also give me free test strips for weekly testing. I enter my INR in a phone app; then my Coagulation Clinic calls me if we need to change my dose. If my dose does not change, they just enter a short report on my medical system account which is visible to all my health providers and to me.

@3mm I really like my coumadin clinic and how it operates. I don't want to be tied calling in or reporting weekly, then worrying about how many strips I mess up. LOL It's really only a personal choice, the Medicare program works great for many people and if I didn't like my clinic, I would use that. My clinic does a lab draw and within an hour, the doctor knows the results and calls me. I usually go ever 4-6 weeks, sometimes longer (they know I have a meter at home). I trust their results and I do my own test, at home, the same morning, to double check them & my meter.

ncw3642 said:

Hi all!

I just had a follow-up with my cardiologist and at my suggestion he ordered an echo to evaluate any post-surgical changes (I had a mechanical AVR w/ aneurysm repair on June 25th, 2024). For background, 28M very active and asymptomatic prior to surgery.

Disclaimer before I share- I realize that echocardiograms- especially TTE can vary widely depending on who is interpreting/it's not an absolute gold standard for function- but I thought the numbers were interesting. (Bolded are the biggest takeaways for me).

Pre-Surgery (April 2024)
1. Low normal global left ventricular systolic function. Ejection Fraction is estimated at 50-55 %.
2. Normal left ventricular diastolic function. Normal left ventricular cavity size.
3. LV wall thickness is within normal limits.
4. Normal right ventricular systolic function. Normal right ventricular size
5. Probable bicuspid AV. There is probably adequate aortic valve cusp separation. There is no aortic stenosis. Mild to moderate, eccentric aortic valve regurgitation.
6. Normal mitral valve appearance and function. Mitral stenosis is absent. There is no mitral regurgitation.
7. Tricuspid Valve: Normal appearance of the tricuspid leaflets. TR envelope inadequate to estimate RVSP
8. Pulmonic Valve: Pulmonic valve not well visualized. There is no pulmonic stenosis. There is no pulmonic regurgitation.

Right Before Surgery (June 25th, 2024)
1. Mildly decreased left ventricular systolic function estimated at 40-50%
2. Mild Left Ventricular hypokinesis
3. Bicuspid aortic valve with bileaflet prolapse. Mild-moderate eccentric regurgitation
4. Ascending Aorta 4.8cm, Aortic Root 5.1cm

Post-Surgery (October 9th, 2024)
1. Normal global and regional left ventricular systolic function. Ejection Fraction is estimated at 60 %. Normal left ventricular diastolic function. Normal left ventricular cavity size. LV wall thickness is within normal limits.
2. Mitral Valve: Normal appearance of the mitral valve leaflets. There is no mitral regurgitation.
3. Aortic Valve: Mechanical AV prosthesis with. The valve is well seated with no rocking or dehiscence no visible regurgitation or perivalvular leak, normal mean systolic gradient of 7 mmHg.
4. Tricuspid Valve: Grossly normal appearing tricuspid valve. Trace tricuspid regurgitation.
5. Pulmonic Valve: Normal appearance and function of the pulmonic valve.

Takeaways:

• Interesting to see the (estimated) rapid decrease in my EF from 50-55% to 40-50% over the course of 2-months (likely due to the aortic regurgitation) for further reference, my echo in 2022 had an EF of 60%. Also interesting to see the remodeling and recovery of my EF up to 60% 15-weeks post-op.
• The hypokinesis of my LV pre-op and immediately post-op was concerning but appears to have resolved or not be significant at this time.
• Biggest takeaway is that my mechanical valve is seated and working well- not that I would expect different- but that's why I picked it- durability and longevity given my age.
• I am back to lifting (light) weights and running ~1 mile without stopping 4-5 times a week. Any more distance than a mile and I start to feel more fatigued, so I am progressively adjusting my time and distance and keeping a slower than normal pace (for me) at 12 min/mile.
• Day-to-day occupational roles as a physical therapist are going well- no issues lifting patients or being on my feet all day.
• I truly think the sternal plating that my surgeon did assist in my return to work/working out. I feel as if my sternum is very secure and while I don't have a comparison to a normal closing technique, I think if your surgeon is experienced and your anatomy/surgery is a fit, it's worth it to look into and consider.
• Still having occasional PACs where my heart feels like it has an extra beat after my normal heartbeat. Cardiologist said not to be concerned- it's normal and not anything to fix/worry about. Just something to live with.
• Given the OK to wean off my beta blocker (currently on metoprolol tartrate 25mg 2x a day) to 1/2 a dose (12.5mg 2x a day) for a few weeks and if that goes well, off completely. If my BP goes back up above 130/80, he discussed using another agent to manage that was not a beta blocker.
• Around week 9-10, I started to have days where I didn't really worry/think about my surgery or heart. This is still the case to this day where, for the most part, aside from my daily warfarin dose/monitoring I really don't consider the surgery or management. Settling back into a routine.
• The INR clinic I use through my cardiologist is useless in my opinion. I am not approved for a home INR machine yet- so I get weekly blood draws and call that number into the clinic. They always offer the same advice and pushback on any of my self-prescribed formula based dose changes. So I make these changes anyway to keep myself in range- and tell the clinic that I am "totally following their dose recommendations." Also received pushback when I wanted to test weekly instead of every 2-3 weeks.
• On the topic of advocating for yourself- my cardiologist was not going to order an echo to evaluate any postsurgical changes until I brought it up myself to which he "totally agreed." If you want a test run/think it's warranted, don't be afraid to speak up- the results gave me peace of mind and I now don't have to get one for 3-years unless I become symptomatic.

Thanks for taking the time to read my thoughts! Overall, I have zero regrets about choosing the mechanical valve- as for me it made the most sense and has no limitations on what I was used to doing before surgery-- a no brainer as far as my health and wellbeing was concerned.

Here's to a lifetime of good reports .

Click to expand...

Great information. I called one of the home testing websites and it seems they are run on a subscription basis. They told me most insurance will cover it. They said you have to be on Warfarin for 90 days before you can use the at home service. Why are you not approved yet? Is it just an insurance delay? I find it funny that insurance will pay for a long term service, in my husband's case this could be 40 years, but not cover the price of the machine. It would be cheaper in the long term for them to pay for the machine up front, but I guess they are hoping you change carriers or die far before the cost of the machine is met. GRRRR... This sort of peeves me. I hate subscription services.

SatoriFound said:

Great information. I called one of the home testing websites and it seems they are run on a subscription basis. They told me most insurance will cover it. They said you have to be on Warfarin for 90 days before you can use the at home service. Why are you not approved yet? Is it just an insurance delay? I find it funny that insurance will pay for a long term service, in my husband's case this could be 40 years, but not cover the price of the machine. It would be cheaper in the long term for them to pay for the machine up front, but I guess they are hoping you change carriers or die far before the cost of the machine is met. GRRRR... This sort of peeves me. I hate subscription services.

Click to expand...

Funny you said this actually. At my follow-up I discussed that with my doctor and he sent off the referral.

Received a call yesterday from a coag clinic (some offshoot of Abbott)-- explaining the process and how it works.

The horrible part is, it's yes a monthly subscription that covers 4 tests and the machine. Since I hit my deductible this year and my insurance is in network, it would be 68/month. Starting Jan 1st until I hit my deductible again it's 138/month. Which wouldn't be ~terrible~ except for the machine is a loan that you never will actually own. If you stop using their service, you have to ship it back (so it's not even a rent-to-own product). They also take my results and call my doctor... which is something that I can do myself and manage my own INR independent of the clinic.

I will be looking into just contacting Roche independently to see if they offer assistance either through insurance or other aid for the Coagucheck machines and I will look into online retailers for strips.

I don't love the idea of a subscription for life service since I'll likely be using it for (hopefully) 40+ years. I want to be as independent as possible and for the prices they are charging, it does make more financial sense to just purchase the machine and strips myself using a HSA or if they can, through my insurance.

ncw3642 said:

Funny you said this actually. At my follow-up I discussed that with my doctor and he sent off the referral.

Received a call yesterday from a coag clinic (some offshoot of Abbott)-- explaining the process and how it works.

The horrible part is, it's yes a monthly subscription that covers 4 tests and the machine. Since I hit my deductible this year and my insurance is in network, it would be 68/month. Starting Jan 1st until I hit my deductible again it's 138/month. Which wouldn't be ~terrible~ except for the machine is a loan that you never will actually own. If you stop using their service, you have to ship it back (so it's not even a rent-to-own product). They also take my results and call my doctor... which is something that I can do myself and manage my own INR independent of the clinic.

I will be looking into just contacting Roche independently to see if they offer assistance either through insurance or other aid for the Coagucheck machines and I will look into online retailers for strips.

I don't love the idea of a subscription for life service since I'll likely be using it for (hopefully) 40+ years. I want to be as independent as possible and for the prices they are charging, it does make more financial sense to just purchase the machine and strips myself using a HSA or if they can, through my insurance.

Click to expand...

Look at your policy summary for your insurance. I was looking at mine and it says they make a cost/benefit analysis. I think you can also appeal the decision on the durable medical equipment. So if a good presentation is made with a break down of the costs maybe they would go for it? I can argue that at my husband's age he is likely to need this for the next 40 years. LOL I downloaded some pamphlet and as far as a subscription service, there is more than one. I may look at advance cardio care and it looks like Roche may actually offer a service. Not positive. Or I'll just keep watching ebay and hoping I find a good seller. LOL I am so leery of buying something like this there. I have never had a bad experience, long ago I bought a fetal heart doppler device that worked great, but still, I worry about scammers, or people selling things that don't really work.