Croatian New member-severe aortic stenosis?

Hi. First, sorry on my English. Learned in elementary school. Have problem with grammar..

I am from Croatia. 46 years old male.We don't have any good forums about heart valves.



I have sistematic check for new job and they heard murmur in my heart for the first time in my life. Done 2 ultrasounds. Same results but first one with unclear aortic valve morphology? Second one was biscupspis valves? They sand me to TEE exam. Waiting for list. I don't have simptoms. Few months ago I benched 80 kg, and doing some bodybuilding. Hard training. I am fit. Few cigarettes weekly and few beers,maybe

Never been sick in my life.



My ultrasound results:

AVA 0,5 cm

Vmax 5,3 m/s

PPG 113 mmHg

LV ejection fraction 56%

Aorta is ok and aortic root is ok.



I walk every day 4,5 km...about 3 miles. I am ok. No short breathe, no pain, feel ok.

They say I have one year maybe if I do not change valves?
This is pict of my ultrasound? What is white accumulations in middle?

Any conclusions? Tnx

Welcome to the forum, I hope you will find it helpful.

Yes that AVA indicates severe stenosis and I’m not surprised they’re ordering a TEE and assuming results are confirmed, valve surgery.

Hello! I hope this forum is useful for you.

kobaha21 said:

Hard training. I am fit.

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I was very fit and I trained hard even after I had a damaged mitral valve and a very damaged aortic valve. I was shocked when a cardiologist told me I needed heart surgery. The cardiologist also said that my heart was becoming more damaged the longer I waited before having surgery, so he recommended having the surgery soon.

I am very glad that I had my mitral valve repaired and a mechanical On-X aortic valve installed, on September 14, 2023.

I pray that everything goes well for you. It will; many people have these surgeries every day, and they all do well. Keep us informed!

Hi and welcome to VR.

kobaha21 said:

My ultrasound results:

AVA 0,5 cm

Vmax 5,3 m/s

Click to expand...

Per your reported results, this would indicate that it is time for surgery. Your AVA is very small, at only 0.5cm2. This would indicate not just severe stenosis, but critical. Your Vmax would be consistent with severe AS. It is considered severe once it is above 4.0m/s, so you are well into the severe category by this metric. Also, in the image you attached, it indicated that your mean PG is 67.5mmHg. This would also be consistent with severe aortic stenosis, as it is severe once mPG is over 40mmHg. So, you have 3 metrics which would all indicate that you are severe and all would be in agreement that you are well into the severe territory, not just borderline.

kobaha21 said:

They say I have one year maybe if I do not change valves?

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Glad that they are being straight with you. Based on all that you have said, and the data which you provided, they are correct in that it is time for surgery. Don't wait for symptoms with your valve that stenotic. You want to get your surgery done as soon as they can get you in.

kobaha21 said:

They sand me to TEE exam

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This will be more data to confirm your first echo. TEE also gets a better look at the aorta to check for aneurysms. Aneurysms are common for those with bicuspid valves and if you have one of significant size, they will likely want to also take care of that when they do your valve surgery.

Please keep us posted and let us know what the results are from your TEE.

The good news is that the surgery to replace your aortic valve and fix your aortic stenosis is a low risk procedure theses days.

To prep for surgery, I would strongly encourage you to stop smoking and go into it in the best physical health posible.


Wishing you the best of luck in getting scheduled soon and in your upcoming procedure.

Chuck C said:

Hi and welcome to VR.


Per your reported results, this would indicate that it is time for surgery. Your AVA is very small, at only 0.5cm2. This would indicate not just severe stenosis, but critical. Your Vmax would be consistent with severe AS. It is considered severe once it is above 4.0m/s, so you are well into the severe category by this metric.


Glad that they are being straight with you. Based on all that you have said, it is time for surgery. Don't wait for symptoms with your valve that stenotic.


This will be more data to confirm your first echo. TEE also gets a better look at the aorta to check for aneurysms. Aneurysms are common for those with bicuspid valves and if you have one of significant size, they will likely want to also take care of that when they do your valve surgery.

Please keep us posted and let us know what the results are from your TEE.

The good news is that the surgery to replace your aortic valve and fix your aortic stenosis is a low risk procedure theses days.

To prep for surgery, I would strongly encourage you to stop smoking and go into it in the best physical health posible.


Wishing you the best of luck in getting scheduled soon and in your upcoming procedure.

Click to expand...

Thx. Very much. I need every info about it. I am really ok and working and walking 3,4

Chuck C said:

Hi and welcome to VR.


Per your reported results, this would indicate that it is time for surgery. Your AVA is very small, at only 0.5cm2. This would indicate not just severe stenosis, but critical. Your Vmax would be consistent with severe AS. It is considered severe once it is above 4.0m/s, so you are well into the severe category by this metric. Also, in the image you attached, it indicated that your mean PG is 67.5mmHg. This would also be consistent with severe aortic stenosis, as it is severe once mPG is over 40mmHg. So, you have 3 metrics which would all indicate that you are severe and all would be in agreement that you are well into the severe territory, not just borderline.


Glad that they are being straight with you. Based on all that you have said, and the data which you provided, they are correct in that it is time for surgery. Don't wait for symptoms with your valve that stenotic. You want to get your surgery done as soon as they can get you in.


This will be more data to confirm your first echo. TEE also gets a better look at the aorta to check for aneurysms. Aneurysms are common for those with bicuspid valves and if you have one of significant size, they will likely want to also take care of that when they do your valve surgery.

Please keep us posted and let us know what the results are from your TEE.

The good news is that the surgery to replace your aortic valve and fix your aortic stenosis is a low risk procedure theses days.

To prep for surgery, I would strongly encourage you to stop smoking and go into it in the best physical health posible.


Wishing you the best of luck in getting scheduled soon and in your upcoming procedure.

Click to expand...

Tnx. Very much. Every info is good. I have option for pay TAVR about 7000 E. If I can I will do that.

kobaha21 said:

Thx. Very much. I need every info about it. I am really ok and working and walking 3,4

Tnx. Very much. Every info is good. I have option for pay TAVR about 7000 E. If I can I will do that.

Click to expand...

TAVI, sorry.

3mm said:

Hello! I hope this forum is useful for you.

I was very fit and I trained hard even after I had a damaged mitral valve and a very damaged aortic valve. I was shocked when a cardiologist told me I needed heart surgery. The cardiologist also said that my heart was becoming more damaged the longer I waited before having surgery, so he recommended having the surgery soon.

I am very glad that I had my mitral valve repaired and a mechanical On-X aortic valve installed, on September 14, 2023.

I pray that everything goes well for you. It will; many people have these surgeries every day, and they all do well. Keep us informed!

Click to expand...

Thx. I will inform.

kobaha21 said:

I have option for pay TAVR about 7000 E. If I can I will do that.

Click to expand...

kobaha21 - TAVI and TAVR are generally recommended for people over age 65. I see that you are 46, so I urge you to research all of your options if you do need valve surgery. There are several threads on the forum which contain information and links to articles, videos, and reports written by medical experts. Earlier you said that English is not your main language, so if you are having trouble understanding any information about heart valves, then ask questions in this forum and we'll try to help answer.

kobaha21 said:

Hi. First, sorry on my English. Learned in elementary school. Have problem with grammar..

I am from Croatia. 46 years old male.We don't have any good forums about heart valves.



I have sistematic check for new job and they heard murmur in my heart for the first time in my life. Done 2 ultrasounds. Same results but first one with unclear aortic valve morphology? Second one was biscupspis valves? They sand me to TEE exam. Waiting for list. I don't have simptoms. Few months ago I benched 80 kg, and doing some bodybuilding. Hard training. I am fit. Few cigarettes weekly and few beers,maybe

Never been sick in my life.



My ultrasound results:

AVA 0,5 cm

Vmax 5,3 m/s

PPG 113 mmHg

LV ejection fraction 56%

Aorta is ok and aortic root is ok.



I walk every day 4,5 km...about 3 miles. I am ok. No short breathe, no pain, feel ok.

They say I have one year maybe if I do not change valves?
This is pict of my ultrasound? What is white accumulations in middle?

Any conclusions? Tnx

Click to expand...

Those numbers are quite severe, I am surprised you have no symptoms. Since bicuspid valve is a congenital condition I would think it is possible that certain things could change so slowly you don't notice, such as if you are breathing harder when exerting yourself, or getting fatigued quicker?

My husband initially went to the doctor for general fatigue. That was the only symptom he could truly discern. He had chest discomfort off and on, but that had been happening for years, and he didn't think it was a big deal since it wasn't actual pain, just a sort of pressure. He was at moderate stenosis when he found out, within a year and a half it had progressed to severe. His ava was .98, the doctor said that is the size of a pencil eraser, so your opening at .5 is about half that. I believe he said a normal aortic valve opening is about the size of a quarter. He worked out at least 3 times a week, usually 5 and hadn't noticed changes to his workout either. He also had a bicuspid valve. I say had because two weeks ago he went through valve replacement surgery and now has a St. Jude's mechanical valve. It's been quite the wild ride.

I am glad you found this site. It is an amazing resource for information and support. I would second the previous poster in saying research all your options at this stage, not just biological valves and make the decision that is best for you. My husband did not want the added risk of a second surgery later on, possibly a third after that. He is 51. You will know more after your TEE. If there is an accompanying aortic aneurysm that needs to be repaired immediately you will have to undergo open-heart surgery anyway. While you may be fine, aortic aneurysms are quite common in those with bicuspid aortic valves (BAV).

Good luck to you in your journey!

Good morning and welcome

kobaha21 said:

Hi. First, sorry on my English. Learned in elementary school. Have problem with grammar..

Click to expand...

I'm Australian, the English tell me I don't speak English properly ... at the end of the day as long as we understand each other it pretty much doesn't matter

I am from Croatia. 46 years old male.We don't have any good forums about heart valves.

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Noted, as an Australian we don't have one either; however I prefer this international one.

I have sistematic check for new job and they heard murmur in my heart for the first time in my life.

Click to expand...

good it was found before it got to the stage that you were irrepariably injured by this "betrayal of you by your body".

So that's good news.

Done 2 ultrasounds.... I don't have simptoms.

Click to expand...

that's good, so best recovery from surgery is more likely.

Few months ago I benched 80 kg, and doing some bodybuilding. Hard training. I am fit. Few cigarettes weekly and few beers,maybe

Click to expand...

give up the bench for the moment ... exersize is for health (not vanity IMO) and so health is not served well by injury or death. You can get back into it later.

Never been sick in my life.

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that's fortunate ... what with COVID and everything

Aorta is ok and aortic root is ok.

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excellent

I walk every day 4,5 km...about 3 miles. I am ok. No short breathe, no pain, feel ok.

Click to expand...

good, and walking is excellent exersize for health.

They say I have one year maybe if I do not change valves?

Click to expand...

I assume this means that if you don't get it changed then you'll be dead in a year. That is to be avoided IMO.

Modern views tend towards getting the surgery done earlier before becoming symptomatic ... I would strongly recommend you read and do your best to understand this thread:

https://www.valvereplacement.org/th...re-vs-waiting-for-symptoms.888781/post-920179

This is pict of my ultrasound? What is white accumulations in middle?

Any conclusions? Tnx

Click to expand...

sorry, I'm not really one to interpret those results, myself I've always left that to professionals. I mainly try to assist those who need to manage Anti Coagulation Therapy (ACT or "blood thinners" ) that comes as a package deal with a mechanical valve. As you are in Croatia and as you are not yet 65 I'm pretty sure you'll get

1. a mechanical valve to replace your diseased one
2. Acitrom as your ACT

I've worked with a few people from that area and I can assist you with that when that time comes (if you seek such a thing).

If you are in the mood for some reading I've put up my experiences, some data from studies and some opinions here:

https://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

HTH

Welcome aboard and I hope they give you surgery sooner than later.

Best Wishes

kobaha21 said:

Tnx. Very much. Every info is good. I have option for pay TAVR about 7000 E. If I can I will do that.

Click to expand...

You're looking at TAVR at age 46? I would give that more thought and do some due diligence on that choice, including getting a second opinion, if that is possible. I know that everyone wants to avoid OHS, but at this point TAVR is more appropriate for elderly individuals for whom OHS would be high risk. The problem is that young patients go through TAVR valves much faster than the elderly and after TAVR, the next procedure is much higher risk.
If you go TAVR, at some point, possibly relatively soon, they will still need to do OHS when the TAVR fails and that OHS following TAVR is a much higher risk procedure.

They might be able to do TAVR inside TAVR for procedure #2, but that would leave you with a very small aortic valve area and very low cardiac output. And, even if you were eligible for TAVR on procedure #2, when that wears out, and it will, you will still be facing OHS for procedure #3.

kobaha21 said:

. I have option for pay TAVR about 7000 E. If I can I will do that.

Click to expand...

my advice at your age is "that would be a very bad decision" because they are simply not durable.

When that fails (not if) what do you do then? Have a more complicated surgery?

https://www.sts.org/press-releases/...60-years-choose-tavr-over-savr-worse-outcomes


Now, if you think you only have 5 years left to live then TAVR is probably the best choice. However if you expect 10 or more years then SAVR is the way to go.

See past the fog of shock to what you want to be doing in 15 years and how many surgeries you want to have in that time.

another article covering this topic in more breadth and depth

https://www.sciencedirect.com/science/article/pii/S0735109717387740

Abstract​

a very good read ... take your time. Read it as if your future health depends on understanding it.

IMO anyone who will perform a TAVR on you is practicing malpractice.

Note: I'm Australian, I'm male and I'm Gen-X ... so expect all that in my communication and my honesty.


Best Wishes

3mm said:

kobaha21 - TAVI and TAVR are generally recommended for people over age 65. I see that you are 46, so I urge you to research all of your options if you do need valve surgery. There are several threads on the forum which contain information and links to articles, videos, and reports written by medical experts. Earlier you said that English is not your main language, so if you are having trouble understanding any information about heart valves, then ask questions in this forum and we'll try to help answer.

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Tnx. Not my main language but I understand 90% what I need. Yes I know that TAVR is for older people who are at risk for open surgery but in Belgrade in Dedinje hospital if you pay you get the TAVR procedure! Dr. Ivan Stojanovic. You have it on you tube. I will pay every euro if I can.

Chuck C said:

You're looking at TAVR at age 46? I would give that more thought and do some due diligence on that choice, including getting a second opinion, if that is possible. I know that everyone wants to avoid OHS, but at this point TAVR is more appropriate for elderly individuals for whom OHS would be high risk. The problem is that young patients go through TAVR valves much faster than the elderly and after TAVR, the next procedure is much higher risk.
If you go TAVR, at some point, possibly relatively soon, they will still need to do OHS when the TAVR fails and that OHS following TAVR is a much higher risk procedure.

They might be able to do TAVR inside TAVR for procedure #2, but that would leave you with a very small aortic valve area and very low cardiac output. And, even if you were eligible for TAVR on procedure #2, when that wears out, and it will, you will still be facing OHS for procedure #3.

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Well, I buy for my self 10 or 15 years with TAVR and who knows...Why do OHS and risk not to wake up from surgery. Who knows what will be with the world in 10 or 15 years.. Don't think that much long. Live day by day.
TAVR is non invasion one hour procedure. Why not for 7000E?

pellicle said:

another article covering this topic in more breadth and depth

https://www.sciencedirect.com/science/article/pii/S0735109717387740

Abstract​

In recent times, there has been a considerable increase in the use of aortic bioprostheses (vs. mechanical prostheses) for treating aortic valve disease, and this tendency is likely to continue in the near future. However, the occurrence of structural valve degeneration, limiting valve durability, remains an important drawback of surgical and transcatheter bioprostheses. In this paper, we provide an overview of bioprosthetic valve durability, focusing on the definition, incidence, mechanisms, predictive factors, and management of structural degeneration of aortic bioprostheses.​

a very good read ... take your time. Read it as if your future health depends on understanding it.

IMO anyone who will perform a TAVR on you is practicing malpractice.

Note: I'm Australian, I'm male and I'm Gen-X ... so expect all that in my communication and my honesty.

View attachment 890625

Best Wishes

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Tnx. I will read it

kobaha21 said:

r my self 10 or 15 years with TAVR

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statistically more like 5 ~ 10 years ... then what? You can't take it out, so its either put another in over the top of the old one or surgery to take it out ... more complex surgery.

How important is it to go against every medical guideline to kick the can down the road?

To be clear I neither suffer not benefit from anything that happens to you. I only hope that if you do take TAVR you have the bravery to follow up what happens to you here.

Best wishes

kobaha21 said:

Well, I buy for my self 10 or 15 years with TAVR and who knows.

Click to expand...

kobaha21 said:

Who knows what will be with the world in 10 or 15 years.. Don't think that much long. Live day by day.

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I understand. Young people often do not ever believe that they will grow old one day. Just consider that the TAVR may very well only last 5 to 10 years and not 10-15. They have very little data on younger patients with TAVR, but young patients go through them faster. Are they telling you to expect 10 to 15 years? If so, I question that guidance.
I totally get the concept of living day to day and wanting to avoid OHS in the short term. But, bear in mind, that you might end up being in your 50s and wishing that you had thought 20 to 40 years ahead, instead of 5 or 10. You're 46 and have a potential long life ahead of you

Regardless, the choice is 100% yours. I would just encourage you to give it a lot of thought before getting set on TAVR.

pellicle said:

my advice at your age is "that would be a very bad decision" because they are simply not durable.

When that fails (not if) what do you do then? Have a more complicated surgery?

https://www.sts.org/press-releases/...60-years-choose-tavr-over-savr-worse-outcomes

From a pool of 37,011 patients, the study identified 2,360 patients under the age of 60 years who underwent these procedures with 22% receiving TAVR and 78% SAVR. By 2021 almost half of patients younger than 60 years were receiving TAVR rather than SAVR. The research team followed these patients for a median time of 2.4 years after TAVR and 4.9 years after SAVR to assess their outcomes.​

​

The primary focus was on 5-year survival rates. Secondary outcomes included rates of reoperation, infective endocarditis, stroke, and hospital admissions for heart failure. Propensity score matching ensured a fair comparison of 358 pairs of patients, balancing factors such as age, major health conditions, hospital volume, and urgency.​

​

While the 30-day mortality rates were similar (0.2% for SAVR vs. 0.4% for TAVR), the 5-year survival rate was significantly better after surgery compared to TAVR (98% vs. 86%, p < 0.001). For secondary outcomes, there was no significant difference between the two groups.​

Now, if you think you only have 5 years left to live then TAVR is probably the best choice. However if you expect 10 or more years then SAVR is the way to go.

See past the fog of shock to what you want to be doing in 15 years and how many surgeries you want to have in that time.

Click to expand...

It is hard for me. I am scary of open heart surgery and TAVR is revolution. Arnold Swarzzeneger have 2 surgery's in 20 years. I don't mind that. Just want to avoid open heart surgery. I must decide. I will read more stuff. Thank all of you for info's.

kobaha21 said:

but in Belgrade in Dedinje hospital if you pay you get the TAVR procedure! Dr. Ivan Stojanovic. You have it on you tube. I will pay every euro if I can.

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can I ask why?

I mean why pay to have someone cause you short term benefit and long term harm?