A little help understanding echo report...

firrone79 · Feb 23, 2012

This is the report from my echo 6 months ago, haven't gotten the report from yesterdays yet to compare with. Here goes.

2.4 right ventricle
1.0 septal thickness (0.8-1.1cm)
3.9 left ventricle (d) (3.6-5.3cm)
2.1 left ventricle (s)
0.9 posterior wall (0.8-1.1cm)
2.9 aortic root (2.1-3.7cm)
2.0 left atrium (2.1-3.7cm)

quatntitative
peak velocity (m/sec) 2.4 (av) 1.1 (lvot)
peak gradient (mm Hg) 24 (av)
mean velocity (m/sec)
mean gradient (mm Hg) 14 (av)
valve area (cm2)
est. rvsp (mm Hg)

echocardiographic images:
interpretation:
1. normal lv wall thickness.
2. normal wall motion with overall normal lv systolic function. estimated ef around 60%-65%.
3. normal cardiac chamber size. ra, rv, lv and aortic root are normal in size.
4. aortic valve is bicuspid. mitral, tricuspid and pulmonic valves are normal.
6. no pericardial effusion noted. no clots or thrombus noted in the cardia chambers.

Doppler:
full doppler and color flow doppler across the valve shows trace tr. mitral inflow doppler shows e/a ratio of 0.9 and e wave deceleration time of 287 msec. tissue doppler shows s' velocity of 8 cm/sec. (end of first page)
(there is a part of the scan missing but second page starts) of 24 and mean of 14 mmHg across the aortic valve. Calculated aortic valve area is 1.4-1.6 cm2

overall impression:
1. technically difficult study
2. normal lv wall thickness.
3. normal wall motion with overall normal lv systolic function. estimated ef around 60%-65%.
4. bicuspid aortic valve.
5. normal cardiac chamber size.
6. color flow doppler across the valves shows trace tr.
7. doppler evidence of lv diastolic dysfunction.
8. there was a gradient of 24 mmHg across the aortic valve however in short-axis views and subcostal views the aortic valve opens very well. I do not see any evidence of aortic stenosis or fusion of the aortic valve cusp.

Sorry for the long post. But what does all this mean? Also I don't understand the # 6 and 7 in overall impression either! Thank you for looking and for any input given!

themalteser · Feb 23, 2012

Everything looks great to me. You have BAV (2 leaflet aortic valve rather than 3) but rest is all normal. Valve is competent, aorta seems good.

No. 6. Means you have a trace tricuspid regurgitation, which basically is nothing, everyone could potentially have trace to mild regurgitation.
No. 7. Possibly check further on this as Left Ventricular Diastolic Dysfunction, which is the phase when the heart is filled (rather then systolic - pushed out) could need some attention.

Furthermore, I note that your Aortic valve peak velocity is 2.4 m/sec, this could be mild stenosis of the valve, as in normals the velocity is 1.0m/sec. Possibly check this swell as the technician later said that there is no evidence of stenosis, but again he said that it was technically difficult study.

I am not a medical professional, this is just general knowledge I gained throughout a couple of years researching about my condition, so any questions I suggest you speak with your cardiologist.

Cheers.

firrone79 · Feb 23, 2012

Thank you! The cardio I saw yesterday told me that he saw mild narrowing in the echo from yesterday. He didn't used the term stenosis, but I assumed that was what he meant. I am interested to see the difference between this one I posted here and the one from yesterday. Seeing as I am so new into my diagnosis of BAV I am trying to learn what is what in regards to everything. Thank you for giving your opinion on that echo though! I am going to make an appt with my cardio soon and have my aunt go with me so that we can discuss everything. She knows more medical words than I do and knows what questions should be asked, where I don't know what to ask him and when I do I don't fully comprehend what he is saying.

themalteser · Feb 23, 2012

Hi Fiona, it’s a pleasure.

Mild narrowing is the same as stenosis.

firrone79 · Feb 27, 2012

Ok got my results from my echo last week (Feb 22) and the layout and wording is so much different from my first one. So again at a loss as to what it all means and what I look at in regards to my BAV. So here goes:

Conclusions:
1. Normal chamber sizes
2. mild left ventricular hypertrophy
3. normal lv systolic function
3. bicuspid aortic valve with mild stenosis, gradients 28/15 mm Hg
4. trace mitral/tricuspid regurgitation

Comments:
1. The left ventricular systolic function is normal with an ejection fraction of 60%-65%
2. The left ventricular cavity size is normal. There is mild left ventricular hypertrophy
3. Normal diastolic function
4. The left atrial size is normal
5. The right ventricular size is normal. Thei right ventricular function is normal.
6. The right atrial size is normal
7. The mitral valve is morphologically normal. Only trivial mitral regurgitation is seen. There is no significant mitral stenosis demonstrated.
8. There is mild aortic stenosis. There is no aortic regurgitation. The aortic valve appears to be bicuspid
9. There is trace tricuspid regurgitation seen
10. There is no pulmonic stenosis demonstrated
11. The pulmonary artery is normal in size
12. The visualized portion of the aortic root is normal
13. Normal inferior vena cava
14. There is no pericardial effusion seen

Measurements:
2D echo
LV diastolic diameter base LX- 4.1cm (3.9-5.9)
LV systolic diameter base LX- 2.8cm (2.1-4.0)
Fractional shortening base LX- .32 (0.27-0.47)
IVS diastolic thickness- 1.3cm (0.6-1.1)
LVPW diastolic thickness- 1.1cm (0.6-1.1)
LA systolic diameter LX- 2.9cm (2.7-4.0)

Doppler
AV mean gradient- 15mmHg
AV velocity time integral- 52.3cm
LVOT peak gradient- 5mmHg
Mitral E point velocity- 106cm/s
Mitral A point velocity- 94.8cm/s
Mitral E to A ratio- 1.1
Mv deceleration time- 271ms
RA pressure (entered value)- 5mmHg
TR peak velocity- 217cm/s
TR peak gradient- 18.8mmHg
RV systolic pressure- 23.8mmHg

Mentu · Feb 27, 2012

Welcome to VR. What I take away from these two reports is that you probably have mild aortic stenosis that is beginning to change some of the measured values away from normal. The issues that are easiest to follow with respect to your aortic valve are:

1. "mean gradient (mm Hg) 14 (av)"
- the aortic valve's mean pressure gradient is 14 millimeters of mercury.
"a gradient of 24 mmHg across the aortic valve"
- The aortic valve's peak pressure gradient is 24 millimeters of mercury.
(In a normal valve the pressure gradient is zero or near zero.)

2. "There is mild aortic stenosis" indicated by the first report which includes this measurement "Calculated aortic valve area is 1.4-1.6 cm2"

(In a normal valve the valve area should be closer to 2.5 cm2.)

3. The "aortic valve appears to be bicuspid"
- You appear to have an aortic valve with two leaflets
instead of the normal three.

Essentially your heart seems to be pretty normal although there is beginning to be some indication that aortic stenosis is present. The "Calculated valve area" is reduced, thus, the mild stenosis. The "mild stenosis" or narrowing of the aortic valve appears to be causing the pressure gradient but the measurement of the pressure gradient has shown no measurable change between the two test. This should mean that your condition is stable for now which is very typical. As time passes and you receive more reports, you will want to check to see if these baseline values are changing. If your valve area and the pressure gradients remain about the same, your doctor will probably tell you to continue the program of regular checks to monitor the state of your heart.

To the best of my knowledge, aortic stenosis can only be treated by replacing the valve so there are no medications at present that can help. You doctor will likely pay more attention to your blood pressure and cholesterol as a means of helping you stay as healthy as possible. In the event your values begin to change, there should be ample time to discuss treatment. Many of us lived with mild aortic stenosis for years or decades before our valve became a problem. For you, it is something to be watched; its possible your values will never change. If they do, you should have plenty of warning.

Larry