Abnormal Echo

[tobagotwo]

Both Bob and MMarshall, if you don't mind...

Just to be clear, is the root expansion within the original aortic root, or the part of the root included in the Freestyle valve? They can be installed with or without the root portion.

Thank you,

 

[Superbob]

Both Bob and MMarshall, if you don't mind...

Just to be clear, is the root expansion within the original aortic root, or the part of the root included in the Freestyle valve? They can be installed with or without the root portion.

Thank you,

Bob, excellent question. Hasn't been explained to me yet; in fact the root expansion hasn't been confirmed, though the echo indicated it. All that the echo tech's report states is that aortic root is dilated "by M-mode measuring 4.22 cm and 4.92 cm by 2D evaluation." Hope to get CAT results and more details soon.

 

[Lynlw]

Both Bob and MMarshall, if you don't mind...

Just to be clear, is the root expansion within the original aortic root, or the part of the root included in the Freestyle valve? They can be installed with or without the root portion.

Thank you,

Thanks you phrased my question much better than me

 

[mmarshall]

Both Bob and MMarshall, if you don't mind...

Just to be clear, is the root expansion within the original aortic root, or the part of the root included in the Freestyle valve? They can be installed with or without the root portion.

Thank you,

Bob,

I got a 29mm Medtronics Freestyle Aortic Root Heart Valve installed and from the all of the research that I did 4.5 years ago, the aortic root was replaced as well, not just the valve. I am in the process of getting the results of that last echo and will get a copy of the one I will have tomorrow, but as of right now, I am not sure if it is the Medtronics root that is expanding or the aorta right above the root. I probably will not have that info until next week.

 

[tobagotwo]

Sorry, Lyn...that post was written, but not sent, and I saw it sitting there unsent on the PC hours later and just sent it without looking. I didn't realize you had posted that question in the meantime, and wasn't trying to rephase what you had sent.

I asked about the root because for a while, it was popular with some surgeons to modify the Freestyle (which is within the manufacturer's intent, thus the name) to use it as just a stentless replacement for the aortic valve. The amount of aorta that would be replaced by that would be quite minimal, and wouldn't really count as a root replacement.

Part of the problem is the definition of "root," which is used quite flexibly by cardiologists. It's a sort of movable feast, which starts at the business end of the aortic valve and goes up the ascending aorta as far as the cardiologist wants it to, but not past the first major feed (the Truncus brachiocephalicus, which feeds the right side of the head and neck, and the right arm).

The greatest likelihood is that the expansion (if any) is at or just above the jointure of the root segment of the valve and the remaining ascending aorta. That's the area that's most likely to have been disturbed, if that's part of the causation.

Best wishes,

 

[Lynlw]

Sorry, Lyn...that post was written, but not sent, and I saw it sitting there unsent on the PC hours later and just sent it without looking. I didn't realize you had posted that question in the meantime, and wasn't trying to rephase what you had sent.

I asked about the root because for a while, it was popular with some surgeons to modify the Freestyle (which is within the manufacturer's intent, thus the name) to use it as just a stentless replacement for the aortic valve. The amount of aorta that would be replaced by that would be quite minimal, and wouldn't really count as a root replacement.

Part of the problem is the definition of "root," which is used quite flexibly by cardiologists. It's a sort of movable feast, which starts at the business end of the aortic valve and goes up the ascending aorta as far as the cardiologist wants it to, but not past the first major feed (the Truncus brachiocephalicus, which feeds the right side of the head and neck, and the right arm).

The greatest likelihood is that the expansion (if any) is at or just above the jointure of the root segment of the valve and the remaining ascending aorta. That's the area that's most likely to have been disturbed, if that's part of the causation.

Best wishes,

I was seriously glad you posted it, since your question made much more sense than mine. I was tring to figure out if it was in the replaced part or the tissue just above that.

 

[Superbob]

Okay, dear friends, my cardio's office hasn't called back yet, but my great GP, who was cc-ed on the CAT results, was able to tell me just now I have a 5.1 cm aneurysm of the aortic root. (That's worse than what the echo showed.) I do not know yet if it was in the portion of the root that was replaced in 2005 or, more likely, just above it.

Obviously, this is not good news. A thousand things are running through my head. I need to get these results to my surgeon and perhaps former cardio in Northern Virginia.

I can't imagine going through all this again. I don't even know if re-surgery is doable or recommended. At this point, I honestly don't think it has anything to do with the choice of device I made 4 1/2 years ago.

Okay, now my cardio has called, and his recommendation is to have a follow-up echo in 6 months, and see if there has been any change. I am going to gather all the records and see what others may advise.

Any and all good thoughts or prayers are welcomed.

 

[kfay]

Bob, I'm sorry to hear that. I would definitely seek second opinions, especially from the original surgeon. I don't know how comfortable I would be sitting on something like that for 6 months. I wish you the best and will keep you in my thoughts.

Kim

 

[bvdr]

Bob, I hate to read this! I'm with you about gathering up your records and getting a second. With the possible rapidity of change you seem to have had I think waiting 6 months would be almost reckless INMO.

 

[Bina]

Oh boy, I would be calling or having a meeting with the surgeon who did the original work.
Breathe deep, relax, and keep us in the loop.

 

[Lily]

This is just awful news. 6 months seems a long time to wait for a f/u.
What size was it the last time they looked? And when was that? So has it rapidly enlarged?
No straining and no weights right now, right?
You have my very best wishes.

 

[njean]

Whoa, I'm so sorry you're going thru this Superbob! I'm sure that you are freaking out about this!

I also don't think that I'd be willing to wait 6 more months to wait & see where it is......it's time for a 2nd opinion!

Prayers going out to you & wishing you the best!

 

[Superbob]

This is just awful news. 6 months seems a long time to wait for a f/u.
What size was it the last time they looked? And when was that? So has it rapidly enlarged?
No straining and no weights right now, right?
You have my very best wishes.

Won't lift anything heavier than a Coors Light. Promise.

On echos, it was 4.0 in 2006, 3.6 in 2008, then 4.22 and/or 4.92 (depending on type of measurement) two weeks ago. Now, the CAT is 5.1 -- but I don't know if the echos all along were giving a low result, and now the CAT is a dose of reality, or what.

I am gathering up all the records tomorrow, and contacting all the docs who went through this with me in '05. Medical care here generally seems good, but I don't have a level of trust yet with the cardio.

 

[Freddie]

Oh yes indeed, get them medical records, cause around here (in my province) they get destroyed in 7 years if you hadn't kept up with your yearly appointments with the same doctor.

Thinking of you.

 

[Duffey]

Won't lift anything heavier than a Coors Light. Promise.

On echos, it was 4.0 in 2006, 3.6 in 2008, then 4.22 and/or 4.92 (depending on type of measurement) two weeks ago. Now, the CAT is 5.1 -- but I don't know if the echos all along were giving a low result, and now the CAT is a dose of reality, or what.

I am gathering up all the records tomorrow, and contacting all the docs who went through this with me in '05. Medical care here generally seems good, but I don't have a level of trust yet with the cardio.

I'll be watching for an update. In the meantime, Superbob, don't go rescuing damsels in distress.

 

[tobagotwo]

I believe it's most likely that the aneurysm is a result of weakness that occurred after or as a result of the surgery, not the particular valve. As was pointed out before, this is not as uncommon as it ought to be. It would be worth it to make sure by getting that information, though

Either way, you're the one stuck with it. You can be sure that my thoughts are with you. It's no more fun doing it the secod time, and it's worse having it hanging over you.

I also agree that 6 months may be excessive, as the speed of expansion hasn't been determined yet. Note that 4.92 cm and 5.1 cm are not much different. It's smaller than the "b" in Superbob at 10 point pitch. That second echo wasn't far from the CT scan.

Best wishes,

 

[mmarshall]

Sorry to hear that the results did not turn out the way we wanted. I will let you know what my echo results are when I get them. If it is the same for me as well, I'm sure my cardio will want to do a CT to get a better reading on it.
However, I will probably put the CT scan off until the first of the year since my deductible is $3K and CT scans are not covered for office visits. I rather look at having surgery sometime in 2010 and hit everything at once then to not hit my deductible this year without surgery, and then have my deductible start all over again in a couple of months.

 

[ShezaGirlie]

Oh Superbob, I'm so sorry you have this stress at present. The good part is you're proactive and knowledgeable and will get to the bottom of it all ASAP.

And mmarshall, I regret that your insurance dictates your health care at present.. It's enough to worry about our health, isn't it..

All the best to both of y'all.

 

[Superbob]

MMarshall, good luck on your echo tomorrow and possible follow-up CAT. Hope you get good results and don't have further surgery in your future.

To all of you who have posted your thoughts and concerns, you are the best! A big heart-felt thanks!

 

[Lionheart]

SuperDuperBob,

Sending you only positive thoughts, SUPER prayers, and a case of Coors lite made with Rocky Mountain spring water.

John