Any idea what this means?

[Dennis S]

I just ditched my cardiologist who (after 2 weeks) still wasn't able to get back to me with a date that I could see him to schedule the angiogram he said I needed. I have a friend who pulled some strings, and I can see my new guy in 4 days. I just got back from picking up my medical records and wondered if I am righ that I am "ripe" for surgery. It says "modrately severe aortic stenosis with a mean gradient across the aortic valve of 34 mm Hg." "Moderat to moderately severe dilation of the aortic root and ascending thoracic aorta with the ascending aorta measuring 4.8 superior to the sinotubular ridge" "Normal RV size and systolic function".

Any help with translating this to english would be great. Thanks

 

[tobagotwo]

I'd be more interested to hear about your left ventricle than your right. Do you see a mention of left ventricular hypertrophy (LVH), or of hyperdynamics? Enlargement, even concentric, is a sign that your heart is working too hard.

If you have a moderate-to-severe dilation of the aortic root, you likely have aortic regurgitation, a.k.a. insufficiency or leakage, due to distortion of the valve (I give up, Betty. It's common usage now).

You also have moderate-to-severe stenosis, and they are a tough one-two punch for your heart to handle. The calcification makes the leaflets of the valve stiff and hard to open. Then the stenosis makes it harder for your heart to push the blood through the narrowed aortic opening (annulus). And the regurgitation lets part of that hard-pumped blood slide uselessly back into the atrium.

To top it off, your aorta is crowding what many here believe to be a critical size marker (5.0), and your aortic root is becoming questionable.

You may not be deemed completely ripe by all cardiologists, but you are very close, and would certainly qualify with some of them.

Of course you want to set up with your new cardiologist first and get his opinion. But you are at a point where you also want to start your search for an appropriate surgeon with a good and busy track record, even if you decide to hold off the actual surgery for some time.

You also want to make sure your interventional cardiologist has a lot of cath hours under his belt before he does you.

Best wishes,

 

[Dennis S]

Thanks for your answer

Thanks for your answer

That was a big help. I looked for the things you mentioned, and found the following:

"Mild concentric LVH" "The LV is normal sized. The LV is mildly thickened. LV systolic function is normal (EF 55-65%) LV diastolic: there is an abnormal relaxation pattern present (may be normal varient) Regional Wall:there are no regional wall motion abnormalities noted.

Regurgitation: there is a trace amount of aortic insufficiency noted

 

[Harrybaby666]

Morning qtson..

Morning qtson..

That was a big help. I looked for the things you mentioned, and found the following:

"Mild concentric LVH" "The LV is normal sized. The LV is mildly thickened. LV systolic function is normal (EF 55-65%) LV diastolic: there is an abnormal relaxation pattern present (may be normal varient) Regional Wall:there are no regional wall motion abnormalities noted.

I just had to post on this one, because I have the same thing. My heart does not relax properly-brought on by a term called Diastolic Dysfunction, or Hypertrophic Cardiomyopathy" Which is alot less common than Systolic Dysfunction and when you have it, your EF can be in the normal range (or even higher) yet you still have HF.

What the Hypertrophic Cardiomyopathy pertains to is the developement of extra fibers (genetics-inherited) growing in the heart muscle which in turn stiffen the heart muscle therefore, not allowing the muscle to relax properly. The concentric part means that it's uniformly effecting the whole ventrical(s). This is how it was explained to me. I also have valve regurgitation in all 4 of my valves and my aortic valve has some calcification on the leaflets, so I definitely know how you feel.

I hope this helps you with some of your answers. Take Care, Harrybaby

 

[TomS]

Two issues

Two issues

You are about to enter into the land of opinions, including different ones from different doctors. I have had similar numbers and been tracking them.
I am not a doctor but just finished Jeffrey Borer's book on Valvular Heart Disease. He is pretty clear to recommend aortic valve surgery only when there is, or about to be, damage to the heart muscle. This is identified through numbers that are changing or "not normal". Borer is a cardiologist at Columbia Presbyterian in NY.
On the other hand, the root carries a separate risk. You will get different opinions on the risks at 4.8 from different doctors, but I have spoken to at least one surgeon that would see 4.5 plus with AR as risky. Others stick with 5.0 as the threshold. I like to make my own decisions and am looking at the risk data of waiting versus that assoicated with moving forward. Others I know wouldn' wait.
I hope that this helps.
Tom

 

[jax3172]

Independent of the cardi...

Independent of the cardi...

Independent of and concurrent with your appointment with your new cardio, get an appointment with a surgeon who does a whole lot of AV and aortic root work and has a good reputation. Do not wait for the cardio to tell you to go get an opinion from a surgeon. Make the appointment now. IMO.

 

[Dennis S]

Thanks for your answer

Thanks for your answer

I will see what I hope is a good surgeon on Tuesday. "These are the times that try men's souls"

 

[tobagotwo]

"Trace" regurgitation is nearly synonymous with none, actually. It just means that the tech wants the doctor to know that he was paying attention and did see it, but it is without any real impact on the heart. Normal hearts have trace-level regurgitation/insufficiency on and off all the time, and it will come and go on any or all of the valves at various times.

That's a good thing, though. I'm a little surprised, because aortic root dilation is often distorted, but yours isn't interfering with the secure sealing of the valve.

Another good thing is that your ventricle is still within "normal" bounds. The ventricular walls thickening some is to be expected, as your heart is working harder to pump blood through an ever-decreasing aperture. However, the growth/thickening is concentric (meaning it has grown evenly all the way around), and still mild: good signs. Your heart itself is still holding up well, and that bodes well for recovery after surgery. As far as the relaxation abnormality, there are several prospects, as Harry pointed out. It could reasonably also be tied to the heart's other woes, or, as was suggested in the report, a "normal varient."

The root and aorta are concerns, especially so with the more forceful pumping that occurs with stenosis. It's good that you are looking at surgeons. Volume and success rates are key for choosing one. Practice does make perfect in the heart surgery business.

It can be very intimidating to choose a surgeon, as it becomes a big question as to who and what to believe. Numbers help. Recommendations from people who have had the same surgery help. It also helps if you feel confidence after talking to him.

Good luck with this next phase.

Best wishes,

 

[Dennis S]

Appointment

Appointment

I think that is good advice as well. I will see my prospective surgeon this coming Tuesday, and I have obtained copies of my medical records to bring to him. I have some surgeon friends and I have pushed as hard as I can for candid assesments of possible thoracic surgeons. I generally like to proceed slowly and give someone the benefit of the doubt. But I won't be doing that for these decisions.

One thing that I seem to have discovered is that there is no need to be bashful when you are shopping for a place to drop nearly $100,000.00. There seems to be a degree of competition for these cases (even among the top doctors). if I don't make the best choice it won't be for lack of trying, or being too timid!

Independent of and concurrent with your appointment with your new cardio, get an appointment with a surgeon who does a whole lot of AV and aortic root work and has a good reputation. Do not wait for the cardio to tell you to go get an opinion from a surgeon. Make the appointment now. IMO.

 

[ALCapshaw2]

You are in the 'limbo' area where many cardiologists like to take a 'wait and see' approach and many surgeons say "let's get on with it before permanent damage occurs".

I vote with the SURGEONS. They SEE what happens from waiting too long so let them make the call as to when to proceed. What's the value of waiting around a few months until your condition worsens? NO POINT to it.

You're moving in the right direction. Best to have a good and trusted surgeon lined up before your become critical.

'AL Capshaw'

 

[tobagotwo]

More about diastolic dysfunction, and its relationship to AS...

From eMedicine, an article: Aortic Stenosis, Author: James V Talano, MD, Director, Cardiovascular Medicine, SWICFT Institute (bolding mine):
http://www.emedicine.com/med/topic157.htm

"Another consequence in the pathophysiologic response to AS, LV diastolic function commonly is abnormal, resulting in elevated LV filling pressures, which is reflected onto the pulmonary circulation. Diastolic dysfunction occurs as a consequence of both impaired LV relaxation and decreased LV compliance that is caused by increased afterload, a thick noncompliant LV, and relative myocardial ischemia. Chamber stiffness can revert toward normal as LV hypertrophy regresses following relief of valvular obstruction, and in some patients, muscle stiffness also may revert to normal. Extensive myocardial fibrosis develops with long-standing hypertrophy, which may not disappear despite regression of hypertrophy."

Best wishes,