Aortic valve Regurgitation, mm Hg numbers

[d333gs]

Hi everyone,
I guess you would say I am new to the waiting room:
I am 63, I have Aortic valve Regurgitation, think I was born with it .I went to see a cardio as part of a general check up , and got a 37 mmHg number.Cardio said
when it hits 40 mmGh it is time for OHS. I have been very active in tennis and fast cross country walking. No symptoms and always felt good afterwards.
To say the least I am worried about recovery time more than the surgery which seem to be almost routine.
Is there any one out there, in the same waiting room, with Aortic valve Regurgitation with similar numbers?
John

 

[NotHuman]

I have a mean gradient of 25mmHg that is getting worse so I'll be in your boat soon unfortunately. I am looking into getting "Minimally Invasive Aortic Valve Replacement" which is also known as keyhole. I am only 32 so I don't want TAVR since the valve won't last long with me being very active. Don't settle for OHS if you don't have to. Doctors usually won't suggest easier surgeries unless you say something.

 

[d333gs]

I am still here ........ I am very active,....... I think, .........2hr rigorous walk /jog a day needing shower and cloths wash after each session .......feel great , no symptoms ........... just had my cardio check-up and my mean gradient is 48!!?? I have an appointment at the end of the month with another cardio . Anyone out there in a similar situation?

 

[PAN]

Hi,

My last echo report shows mean pressure of 38mmHg. Peak was 65 and max average 58mmHg. Recent TOE gave me a free upgrade to severe regurgitation. Ventricle size and function is still normal(ish)

I remain active but I'm sure performance is on the decline. Instead of continuous running I tend to do long intervals. Walking and running. Some weights. Not heavy.

Last few months I've noticed some light headed feeling. Generally a vague feeling. I've had moments of shortness of breath at rest to. Can be breathless doing mundane tasks about the house but can recover it quickly. Gradually building into any strenuous activity is working best.

So for now I'm in this holding pattern apparently waiting for additional deterioration. Have some consultations coming up. It'll definitely have to be done, I won't be happy if things must get much worse before it gets sorted.

So by the end of the month we should both know some more

P

 

[nobog]

Pressure drop (or gradient) across the valve is measured in mmHg (millimeters of mercury). The lower the better. Big difference between the numbers for aortic or mitral.
Regurgitation is measured in ml/pulse (milliliters per pulse) - again the lower the better. Valves are usually not replaced until "moderate" or greater, which would be more than 30 ml/pulse.

 

[d333gs]

Thanks Pan. I find it hard to recognize real from imaginary symptoms. When I first received a 38mmhg and the Cardio told me to stop tennis and be careful climbing stairs, I started to think everything was a symptom, stopped carrying grocery bags , one step at a time going upstairs and then, over about a year I really got out of shape and hated it. So I started picking up the pace again. Now I am back to careful full rigorous exercise and feel really good. the only thing I did not restart, like you, was heavy weight workouts . 10k barbells is my max. I would say the only difference in my exercise method is to keep breathing , no breath holding for anything , always make sure I have oxygen. Found this interesting suggesting regurgitation backs off during exercise; http://imaging.onlinejacc.org/content/jimg/7/3/314.full.pdf . This is interesting too; Effect of isometric exercise on aortic regurgitation assessed by cardiovascular magnetic resonance

 

[PAN]

I find it hard to recognize real from imaginary symptoms.

Absolutely. If the decline is slow then it can be a bit of a mind game. The body can compensate quite well for quite a while. Personally I think it is catching up on me now. I think it is also difficult for people who feel absolutely fine before they go for surgery. Just counter intuitive

The articles you posted are interesting. On multiple occasions I've finished a cardio workout and experienced a few seconds of absolute clarity. (20sec to 60 sec) Clear head, what feels like improved vision. Seems odd but is very real if not very repeatable.

Best we can do is report our symptoms accurately, keep informed and if possible maintain some pre surgery fitness. Eventually it'll be sorted

Best of luck d333gs...

P

 

[tom in MO]

Many of us who have had surgery thought we were asymptomatic before our echo said it was time. I did. But like many others, after surgery, my increase in stamina and overall performance was evident as soon as the immediate effects of the surgery wore off.

So the message is that if the decline is slow, it is a "mind game", but you can convince yourself you are OK, when you are not. Don't put off surgery because you "don't feel bad". If your numbers say it is needed you may be risking death by not getting it taken care of in time.

 

[PAN]

Absolutely agree Tom, there shall be no gambling at all. As soon as the numbers point towards surgery then it'll happen.

Today has been a superb day for mind games by the way

All the best

 

[d333gs]

Thanks Tom , I for sure don't want to be in denial !

 

[bizinsider]

Many of us who have had surgery thought we were asymptomatic before our echo said it was time. I did. But like many others, after surgery, my increase in stamina and overall performance was evident as soon as the immediate effects of the surgery wore off.

So the message is that if the decline is slow, it is a "mind game", but you can convince yourself you are OK, when you are not. Don't put off surgery because you "don't feel bad". If your numbers say it is needed you may be risking death by not getting it taken care of in time.

This "mind game"" conversation is interesting. I have always considered myself asymptomatic, even though now I apparently have severe regurgitation of my BAV with moderate to severe stenosis. I'm having surgery in several weeks at the Cleveland Clinic. The surgeon, Lars Svensson, suggested as much as "mind game" when he explained that your heart/body compensates for the deterioration in the valve's performance. He then said that after the surgery I'll have more energy, making my wife and me laugh because I have always been considered high energy. We will know soon enough! By the way, John, I still walk up hills fairly quickly.

If I were you I would get several opinions, if you can. I sought out someone who focuses on the aorta, but to be fair, I also will have my root and ascending aorta replaced.

Best,
Herb

 

[d333gs]

Hi herb, Mind games! I am sure 50% of my conscious attention goes to wondering it "this or that" physical sensation is triggered by my bad heart........
Re "several opinions ": My small town cardiologist has sent to a big city cardiologist for a stress test on the 25th and another ECG on the 28th. They also want me to get a BNP test before which tells them if I have had heart failure? Re walking up hills: I found this interesting "Physical Exercise Reduces Aortic Regurgitation " http://imaging.onlinejacc.org/content/jimg/7/3/314.full.pdf ..........goes against everything I have heard
John

 

[tom in MO]

When I was told I needed surgery, I was asymptomatic and didn't really believe it. When I asked how soon I had to get the surgery, my cardio told me that I shouldn't wait more than 4-8 weeks. When I didn't seem convinced, he used the following phrase to focus the issue: "Well you need the operation soon because you don't want to suffer the syndrome known as sudden death." A week or so later I had my first "dizzy" spell from the bad valve.

My surgeon explained to me that once the numbers say you need surgery, you can't wait too long. These problems (in my case a BAV) slowly deteriorate, but at the end the deterioration usually accelerates. Think of valve performance as a curve gently sloping downward, reaching a tipping point, and plunging down off the cliff (the surgeon's imagery.)

People die from untreated valve disease. When I was researching my BAV to see if they were right, I found a paper that examined autopsy results to find BAV cases. Of those that died from untreated valve disease, the age of death from BAV failure ranged from 16 - 80 yo with the median at about 55 yo. So you can go a long time with a bad valve, but you might not want to bet on it once the numbers say it's time.

 

[bizinsider]

Hi herb, Mind games! I am sure 50% of my conscious attention goes to wondering it "this or that" physical sensation is triggered by my bad heart........
Re "several opinions ": My small town cardiologist has sent to a big city cardiologist for a stress test on the 25th and another ECG on the 28th. They also want me to get a BNP test before which tells them if I have had heart failure? Re walking up hills: I found this interesting "Physical Exercise Reduces Aortic Regurgitation " http://imaging.onlinejacc.org/content/jimg/7/3/314.full.pdf ..........goes against everything I have heard
John

John, thanks for sending that study. Had not seen it.

 

[bizinsider]

When I was told I needed surgery, I was asymptomatic and didn't really believe it. When I asked how soon I had to get the surgery, my cardio told me that I shouldn't wait more than 4-8 weeks. When I didn't seem convinced, he used the following phrase to focus the issue: "Well you need the operation soon because you don't want to suffer the syndrome known as sudden death." A week or so later I had my first "dizzy" spell from the bad valve.

My surgeon explained to me that once the numbers say you need surgery, you can't wait too long. These problems (in my case a BAV) slowly deteriorate, but at the end the deterioration usually accelerates. Think of valve performance as a curve gently sloping downward, reaching a tipping point, and plunging down off the cliff (the surgeon's imagery.)

People die from untreated valve disease. When I was researching my BAV to see if they were right, I found a paper that examined autopsy results to find BAV cases. Of those that died from untreated valve disease, the age of death from BAV failure ranged from 16 - 80 yo with the median at about 55 yo. So you can go a long time with a bad valve, but you might not want to bet on it once the numbers say it's time.

Fascinating, Tom. When I saw the folks at Cleveland Clinic last month, they pointed to the sudden change in the regurgitation number, which had been moderate to severe for a long time; ditto for the stenosis. They told me when they change they change fast, and the surgeon said the surgery should be "soon." I scheduled it for 4 weeks later. There was an opening 3 weeks later but short of it being an emergency, it was too long. This is interesting, because the cardiologist at the clinic said I should definitely have it done within a year, or by year's end. When I saw the surgeon a day later I mentioned I was hoping for August - after the birth of our first grandchild. That's when he looked me in the eyes and said his recommendation would be "soon." So soon it will be, as in two weeks! I have no desire to end up in one of those autopsy papers.

 

[d333gs]

Thanks Tom
Anyone with D2 here? I am pre-diabetic.Time to time my blood sugar falls which causes dizziness, sweating and rapid heart rate. When exercising I keep sugar and a banana handy.
Interesting article linking diabetes to valve degeneration.
Risk of heart valve hardening increased by diabetes - Diabetes

 

[d333gs]

Herb
Two weeks
I will be very interested in following this Hope you keep posting!
John

 

[d333gs]

Jus got my BNP blood test numbers 103pg/ml, .........test says under 125pg/ml is good.
Reading up a bit about them , diabetes 2 will raise them, numbers rise with age, and male values are usually lower than female values. Here is a bit of info: NT-proB-type Natriuretic Peptide (BNP) | Cleveland Clinic

 

[d333gs]

Had my stress test ,on a bike , didn't get very far before my knees gave out , nevertheless the cardio-technician said the aortic valve needs a change. I will see another cardiologist Friday for another ecg to confirm it. If I have any say about it I will get it done in the fall when we have wrapped up our AirBnB bookings here plus a few other commitments. .......I will know more on Friday

 

[tom in MO]

Good luck. I see you live in France. One of my pleasures is the French take on news on France24. I watch it every week day morning.