Bicuspid valve with slight enlargement results

Alisbaba · Jan 7, 2019

Hi all,

Ive just had my MRI and then received a letter from my cardiologist saying it was good news as there was only a slight enlargement. I never got to see him just a letter and said see you in 2 years.

After doing some research and the advice all you guys gave me I never got the chance to ask “How big, any regurgitation?” And so on.

I called his secatary and asked for a copy of the MRI and have received it but need help with understanding it.

Low LV mass with normal LV wall thickness.
the mitral valve is unremarkable
The aortic valve is bicuspid with fusion of left and right coronary cusps raphe present.Left sided aortic arch with normal branching pattern.

From LVOT cane image:
Sinus of Valsalva 31 x 30mm
Sinotubular junction 27 x28mm

From MRI:
Ascending aorta level of MPA 38x38mm
Proximal arch 30 x29mm
Mid arch 21 x22mm
Distal 22 x 21 mm
Mid Thoractic Descending 21 x 20 mm
Descending level of diaphragmatic hiatus 18 x 29 mm

right ventrical has visuallly normal volumes and systolic function

conclusion
Normal LV volumes and systolic function
Bicuspid valve with no significant stenosis or regurgitation
Dilated ascending aorta max 38mm
No thoracic aortic coarctation

no previous for comparison

Flow mapping
Peak 151 cm/s
Antegrade 73 ml
Retrograde 1 ml
Regugitant Fraction 1%
Stroke volume 72 ml

Sorry to add everything as I’m not sure about what to put as this is the first time I’ve had this done. Can you help me interpreting this please.

Thanks

Ali

pellicle · Jan 7, 2019

Alisbaba;n886228 said:
Ive just had my MRI and then received a letter from my cardiologist saying it was good news as there was only a slight enlargement. I never got to see him just a letter and said see you in 2 years.

which means "there is nothing significant wrong with your results ... so just pick something else to worry about and worry about that

I had the same thing for about 15 years after my 2nd surgery ... eventually I stopped going and just waited till I felt something amiss (it was subtle, but I was simply not improving in measured lap times of my ski track over 3 ski seasons when I knew my technique was improving ... turned out my valve was becoming incompetent (stenosis and calcification) - plus as a bonus they found I'd been growing an aneurysm so they did both jobs

conclusion
Normal LV volumes and systolic function
Bicuspid valve with no significant stenosis or regurgitation
Dilated ascending aorta max 38mm
No thoracic aortic coarctation

I've bolded the conclusions which make it clearer (although as you must have typed that in you should have seen those points

with respect to the aorta:
https://www.anzsvs.org.au/patient-in...rtic-aneurysm/
When do aortic aneurysms require treatment?

In healthy people the aorta (the main blood vessel that becomes swollen) is usually about 2.0-2.5 cms (20-25mm) in diameter although this can vary with age and whether you are a man or a woman. We know from two large studies in the USA and UK (Lederle FA et al, 2002) that aneurysms less than 5.5 cms (55mm) across can be safely watched as long as they are monitored on a regular basis. For aneurysms less than 4.4 cms across or less, a yearly ultrasound scan is sufficient to monitor aneurysm growth. For aneurysms between 4.5 and 4.9 cms across, a scan every 6 months is advised. An aneurysm greater than 5.0 cms across requires scans every 3 months although there is some variation in recommendations.

When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention.

and you are certainly under 4.4

enjoy life ... you don't have any reason not to

was there any other specific question?

Alisbaba · Jan 8, 2019

Hi Pellicle,

thank for that, I wasn’t worried it just would of been nice to get this infor from from doctor in person.

It said on my echo report mild narrowing and I could see anything on this report.

Im only 5ft

cheers

Ali

pellicle · Jan 8, 2019

Hi

Alisbaba;n886230 said:
thank for that, I wasn’t worried it just would of been nice to get this infor from from doctor in person.

that's good (that you're not worried). I've experienced many times that Doctors seem to consider it unimportant to let the "subject" know, its almost like they would be better at being a Vet than a Specialist treating humans ...

It said on my echo report mild narrowing and I could see anything on this report.

well I'm guessing here, but my expectation is that because it was mild the cardio decided that it wasn't worth mentioning on the final report (as it would be on the one that he/she had), and was of no interest to anyone (after they'd read it and decided).

Im only 5ft

shouldn't make a huge difference, and without numbers "Mild" may have taken your body size into account ... again conjecture

Either way I think that there is nothing to worry about as all that I saw above suggested its a "watch and monitor" indeed the words: "no previous for comparison " in your initial post suggest that as they have no previous data for comparison and that they don't think the numbers are concerning, that they'll get the numbers on the next scan and then use this as the baseline.

Out of interest, there is quite some natural diversity with regards to anatomy (such as diameters of things) just as there is with height and build. My own aortic arch anatomy is mildly "atypical" and fits into this category:
http://www.ajnr.org/content/27/7/1541

Best Wishes