Can anyone help me understand my echo results and what they mean?

[chris.c]

I am going to see my surgeon in 5 days(next monday may 7 2012)

NORMAL NORMAL
RV 24 9-27mm Ao Root 37 20-37mm
IVS D THICK 17 6-11mm Ao c CUSP EX 14 15-26mm
LVPW D THICK 15 6-11mm LA 52 19-40mm
LVID/D 61 35-57mm
LVID/S 42
% EF 58
DOPPLER: DT 261 Ms IVRT ms FS
AV PK 4.32 m/s PPG 75

INTERPRETATION:
Technically difficult study with limited views. The left atrium is severely dilated The left ventricle is severely dilated. The left ventricle is mildly dilated. There is moderate concentric left ventricular hypertrophy. All segments of the left ventricle contract normally with a preserved grade 1 LV function. RV function is also normal. The aortic valve is calcified. There is limited cusp excursion. It is difficult to determine the number of cusps present. Peak gradient across the valve is 75mmHg peak systolic consistent with a moderate severe obstruction This may be underestimated given the difficult visualization. The aortic annulus measures 30mm, sinus is 37mm, sinotubular junction is 33mm and the ascending aorta is 35mm. There is some aortic annular calcification. Mitral valve appears normal although there is some spotty calcification of the anterior leaflet and anterior annulus. The valve opens unobstructed without any valvular regurgitation. There is trace of tricuspid regurgitation.

CONCLUSION:
1) Technically difficult study with limited views.
2) Moderate left atrial dilation.
3) moderate concentric left ventricular hypertrophy with mild left ventricular dilation and preserved grade 1 LV function.
4) Preserved RV function
5) Probable sever calcific aortic stenosis
6) Normal aortic root dimensions.

 

[chris.c]

ANGIGRAM

I was asked by Dr. ----------- to undertake an angiogram attempt via left radial artery. This patient has significant aortic stenosis echographically along with symtomes of dyspnea. He is also obese. The right radial pulse was absent and the right brachial pulse was barely palpable. Angiogram attempt by Dr, ---------- via the right brachial artery was unsuccessful.

PROCEDURE PERFORMED:
1) Slective coronary angiography.
2) Aortic root angiogram

PROCEDURE DETAILS:
Arterial access was gained successfully via left radial artery using a 6 french sheath. Mild radial artery spasms was encoutered throughout the case.

Coronary arteries are large in caliber compatible with his large body size.

Left main is normal. LAD is normal. The circumflex which is a dominant vessel is clear. I was unable to cannulate th RCA.

Aortic root angiogram revealed a mildly enlarged aortic root and ascending aorta with maximal dimension of 39mm. Aortic cusps appeared bicuspid. The anterior cusp appeared marketly thickend and immobile. The remaining cusps appear moderately restricted in mobility. I was unable to cross this valve. Visually, the aortic valve appears in keeping with severe stenosis. There was no aortic root regurgitation.

The RCA could be visualized during aortic root angiogram as expected; this is a small non-diminant vessel that is open.

CONCLUSION:
1) Normal coronary arteries
2) Bicuspid aortic valve that appeared severely stenotic visually.
3) Mild dilatation of the ascending aorta 39mm

 

[chris.c]

I am trying to figure out how much time i have left before i have no choice but to have this open heart surgery. I am going to try and get a referal for a second opinion for a Dr in London Ontario to see if they would do less invasive surgery on me. Thanks for your help.......

 

[Bill B]

I'm guessing your current doctors may be recommending surgery fairly soon based on the severe stenosis, high pressure gradient and LV changes, although you appear to be well compensated, retaining good cardiac function. A second opinion is always a good thing. In my case, with a heart a lot like yours (bad aortic valve with lots of calcium, high pressures, good LV function although enlarged, mildly dilated aorta, good coronaries), my cardiologist was "wait and watch" but an expert surgeon I saw was insistent I needed surgery within 5 months. I had it done in 3. It's not going to get better and some damage is being done by the stenosis, which will only increase. With your good coronaries and preserved LV function at this point, you should do very, very well with surgery. You can tell how I lean on this issue. Go get that second opinion.