Change in Echocardiogram Guidelines for Mechanical Valves

[tom in MO]

My aortic valve has been in for about 8 years. My cardio told me on Tuesday that the new standards of care for mechanical valves no longer recommends an echo every 5 years. Research has shown it's not needed. Echos are indicated if there is other clinical evidence of a problem or potential problem. So for those of us in the US, that's one less medical cost. It also speaks to the stability of the mechanical valve.

For biological valves, routine echos are still required to track the inevitable degradation of performance.

 

[Amy]

I was just wondering about this yesterday - how often I’ll need an echo after next week’s AVR with a shiny new ticker.

Hooray!!!!!!

 

[egar]

I have a mechanical mitral valve. I had my last echo at Mayo Clinic in August 2020 (about 22 months post surgery). The results were great, all measures within normal ranges for someone without a mechanical valve. My cardiologist (also at Mayo), said that unless other issues come up, I did not need another echo for 10 years.

 

[Amy]

That’s awesome. Thank you for sharing that.

 

[pcannon]

wow I guess I was so use to getting an echo every 6 months prior to getting my mitral valve I never thought I might not need to do that anymore. Thanks for sharing that information.

 

[Amy]

Just found this paper, published 2 years ago (asterisks (*) mine) :

The purpose of routine echocardiography is to detect early SVD in order to observe the patient more frequently both clinically and echocardiographically and plan a redo procedure. However, SVD of modern mechanical valves is exceptionally rare (7) and happens suddenly with critical hemodynamic deterioration. Routine echocardiographic follow-up of mechanical valve prostheses in asymptomatic patients with no coexistent pathology is therefore not usually needed. *****However, patients with a mechanical mitral valve should have a routine echocardiogram at 5 years to assess for tricuspid regurgitation or worsening RV dysfunction if they did not undergo concomitant TV repair. ******

 

[egar]

wow I guess I was so use to getting an echo every 6 months prior to getting my mitral valve I never thought I might not need to do that anymore. Thanks for sharing that information.

I had been doing them annually for several years, both before and after surgery. I just figured it would always be an annual thing. I was surprised (and happy) at the cardiologist's recommendation of a 10 year interval.

 

[Amy]

And for BAV, “Continued post-AVR monitoring of aortic size if aortic diameter is ≥4.0 cm at time of AVR”

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923

 

[mom2angel]

Wow. Didn’t know this. I still get them every year. Mine is coming up in 2 weeks. I have a feeling they are watching mine closely as it is my 2nd mechanical and is over 28 years old. Very interesting that they have changed the standards. That’s good to hear.

 

[Mister_James]

Unfortunately some of us will have to continue the annual echos. Though I had a mitral replacement, my aortic has stenosis too thanks rheumatic heart disease and maybe a candidate for replacement at some point.

 

[thomas999]

Unfortunately some of us will have to continue the annual echos.

I don't see the issue of concern getting an echocardiogram, unless it's for financial reasons that your insurance company doesn't pay for. They are very simple tests as far as the patient is concerned and they are done and over with quickly.

 

[QuincyRunner]

I agree with Thomas and I don't understand the hoopla surrounding the changing of echocardiogram guidelines. I actually think the more frequent the better. They are simple and quick, and any status report on the condition of my mechanical mitral valve is welcomed and looked forward to. Currently I get it done yearly and I wouldn't want a longer delay between "check-ups".

 

[tom in MO]

My cardio's statement was made in the context of my having a aortic mechanical valve. We didn't discuss a mitral replacement valve since I don't have one. Since tissue valves will fail, I'd assume routine echos are still needed by those people with a tissue valve.

An echo is not inexpensive when you have a $500 deductible and a 30% copay. Why test if not needed? You don't need a belt and suspender

 

[thomas999]

I am sitting in the waiting room waiting for the results of an ekg/echo testing just minutes ago. I am 35 yr post surgery. My cardiologist says every two years for an echo for me.

 

[Superman]

Routine echo caught my aneurysm 19 years after I got my valve. I’m a fan.

 

[carolinemc]

Routine echo caught my aneurysm 19 years after I got my valve. I’m a fan.

Mine has caught a calcification of the mitral valve. We were trying to figure out my short of breath. And they will keep an eye on the Mitral Valve.

 

[vitdoc]

With single valve disease depending on the status of the heart there may be other issues that develop. For example in my case I had aortic stenosis repaired with a St. Jude and had no valve problems with it. But I did develop two things both of which needed to be dealt with. One was an aortic aneurysm and the other was progressive mitral insufficiency. I had a crummy cardiologist that I think never looked at the echo results. He ignored an aneurysm that reached 6.5 cm which was discovered serendipitously leading to surgery. I also had mitral leakage that started as mild but gradually worsened. So maybe not every year but probably every two years seems appropriate.
Medicine is full of these studies that depend on large statistical data bases. When a few people fall through the cracks it might not show up as marked statistical changes. But for the individual who has the problem it is not insignificant. I bet most cardiologists would want to see an echo more often than 5 year intervals.
As Mark Twain said "Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: “There are three kinds of lies: lies, damned lies, and statistics.”"

 

[carolinemc]

With single valve disease depending on the status of the heart there may be other issues that develop. For example in my case I had aortic stenosis repaired with a St. Jude and had no valve problems with it. But I did develop two things both of which needed to be dealt with. One was an aortic aneurysm and the other was progressive mitral insufficiency. I had a crummy cardiologist that I think never looked at the echo results. He ignored an aneurysm that reached 6.5 cm which was discovered serendipitously leading to surgery. I also had mitral leakage that started as mild but gradually worsened. So maybe not every year but probably every two years seems appropriate.
Medicine is full of these studies that depend on large statistical data bases. When a few people fall through the cracks it might not show up as marked statistical changes. But for the individual who has the problem it is not insignificant. I bet most cardiologists would want to see an echo more often than 5 year intervals.
As Mark Twain said "Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: “There are three kinds of lies: lies, damned lies, and statistics.”"

 

[carolinemc]

The Cardio's that I have seen since I was born in 1965, have seen me once to twice a year, before my valve replacement. I still see them twice a year, and good reason now. They have caught an irregular heartbeat and did an echo a month ago and found that the Mitral Valve has some calcification, and they will keep an eye on it for any changes. So, there are many that still visit a cardio often. Not just every five years. My health issues have nothing to do with statics or studies.

 

[carolinemc]

I am sitting in the waiting room waiting for the results of an ekg/echo testing just minutes ago. I am 35 yr post surgery. My cardiologist says every two years for an echo for me.

And I get them every year and great that I do, for I have calcification of the Mitral Valve. It is not bad at the moment. They will keep an eye on it. And at 57, doing good.