Criteria for valve replacement

[Geoff]

I am 68 and have an aortic valve leak with gradually increasing left ventricle size. (I also have Marfan syndrome, but my aorta size is stable.) I have previously been told by two cardiologists that I should have a replacement aortic valve in the not too distant future, in particular before the LV becomes so distended as to cause unrecoverable loss of heart function. This is irrespective of the fact that I am symptom free at present.

However, I have just been referred to a new cardiologist (whose particular interest is Marfan). He has said that the previous doctors were measuring the diastolic LV size, (which is indeed distending), but they should have been looking at the systolic size, which looking back over the last few echocardiograms is not increasing. His opinion is that as long as the systolic size is stable, the diastolic size can do more or less what it likes, and I won't need a new valve.

How can I reconcile these apparently contradictory views? Did the previous two doctors not know their job? How do I know the present advice is correct? Where can I find out what the current best informed thinking is on this issue?

 

[bvdr]

Have you checked out this link?

http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm

 

[Geoff]

Many thanks, Betty! This is a serious article which will clearly repay careful study. On a quick scan, it looks as if both diastolic and systolic LV sizes are significant, but I shall have time to read it carefully before my next appointment with the new doctor. Once again, thanks. This is just the sort of detail I wanted.

Geoff

 

[ALCapshaw2]

GOOD Question Geoff.

I hope your cardiologist can provide appropriate guidance.

You are wise to be concerned about increasing size (and /or
'thickening'). SURGEONS like to operate before there is any permanent damage to the heart muscle. I prefer their philosophy over the 'wait to the last moment' approach often taken by many Cardiologists.

'AL'