Echo results confusing

[Butterfly]

Hi has anyone had an echo that wasn,t accurate. I have a bisucspid arotic valve - no symptons. I had an echo about four years ago and the gradient was 18 . Recently I had another echo and the graident was suppossed to be 38 - meaning that I had a rather rapidly deteriorting valve - however I consulted another more well known cardiologist who performed a second echo and physical examination and found that the gradient was only 19 and not 38. He also suggested that this may have been the case for most of my life and that I had excellent contractibility of my heart. The first inaccurate echo also said my valve size was 1.1 however the second echo said that the valve size was 2.2 and may have also been this way for the most part of mylife.

Needless to say I was quite distressed over the first result as I believed that I may had had to have surgery next year due to the first cardio saying I had moderate setnosis , a high gradient and small valve area. Glad I got a second opinion but concerned that the first doctor and technician could have got it so wrong.
Has anyone else had very different results like this.?

 

[Ross]

This is precisly why no one should rely on an echo for a diagnosis. It's ok for ball park figuring, but more definative tests are needed for the true picture. It depends mainly on the ability of the technician performing the test. If they aren't experienced enough, wrong figures and facts go into the report and are seldom second guessed by the Doctor. My report that I just got has my valve area stated as 1.1, but a note in addition that it's likely not the correct figure. She (The Echo tech) couldn't' get a clear enough picture to make the call. Here is a copy of it. See the Doppler exam notes, second to last line.

Page 1

 

[PJmomrunner]

Hi Butterfly-

I'd say you have two very good reasons to have a more definitive imaging study done: 1) the two echos you've had done are so disparate as to be completely unreliable and 2) neither provides an assessment of your aorta, which is critical for one with a BAV. If I were you I would express my concern that I have no definitive info about the valve and no info at all about your aorta and request a CT with contrast or an MRI with contrast or a TEE.

 

[Nancy]

Joe has so much scar tissue in his chest from three valve surgeries and two lung surgeries, they sometimes can't "see" ANY of the valves well. I have been very upset over the years over this, blaming the techs. But I have come to think that it is indeed a problems for any of the techs with Joe.

We have fired a couple of techs and asked for the very most experienced, persnickity (sp?) one available and we got her. She took forever repeating several things over and over and got very upset herself.

Some people are not a good match with an echo. In the first place, they aren't that accurate, and in the second place, they DO depend on operator skill, and in the third place, the patient may have abnormalities which make it all hard.

I know that cards love to do them. They are non-invasive, but if you have difficulties with them, ask every now and then for more definitive testing. But then many of them have radiation to consider and that adds up over a lifetime.

Things are not easy for some folks.

 

[tobagotwo]

Did either of the echoes show enlargement of the left ventricle from the one four years ago? Do you have other symptoms, like shortnesss of breath or angina? If not, the second sounds more accurate.

I would sit on it for a while, so your insurance can catch up. They usually only allow so may echoes per year. Either way, waiting six months won't cause you any harm at all. Then go for another echo from a third tech at a third institution.

If you are generally happy with your initial doc, I suggest you point out the huge difference in the two echos, and tell him your concern. He may suggest a cath or a TEE, if you are desperate to have results right away. Of the two, I'd probably pick the TEE.

BUt I still hold by the first paragraph above. Let an uninformed third tech at a different institution do the next one, and see what it says. The cath is invasive, and the TEE has some possibility of damaging your vocal cords.

Best wishes,

 

[Gnusgal]

My card no longer relies on echos for accurate info regarding my heart because of scar tissue making it difficult to see much. She still does them to keep a regular eye on things, but once a year she has me do a MUGA scan (non-invasive) to get a better reading. And even then, she reminds me that the numbers aren't 100% accurate.

 

[davidfortune]

Medical Science? or Art?

Medical Science? or Art?

Butterfly,

Your results are not surprising really. Society generally accepts medicine as science when in reality there is a tremendous amount of art involved. Don't think so - consider the training doctors go through - like an understudy in a ballet or an apprentice in a trade.

Medical knowledge is just a collection of historical trials and errors - learning what worked well and what didn't.

I had a similar result with an echo almost three years ago with the cardiologist stating Unequivocally that I needed aortic valve replacement within three months. This was a bit alarming since I was asymptomatic and had not been to a doctor previous to the recent trip to a local family doctor who diagnosed my heart murmur in almost 20 years. So I was a bit skeptical of a cardio who would recommend surgery in an asymptomatic patient with only one data point (especially a fuzzy echo) with no more definitive testing.

I went for a second opinion (and a second echo) at a larger cardiac center with a well respected cardiologist. He said "Not time yet. Let's monitor and decrease your blood pressure". With two conflicting assessments, I went to another top cardiology center for a third test. He recommended a stress echo and then a comparative analysis of all 3 videos side by side by side. Their conclusion was also "Not time yet. let's monitor and decrease your blood pressure".

I found out at that point that there is tremendous variety in skill and philosophy out there. Sonogram Technician skill, Sonogram Interpertation Skill, Surgical philosophies, and equipment capabilities all make a tremendous difference in the answer/results you get.

I would ask about a stress echo or TEE from a center and a doctor with a strong reputation and validate one of the two OPINIONS that you have now. You might want to discuss with your insurance first to make sure that they are paying - generally that shouldn't be a problem especially with conflicting OPINIONS.

Generally BAV is not a rapid progression lacking some other precipitating event (such as bacterial endocarditis) so taking appropriate time to get additional opinions shouldn't pose much of a risk (unless you are experiencing symptoms of heart distress.).

Good luck.

 

[Butterfly]

Confusing ech results

Confusing ech results

Thanks so much for all your postings. Just shows you not to accept a result you somehow don't feel right about and to get a second or even third opinion. The second cardio seemed to feel that the situation with my heart had probably existed relatively the same for many years and hopefully will continue to do so.In the mean time I'll keep watching this site so if the time comes I will be more knowledgeable with all your help. keep up the good work.