echo results, needing advice

[jx05]

Hi, i'm needing advice on my echo results , do these numbers mean anything to any one. Are these numbers to severe or is there a range on each category that i should wait for before surgery. I'm getting a second opinion on friday by another cardiologist. My current cardiotherasic surgeon suggest surgery this month.

My surgen had me do a cath 3 weeks ago and it came out good.

I'm confused because i have no major symptoms.

If i have surgery which valve would be best for me at 38 years old

Diagnoses: moderate to severe aortic insufficiensy

My heart size:

Contracted : 4.2
relaxed : 5.9


EF: 60%

aortic root : 4.1

frac shortening: 29%

LA (ES) 3.0 IVS(ed)1.0 LVPW (ed)1.1

LVID (ed) 5.9 LVID (es) 4.2

aorta: aortic root is dilated
doppler: moderate to severe aortic regurgitation

Conclusions:

1. Lower limits of normal to mildly reduced LV function. Mild left ventricular enlargement with normal wall thickness.
2. Bicuspid aortic valve with moderate to severe aortic regurgitation and dialated aortic root.
3. No segmental wall motion abnormalities were seen.

 

[Ross]

1. Lower limits of normal to mildly reduced LV function. Mild left ventricular enlargement with normal wall thickness.
2. Bicuspid aortic valve with moderate to severe aortic regurgitation and dialated aortic root.


I'll give you a link to interpreting the numbers, but these two statements sum it all up. Your looking at surgery soon.

http://www.echobyweb.com/htm_level1_eng/echo_examination.htm

 

[jx05]

Thanks for the info Ross, when i get some time i'll try to compare my numbers with whats on that website. At my age , do you have any thought what type of valve would be a good selection. thx

 

[mmarshall]

uuh oooh...here we go again...lol...just kidding we kinda had a heated debate over valve selection a little while ago. but the right decisision is just a personal case by case selection. at your age...i would talk to your surgeon...or multiple surgeons...i talked to 3 different ones before my surgery...but given your age, you may want to ask and research the ross procedure, mechanical and the latest stentless tissue valves. i went in with the intention to do the ross procedure but ended up getting a tissue valve as a back up...my surgeon was not comfortable with doing the ross due to the state that my heart was in once he was in there. but research it and decide what you are comfortable with...a lot of people decide because of the coumadin issue and lifestyle issue...but being on coumadin is not the end all from what i hear. im not on coumadin but my decision to go tissue is this latest valve that should last longer and at my age...31...i am looking at another surgery in my lifetime no matter what valve i chose...so the thought of avoiding another surgery really was not an option for me. let me know if you need any help or questions about anything...you are about to go through a lot of head banging against the wall moments with all of the research, surgeon consults, and decisions making.

 

[Ross]

The dreaded heated valve debate!

Guys this is my opinion and I give it because with both of my surgeries, I nearly did not make it back.

You only want to do this surgery one time if it can be at all helped.

Do not condemn Coumadin because of "Someone said" Or "Someone told me" Get the facts for yourself. There are far too many horror stories being told that are totally false, as well as other poor information given.

Realize the facts that Atrial Fib and even Coumadin might well develope in your life later anyhow.

Do not try to base a decision on what may be in 10 or 15 years. The likelihood that any major change is coming is very very small.

It's your decision, (There, now no one can say I strongly implied it!) on what type of valve you chose. Just remember basic concept #1-Only one time if it can be helped.

 

[jx05]

thx for the replys, from what iv'e read so far , both valve types have there advantages and disadvantages.

Mechanical has long durability with drawbacks of taking comadiun and coping with brucing and bleeding which can be controlled by changing your lifestyle. ( all this to me doesn't sound to bad )

Tissue last 10 - 15 years dependent on certain factors without comadiun and this according to people is not a gaurantee.

Both valves seem to make noise to certain level.

But i'm really not clear as to the advantages or disadvantages as far as activities go like sports , work , etc

I've read that with tissue valves it allows you to do competitive activites, but at what persentage more than with a mechanical.

Do any of you have an answer to clear this up , i played soccer before, at what persentage rate would the tissue valve allow me to play vs mechanical

 

[tobagotwo]

Tissue valves do not make discernable noise internally or externally. With certain types of tissue valves, your doctor may be able to detect it with a stethoscope. You will not be able to.

As far as playing contact sports, presumably without a helmet, doctors don't want anyone playing them. And they are only somewhat more lenient in their suggestions for tissue valve owners than mechanical owners, even regarding heavy, non-contact exercise.

Head injuries or head collisions are the main reason for concern with a mechanical valve. There is a greater likelihood of brain bleeds than normal with head injuries on warfarin. A tissue valve (without warfarin) leaves you with the same likelihood of that as someone with their original valve. For many (but not all), heavy bruising can also be a problem on warfarin in violent sports.

However, ignoring doctors' advice, many members of VR indulge in rough sports play, with both types of valves, quite successfully. Reasonably, there would be a lower overall risk with a tissue valve and no Coumadin, however.

Best wishes,

 

[Ross]

Anything rough is going to be hard on you, but your having the valve replaced to live life. Do what you can to protect yourself and go have fun!

 

[Ross]

If we listened to everything these Doctors tell us, we might as well just forget having a valve replacement and die. They don't want us to do anything and treat us like fragile eggs. Hank goes boat skiing, Robthatsme still uses chainsaws, I still tear myself up on vehicles, many are into mountain biking, motocross, you name it.

 

[MarkU]

If we listened to everything these Doctors tell us, we might as well just forget having a valve replacement and die. They don't want us to do anything and treat us like fragile eggs. Hank goes boat skiing, Robthatsme still uses chainsaws, I still tear myself up on vehicles, many are into mountain biking, motocross, you name it.

I hate to read implications that all doctors are clueless. Admitedly, some may be, but not all are.
My cardiologist and PCP are very supportive of my participation in triathlons. My PCP is also a triathlete and we have actually done some races together. My cardiologist says the absolute worst thing I could do is become a couch potato.
My $0.02
Mark



Mark

 

[Hank]

Doctors

Doctors

I have much experience with Doctors. Having worked for 10 years in a hospital side by side with doctors as a respiratory therapist in ICU's.

Doctors are just people. But they are highly educated people who take information into their brains and translate that information to the order sheet on the patient's chart.

Doctors are just the same as mechanics or plumbers or respiratory therapists.

There are gems and there are jerks.

The vast majority do credit to their professions, but there are some who suck. It's the same with any walk of life.

Anyway, I only brought this up to defend Ross's comment, and to defend Mark's comment.

Plus I wanted to blab my 2 cents to the thread....

 

[Karlynn]

The vast majority do credit to their professions, but there are some who suck. It's the same with any walk of life.

And just like in most any situation, it's the few bad ones that make the whole group look substandard.

I've said that for 10 years I had 3 bad doctors and 1 good one. I had only one good one because I stopped looking once I found him. There was no need to continue looking.

 

[KAJ]

Before my surgery, I too was very afraid of Coumadin. Since I really did not have a choice about the type of valve, I had to learn to deal with it. I heard the stories of bleeding and brusing easily. I had visions walking around looking like one giant bruise. I know we are all different as how the drug can affect us. Since the surgery, I have had a few minor cuts and did not bleed to death. In addition, so far, I have not brusied once and am very active. In a nutshell, so far Coumadin has not be the dreadful dragon I thought it would be for me .

Karl

 

[ALCapshaw2]

EVERY valve has it's own set of Good Points and Bad Points. Look at the BAD points and see which set you can best live with. That is probably your most compatible choice.

'AL Capshaw'

 

[alan_delac]

Operation Time

It is very important how you feel. Do you have any symptoms? I have lived with aortic regurgitation and LVD of 64mm (left ventricle size) for 15 years. For most of that time I didn?t have any symptoms and lived normal life. This year my symptoms got much worse so I had AVR 7 weeks ago.
I you are too late for the surgery there is a danger that your left ventricle won?t shrink back and that means damaged heart and problems. I had an echo done on the 5th day after the surgery and my LV shrunk from 64mm to 49mm and that means that the muscle was still fully elastic. I must say I am glad that I delayed my surgery as long as I did.
Please bear in mind that I have no medical training but I would recommend the following:
· If you experience symptoms in your everyday life go for the surgery now.
· If you are symptom free, have an echo every 6 months and follow the numbers closely. I they are stable delay the operation. If numbers are changing and your LV reaches 65mm you may as well go for the operation.

The point is that heart can often successfully compensate aortic regurgitation for years. The AVR is life saving operation, however it carries risks. If you chose a tissue valve, like me, as soon as you have your first operation, the clock is ticking for the next one. Younger you are shorter will be the life of your tissue valve. If you pick a mechanical valve you will be on warfarin that many people handle very well but it is at least a nuisance and as you are only 38 there is a chance of second operation. A successful Ross should last longer than tissue valve but you may have to deal with two valve problem sooner or later.