I'm too slow. I posted on the old thread. Reposted here:
From the results in your post, blended with the limits of my nonmedical understanding, I'm uncertain whether what they're reporting is entirely valve-related or not.
A dilated aortic root means that the area the valve is seated in is larger in diameter than normal. If the root has dilated since the OHS, it is possible for the change to distort the shape of the valve enough to cause leakage. Was your original valve bicuspid? A dilated aortic root is sometimes a companion to bicuspid valves. If so, you should also have an interest in knowing the status (size) of your aorta itself, to see if it has also enlarged.
Your EF (ejection fraction) is normal, if it was correctly determined. You do have moderate aortic insufficiency (AI), which means that the aorta is not completely filled from each pump of your heart. While there is usually a mention of aortic regurgitation (AR - a.k.a. valve leakage) if it is there, it is possible it was assumed by the AI and not specifically mentioned.
There is mention of an eccentric AI jet, which could be caused by the mentioned dysfunctional movement of the left ventricle (LV), aortic root deformation, an injury to the valve leaflets, or the presence of a blood clot or scar tissue at the valve.
Although the cadiologist is sending your for an angiogram catheterization, an MRA (an MRI with dye for the coronary arteries), to check for signs of thrombosis (blood clot), blockage of the coronary arteries, or scar tissue, or a TEE to check the condition of your valve more accurately are other options.
I can offer you this, from the ACC/AHA guidelines, "Segmental LV wall motion abnormalities are characteristic of myocardial infarction. Their location correlates well with the distribution of coronary artery disease and pathological evidence of infarction...However, regional wall motion abnormalities also can be seen in patients with transient myocardial ischemia, chronic ischemia (hibernating myocardium), or myocardial scar. Segmental wall motion abnormalities can also occur in some patients with myocarditis or other conditions not associated with coronary occlusion...In patients presenting with chest pain, segmental LV wall motion abnormalities predict the presence of coronary artery disease, but can diagnose an acute myocardial infarction with only moderate certainty, because acute ischemia may not be separable from myocardial infarction or even old scar."
Looking at this, the main causes for test results like yours (insofar as I understand them as written, and assuming they're complete), seem to be a previous mild heart attack or a current blockage/partial blockage of arteries feeding the heart. Ischemia and segmental wall abnormalities together usually talk to lack of oxygen to parts of the heart muscle. While people with bicuspid valves tend to be less apt to have those issues, pneumonia can create thromboses by causing inflammation that can loosen otherwise minor arterial wall plaque, which can then agglomerate.
Pneumonia can also lead to endocarditis, which you might have had during the infection, masked by antibiotics. Or it can cause more direct damage.
Ventricular oxygenation issues (ischemia) and segmental wall abnormalities can also result from chronic AI. However, it takes time (usually many years) for it to develop. As the ventricle hypertrophies (enlarges) to push the blood through the leaky valve, it becomes poorly oxygenated, due to differences in the cell structures of the added ventricular mass. Usually, the ventricle has reformed itself somewhat into a more spherical shape by that time.
So, I don't know which way this is pointing without more history. (Of course, I might not know with it, either.)
Your cardologist didn't rush you to the emergency room, and was willing to wait to do the angiogram, so I guess he doesn't feel it's that bad.
However, my personal opinion as is that you should refuse any further stress echoes/exercise test echoes. The ACC/AHA guidelines specifically mention that exercise/stress echocardiograms are not accurate for ischemia when applied to symptomatic valve patients, and they may also have enhanced risk for the patient.
Don't get nervous over this reply, as it's basically a tea-leaf reading. Picture me in a do-rag, telling you this over a glowing crystal ball...
Best wishes,
