Echocardiogram

[Harmony]

I have MVP with moderately severe regurg. Yesterday I received a copy of my last echo done 6/3/05. Everything is basically the same as the echo I had done 6 months ago. However this time he listed the value of the Aortic Root as 3.5 normal value is 3.7 cm. The Cleveland Clinc says the normal Aortic Root is 2.6 and above 4 cm is regarded as an anuerysm. I asked my Cardio why the echo says 3.7 is normal and CC says 2.6 is normal. He feels that up to 4 or 4.4 is normal. Can some one tell me what should a normal Aortic root value be. I never paid much attention to my MVP before last year as the Cardio I was seeing always told me it was just a minor leak until last year when he suddenly told me it was not very good any more and should see a surgeon. My present Cardio who first diagnosed me 10 years ago says because of certain factors I can wait to have an operation. I ask about the size of Aortic Root because I want to be well informed about what is going on in my heart
Thank You

 

[Abbanabba]

Hi Harmony - first of all, I'm no expert, but my echo's list the "normal" parameters for the AR as anthing below 3.7. Mine is currently sitting at 4.0, but my cardio isn't overly concerned about it. She (and other cardios I've consulted with) start to get worried once it gets up around 5.0.

Personally, I think they should be more concerned about where you STARTED from, rather than where you end up. For example: if your "normal" AR measurement was 3.6, then a change to 4.4 probably isn't anything to be too concerned about, but if your "normal" AR was 2.0 and it has enlarged to 4.4, then surely that's a pretty big change.

I don't know if other problems with your heart make a difference (ie. MVR, cardiomyopathy...) but it never hurts to question your doctors.

Cheers
Anna : )

 

[Arlyss]

"Normal" Values for Aorta

"Normal" Values for Aorta

Hi Harmony - first of all, I'm no expert, but my echo's list the "normal" parameters for the AR as anthing below 3.7. Mine is currently sitting at 4.0, but my cardio isn't overly concerned about it. She (and other cardios I've consulted with) start to get worried once it gets up around 5.0.

Personally, I think they should be more concerned about where you STARTED from, rather than where you end up. For example: if your "normal" AR measurement was 3.6, then a change to 4.4 probably isn't anything to be too concerned about, but if your "normal" AR was 2.0 and it has enlarged to 4.4, then surely that's a pretty big change.

I don't know if other problems with your heart make a difference (ie. MVR, cardiomyopathy...) but it never hurts to question your doctors.

Cheers
Anna : )

The normal diameter of the aorta and what represents "normal" versus an aneurysm is an important topic. There is often confusion about this, and the use of a "normal" size range on these reports adds to that confusion.

What is normal for an individual depends on body size, gender, and age. Around 2.5 cm is a good ball park number for the ascending aorta in adults. Some people will be smaller, around 2.0 cm, and others larger.

There is more than one way to define when the aorta is so enlarged it should be called an aneurysm, but there is fairly general agreement that 4 cm represents an aneurysm.

The normal range on an echo report is just listing the variation in the size of the aorta in different people. When they give a size like 3.7 cm, that might be normal for someone who is probably a large adult male. A petite female may be 2.0 cm. So, if they want to include a range that covers everyone, they might say 2.0 cm to 3.7 cm. However, as an individual, you are not interested in the range in the population. You need to know what number is normal for you, and whether some part of your aorta has begun to enlarge.

My husband's aorta had begun to enlarge, but we were never told because even though it had grown since the last echo, it was still within the so-called normal range, so nothing was said. As an adult, his aorta should not have been growing significantly, and that should have been the first indication that he had a problem with his aorta. The next time it was measured, he had a large aneurysm! (We know this now because we got all his reports years later, at the time of his aneurysm diagnosis.)

Yes, you want to know what your normal size is/should be for you individually, you want to know if it is enlarging, and also how fast it is growing. A fast growth rate is also a concern, regardless of size, because aortic tissue can be unpredictable.


I hope this helps!

Arlyss

 

[Karlynn]

Harmony, I'm really curious as to why your aortic root is changing, when it your mitral valve the is has the problem. Is your aortic valve now affected? It might be time to check in with a surgeon to get their take on your situation. You might not be ready for surgery, but since surgeons most often like to operate before permanent damage is done, and cardiologist tend to want to see damage before they order surgery, you could benefit from the surgeons opinion.

 

[KimC]

"You might not be ready for surgery, but since surgeons most often like to operate before permanent damage is done, and cardiologist tend to want to see damage before they order surgery, you could benefit from the surgeons opinion."

I MAY be living proof of this tendency, as my surgeon asked for annual echoes back in 2003. My first cardio (now fired) balked and said I'd only need echoes every two years for moderate aortic insufficiency and mild tricuspid insufficiency.

Fast forward to 2005, and the right side of my heart MAY be permanently damaged as a result of a more conservative approach to my care. Everyone's different; I'm a small person and perhaps that skewed my numbers.

My point here is that be assertive in your care. I don't know the specifics of your case, and don't want to scare you Harmony, but push for answers, seek a second opinion and ask the hard questions.

Best,

 

[Jewel]

Many considerations

Many considerations

Having JUST been released from the hospital 10 minutes before I was supposed to go into surgery for aortic aneurysm and valve replacement - some of the points are clear in my mind.

Here is what I would look at if I were you:

1) as they said, what is causing an aortic root anuerysm at this time when they have been previously looking a mitral valve?

2) what is the size (which should be clearly measured by more than one test)

3) what is the size of YOUR aorta and heart etc, as compared to the enlarged area

4) what is the shape/length etc of the enlarged area - my understand was an irregular shape or a "ballooned area" is treated differently than the entire "tube" enlarged at the same size/same rate

These were the considerations given for NOT operating on my ascending aorta that is enlarged.

Best

Julie

 

[CCRN]

Numbers

Numbers

I have MVP with moderately severe regurg. Yesterday I received a copy of my last echo done 6/3/05. Everything is basically the same as the echo I had done 6 months ago. However this time he listed the value of the Aortic Root as 3.5 normal value is 3.7 cm. The Cleveland Clinc says the normal Aortic Root is 2.6 and above 4 cm is regarded as an anuerysm. I asked my Cardio why the echo says 3.7 is normal and CC says 2.6 is normal. He feels that up to 4 or 4.4 is normal. Can some one tell me what should a normal Aortic root value be. I never paid much attention to my MVP before last year as the Cardio I was seeing always told me it was just a minor leak until last year when he suddenly told me it was not very good any more and should see a surgeon. My present Cardio who first diagnosed me 10 years ago says because of certain factors I can wait to have an operation. I ask about the size of Aortic Root because I want to be well informed about what is going on in my heart
Thank You

I agree with Arlyss. My aorta was 4.5 and might not have been a problem for some people but, compared to my descending aorta, it was 3 times the size. You really have to look at the big picture. No one knew this until I had my cath. I have been wondering lately if just maybe I'd had a CT with contrast we might have known this sooner. It's one of the questions I have listed for my post-op appointment.

 

[Jewel]

good websites for this info - from another post

good websites for this info - from another post

Hi,
These questions are not silly. They are very important. Dealing with the aorta and potentially fragile tissue requires very exacting skill in order to have the best possible results in both the short and long term.

Do you know how large your aorta is? Was anything said that might indicate they are talking about wrapping your aorta to reinforce it?

I will list some links here that may help you.

http://www.slrctsurgery.com/Thoraci...20aneurysms.htm
http://www.cedars-sinai.edu/aorta
http://www.bicuspidfoundation.com

Please feel free to send me an email or private message.

Best Wishes,
Arlyss
__________________
My husband is the patient
AVR for BAV in 1990
Ascending aortic aneurysm 2001

 

[Harmony]

I asked about the normal size of the Aortic root because I am curious. I found 2 copies of older echos and a copy of a tee. Echo from 2003 say AO 3.4 from 2004 say 3.2 a Tee from 2004 say 3.0. The echo I took 2 weeks ago say 3.5. My Cardio does not feel this is bad as I said before he feels that up to 4 or 4.4 might not be bad. I am a tall woman 5'9 and weigh 135. My Cardio feels as I am big many of measurements are a little bigger. Although I am really very slender. I have what is called a typical MVP body long and lean with very long arms,fingers, legs, toes. On my last echo Cardio wrote Aortic Root/ascending Aorta all appear normal. I worry so much about my MVP and constantly look for other things that might be wrong.

 

[Arlyss]

I asked about the normal size of the Aortic root because I am curious. I found 2 copies of older echos and a copy of a tee. Echo from 2003 say AO 3.4 from 2004 say 3.2 a Tee from 2004 say 3.0. The echo I took 2 weeks ago say 3.5. My Cardio does not feel this is bad as I said before he feels that up to 4 or 4.4 might not be bad. I am a tall woman 5'9 and weigh 135. My Cardio feels as I am big many of measurements are a little bigger. Although I am really very slender. I have what is called a typical MVP body long and lean with very long arms,fingers, legs, toes. On my last echo Cardio wrote Aortic Root/ascending Aorta all appear normal. I worry so much about my MVP and constantly look for other things that might be wrong.

Hi Harmony,
Echocardiograms are very dependent on who performs them. They are essentially a manual process, done by hand, especially when done by moving a wand around on the outside of the chest (TTE). It depends very much on how the individual moves that wand. Traditionally the echo has been used to study the valves and chambers of the heart.

If I wanted to know about my aorta, I would have an MRI with contrast of my chest. (If I had metal in my body and could not have an MRI, I would have a CT scan with contrast, which will also show the aorta, but will expose me to x-rays!) This will show the entire aorta. The root, ascending aorta, arch, and descending aorta can all be measured. When it is the root and ascending aorta that is enlarged, the descending aorta gives a good indication of what is normal for your aorta. When this evaluation is done by an aortic expert, you will know exactly where your aorta stands.

You might also want to consider being evaluated by someone familiar with connective tissue conditions.

Words like "good" and "bad" are general and not very helpful. What is helpful is knowing facts about yourself individually and what they mean. I have found that facts and information are the best tools I have to banish worrying!

Best Wishes,
Arlyss

 

[Arlyss]

Example of Connective Tissue Disorder

Example of Connective Tissue Disorder

Hi Harmony,

This is to follow up on my comment about being checked for a connective tissue disorder. Here is a link to a story from the Mayo clinic that is an example of both MVP and aortic issues associated with a connective tissue disorder. You will see why this story reminded me of you when you described how tall and slender you are, with long arms, legs, fingers, and toes.....

http://www.mayoclinic.org/patientstories/heatherhinton.html

In this case it is Marfan syndrome, but one does not necessarily have to meet all the criteria of that syndrome in order to have heart/vascular issues due to some form of connective tissue problem.

When mitral and aortic tissue are both involved, I just want to encourage you to seek out help from someone who is knowledgable in connective tissue conditions. Please feel free to email or send me a private message if I can help further.

Best Wishes,
Arlyss