Ross
Well-known member
How in the world would one with a St. Jude mechanical valve with graft sleeve have mild stenosis?
Educate me
- Thread starter Ross
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Bonzo Dog
Well-known member
Shot in the dark:- It's a little too small? Bad judgement on size by implanting surgeon?
Ross
Well-known member
I attached a picture of it. I don't see how it's possible.
L
Lisa in Katy
My guess, only because I know it can cause problems - scar tissue is blocking part of the valve? That picture is scary. It looks way too flimsy to keep anyone alive!
Ross
Well-known member
I don't know, but my echo report says mild stenosis noted. I sure can't see how.
When do you talk to the cardio?
pamela
Well-known member
Ross, mild stenosis is merely a very slight narrowing, perhaps there's a light deposit of solids on the static surfaces of the valve or the dacron, coumadin keeps clotting away, but from what I figure, not too much can change the way hemodynamics allows calcification. Dacron, although slippery, isn't perfectly friction free. Unless the doc says worry, I wouldn't be too concerned apart from being aware that life is proceeding as it should.
Ross
Well-known member
I'm not worried, I just don't understand how it could build up on the graft. That's what has me confused.
If there was no stenosis before from the valve, then there shouldn't be any now. Check to make sure it hasn't been mentioned before.
Possible reasons include pannus tissue or calcification that is blocking it from opening all the way, an inept technician with a high gradient computation, a bad read of the flow, laying on your left side too hard for echo so the valve was at an angle that made the valve hit the side wall of the aorta so it didn't open all the way.
Your endothelium grows upon and through the dacron. It becomes a scaffold full of you. It's conceivable there could be too much you in the sleeve.
I'm voting for a bad read or computation by the technician.
However, you should make your cardiologist explain why it's there, or at least what prompted him to think it was there.
Best wishes,
Possible reasons include pannus tissue or calcification that is blocking it from opening all the way, an inept technician with a high gradient computation, a bad read of the flow, laying on your left side too hard for echo so the valve was at an angle that made the valve hit the side wall of the aorta so it didn't open all the way.
Your endothelium grows upon and through the dacron. It becomes a scaffold full of you. It's conceivable there could be too much you in the sleeve.
I'm voting for a bad read or computation by the technician.
However, you should make your cardiologist explain why it's there, or at least what prompted him to think it was there.
Best wishes,
Just to make you feel better, here's a short study that found that those with a full Bentall Procedure have a better life expectancy than those with just a valve swap:
http://www.sciencedirect.com/scienc...=6564521&md5=b84bc783a9f5be5571f6ff4214945509
Best wishes,
http://www.sciencedirect.com/scienc...=6564521&md5=b84bc783a9f5be5571f6ff4214945509
Best wishes,
That's just like.. pannus though.
Ross, where's the stenosis at? The valve? The graft? the anastomised part? I'm not sure how this can happen either, other than pannus or maybe a twisting/kinking of the graft.
Ross
Well-known member
I'll know more when I have the report in my hand, right now, it's word of mouth from the Cardio's nurse calling with the results.
I'm figuring bad view myself because none of my other reports indicate anything of that nature.
Trinityheart8891
Well-known member
ross,
from my understanding the valve could just have a gradient through it because its different than native tissue, it may be a bad reading, but I thought all mech valves had some degree of stenosis/regurg just because of the design, especially related to the fact that the valve couldnt be too big cause it had to fit inside the annulus, I am not sure about this but it makes sense, but if it is different than previous echos its probably something to keep an eye on, keep us posted!
from my understanding the valve could just have a gradient through it because its different than native tissue, it may be a bad reading, but I thought all mech valves had some degree of stenosis/regurg just because of the design, especially related to the fact that the valve couldnt be too big cause it had to fit inside the annulus, I am not sure about this but it makes sense, but if it is different than previous echos its probably something to keep an eye on, keep us posted!
I've had echoes that said I had possible coarctation of the aorta if it makes you feel any better. Boy, were they wrong. They're not very precise man.
I do wonder though (not trying to cause you any more anxiety) how do the platelets not build up inside of the graft and stick together until it just clogs like an old clogged pipe?
I do wonder though (not trying to cause you any more anxiety) how do the platelets not build up inside of the graft and stick together until it just clogs like an old clogged pipe?
ctyguy
Well-known member
that photo is the valve ? I would expect something like mine which is shaped like a donut more or less. I'm blown away by that picture.
In regards to the stenosis, Im no help but Im sure if it was a concern it would have been mentioned to you.
In regards to the stenosis, Im no help but Im sure if it was a concern it would have been mentioned to you.
aussigal
Well-known member
Thats a pic of the valve with the graft ie: Dacron Aorta ...for those of us who had the full Bentalls procedure/operation where we had our ascending aortas replaced due to aneurysms. Valves them selves are only little and dont have the big white dacron bit. I am thinking the plastic tube thingy inside the dacron sock-tube is the applicator thingamajig!
Rossman has one of these, so do I and lots of others on here too.
I like tobagotwo's response.
this is another look at our valve & graft without the applicator...regular valves look like shiny black bit, but without the white sleeve and are about 1 1/2 inches across and 1/2 inch deep, actually when you click on the pic its real close to life size.
ctyguy
Well-known member
the stuff that can be done now just blows me away. 50 years ago we are all toast !
Scott, you are so right. It is remarkable how far valve replacement technology has come.
Jim
Ross
Well-known member
M-Mode Echocardiogram:
The left atrial size appeared to be dilated with a normal aortic root diameter. The aortic valve appeared to be a prosthesis. The mitral valve opening appeared to be with normal limits without evidence of mitral stenosis. The left ventricle chamber size was mildly dilated at end-systole and at end distole, however, a vertically positioned heart may have tended to overestimate ventricular dimensions.
2-D Examination:
The left atrial size again appeared to be mildly dilated with normal aortic root diameter. The aortic valve appeared to be a prosthetic valve with some thickening and echo reflectivity suggested but with stenosis being difficult to discern due to the metallic framework of the prosthesis.The mitral valve leaflets appeared thin and pliable. The left ventricle appeared to be within normal limits with an estimated left ventricular ejection fraction of 65%. No segmental left ventricular wall motion abnormalities were apparent. Mild left concentric left ventricular hypertrophy was noted. The right ventricular chamber size appeared to be normal with normal right ventricular free wall motion. The right atrial chamber size was at the upper limits of normal. No pericardial effusion was identified.
Doppler Exam:
Inflow velocities across the tricuspid valve appeared to be within normal limits. Mild tricuspid regurgitation was noted with a peak flow velocity reaching 1.6 meters per second, suggesting pulmonary artery systolic pressure of 20mmHg. Flow velocities in the right ventricular outflow tract and across the pulmonic valve appeared to be within normal limits. Antegrade flow velocities across the mitral valve appeared to be within normal limits without evidence of mitral stenosis. No significant insufficiency was apparent. Flow velocities in the left ventricular outflow tract and across the aortic valve prostheses were elevated to 3.5 meters per second. A peak gradient across the prosthesis of 50mmHg with a mean gradient of 30mmHg was recorded.
The prosthetic area was estimated at 1.2 sq cm. consistent with prosthetic valvular stenosis. No prosthetic or peri prosthetic insufficiency was apparent.
Conclusions:
1. Somewhat technically limited study due to patient body habitus and chest wall configuration. Acoustic imaging windows were suboptimal.
2.Normal left ventricular chamber size at end-systole and at end-diastole with normal global contractility.
3.No distinct segmental left ventricular wall motion abnormalities were identified.
4.Concentric left ventricle hypertrophy.
5.Dilated left atrium.
6. An aortic valve prosthesis was identified that appeared to be a tilting disc variety. Mild prosthetic stenosis was apparent. No prosthetic or peri-prosthetic insufficiency was identified.
7.Mild tricuspid regurgitation.
8.Pulmonary artery systolic pressures were estimated at 20mmHg.
9. There was no evidence of pericardial effusion.
10.Compared to prior echocardiographic evaluation dated 7/21/2006, there has been a mild increase in the peak and man gradients across the aortic prosthesis, thought without development of critical aortic stenosis and with a similar estimated valve area. There has been little change in the qualitative tricuspid regurgitation, nor the estimated pulmonary artery systolic pressure.
The left atrial size appeared to be dilated with a normal aortic root diameter. The aortic valve appeared to be a prosthesis. The mitral valve opening appeared to be with normal limits without evidence of mitral stenosis. The left ventricle chamber size was mildly dilated at end-systole and at end distole, however, a vertically positioned heart may have tended to overestimate ventricular dimensions.
2-D Examination:
The left atrial size again appeared to be mildly dilated with normal aortic root diameter. The aortic valve appeared to be a prosthetic valve with some thickening and echo reflectivity suggested but with stenosis being difficult to discern due to the metallic framework of the prosthesis.The mitral valve leaflets appeared thin and pliable. The left ventricle appeared to be within normal limits with an estimated left ventricular ejection fraction of 65%. No segmental left ventricular wall motion abnormalities were apparent. Mild left concentric left ventricular hypertrophy was noted. The right ventricular chamber size appeared to be normal with normal right ventricular free wall motion. The right atrial chamber size was at the upper limits of normal. No pericardial effusion was identified.
Doppler Exam:
Inflow velocities across the tricuspid valve appeared to be within normal limits. Mild tricuspid regurgitation was noted with a peak flow velocity reaching 1.6 meters per second, suggesting pulmonary artery systolic pressure of 20mmHg. Flow velocities in the right ventricular outflow tract and across the pulmonic valve appeared to be within normal limits. Antegrade flow velocities across the mitral valve appeared to be within normal limits without evidence of mitral stenosis. No significant insufficiency was apparent. Flow velocities in the left ventricular outflow tract and across the aortic valve prostheses were elevated to 3.5 meters per second. A peak gradient across the prosthesis of 50mmHg with a mean gradient of 30mmHg was recorded.
The prosthetic area was estimated at 1.2 sq cm. consistent with prosthetic valvular stenosis. No prosthetic or peri prosthetic insufficiency was apparent.
Conclusions:
1. Somewhat technically limited study due to patient body habitus and chest wall configuration. Acoustic imaging windows were suboptimal.
2.Normal left ventricular chamber size at end-systole and at end-diastole with normal global contractility.
3.No distinct segmental left ventricular wall motion abnormalities were identified.
4.Concentric left ventricle hypertrophy.
5.Dilated left atrium.
6. An aortic valve prosthesis was identified that appeared to be a tilting disc variety. Mild prosthetic stenosis was apparent. No prosthetic or peri-prosthetic insufficiency was identified.
7.Mild tricuspid regurgitation.
8.Pulmonary artery systolic pressures were estimated at 20mmHg.
9. There was no evidence of pericardial effusion.
10.Compared to prior echocardiographic evaluation dated 7/21/2006, there has been a mild increase in the peak and man gradients across the aortic prosthesis, thought without development of critical aortic stenosis and with a similar estimated valve area. There has been little change in the qualitative tricuspid regurgitation, nor the estimated pulmonary artery systolic pressure.
Ross, just out of curiosity, what was the valve area post-op originally?
Jim
