gradient has improved

[bivalve1]

My pressure gradient (across stenosed bicuspid aortic valve) has improved to 58 mmHg from 64 six months ago. Both measurements from an echocardiogram. After the 64 reading, I was told to expect an op this autumn, and was getting ready to meet the surgeon. That's now postponed, don't know till when. I expect I will have the op eventually. Valve size: 1.3 square cm. Recent exercise test: did 130 per cent of expected amount of 'work'.

How unusual is this improvement in the 'gradient', does anyone know? I'd also be grateful to hear if anyone else has had a similar experience and what happened afterwards.

 

[epstns]

bivalve - I hate to "rain on your parade" but I would bet that nothing has really improved. Both readings are, to me, within the normal variability of the echo measurement process - meaning that one tech may get a different reading than another, one machine may get a different reading than another on the same patient, one patient may get two different readings on different days, etc., but both readings are similar. With a valve size calculated at 1.3 cm2, they wouldn't likely push for surgery, as most cardio's won't head for the OR until your calculated valve area is around 0.8 cm2 - unless you present any of the "cardinal" symptoms (SOB, syncope, angina).

My stenotic valve stayed around the 1.0 cm2 mark for a couple of years, then it progressed from there to 0.8 or less, and to the OR rather quickly. That's how it seems to go -- the worse these stenotic valves get, the faster they get worse. Unless your cardio advises otherwise, or you develop symptoms, I would just keep on enjoying life until things change significantly. It may be several years, or it may be months, but worrying about it won't make it any better. That's my experience talking -- I had over 9 years to plan for surgery. For the most part, they were good years, but now 7 months after surgery, I can see that the next years will be even better.

 

[kfay]

I agree with Steve. Echo's are not exact by any means and the person doing it can also make a big difference in the results. You may actually be somewhere between the two numbers, who knows. The "gold" standard for getting exact measurements is a heart cath, but I wouldn't press for one at this point if you are feeling well and as Steve said, your valve size still has a way to go before it starts getting critical.

 

[Mentu]

BV1, if you read about the expected margin of error found in echo cardiograms you will find that it is likely to be 10%-15%. As Steve said, the difference between your two readings is within the margin of error for this type of test. No one can say how your valve will progress. I can tell that my valve was measured at 1.25 cm2 with an average pressure gradient similar to yours and I also had no problem with a treadmill stress test. Nine months later I was planning surgery with a valve area of 0.7 cm2 and a mean pressure gradient of 65 mmhg with max pressure gradient at 135 mmhg. Because there is no significant change between your two tests, you cannot relax. I would encourage you to promptly report to your cardio any appearance of symptoms. It is sad fact of our lives that stenosis does not improve on its own. Instead it stress the heart to compensate which it can do for awhile. As Steve says, sorry to rain on your parade.

Larry

 

[Julian]

Oh boy... The great echo debate. In the course of two years I had several echos and each had a different report. At one point one echo showed that my valve area was 1.6 while all the others showed around 1.0. Pressure gradients were all over the place. Different techs and different doctors to interpret, in between all this I was symptomatic and could of went for surgery over 2 years ago.

As all the others have posted, WATCH FOR SYMPTOMS. Don't obsess over it but don't mistaken shortness of breath, "chest pain", and fatigue, for just getting old, I did and I'm 28 years old... CAN YOU SAY DENIAL!

True story, I believe the words of Jesus Christ and believed for my healing of this terrible disease. I truly was expecting a miracle and that I would not need the surgery. August of last year I went to start the process of getting the surgery done with no insurance because the symptoms were that bad. They ran two echos on me and showed my valve area was not great but not bad when all the other PAST reports and symptoms stated it was time for surgery. After I received the good report my symptoms did subside for a bit and I ended up getting a job with full benefits. I held the job for 8 months and again I couldn't take the symptoms any longer and the rest is history... I'm now 7 weeks post op and most if not all the symptoms I had have subsided or have been reduced dramatically. Jesus is still alive and people still experience miracles and don't need surgery. My miracle came a bit differently then I expected but none the less it came.

It's all about developing peace in the fire. Surgery, no surgery, symptoms, no symptoms, living, dying. Find a way to have peace in this and don't fear Goliath, it's only flesh and if you have a purpose and vision in your life you will survive and thrive. Don't get me wrong, it can get hellish but hell shall not prevail.

 

[Bina]

Sorry BV, more rain on your parade. A gradient of 58 or 64 is really the same thing with maybe a slight variance
in the interpretation of the echo numbers. Your valve area of 1.3 is still quite decent though and I'm sure that your
docs will follow you closely during the next year or so.