Help with echo report

[Eva]

Hi, Lisa. I cannot tell what is going on, but I CAN definitely pray that all goes well.

 

[ALCapshaw2]

I recall seeing a Very Low Gradient listed (on www.heartvalvechoice.com) for one type of Porcine Tissue Valve, which to my mind was it's primary advantage.

The downside of Porcine Valves is that they typically have a shorter useful lifetime, especially the untreated ones. I'm thinking the newer models haven't been out long enough to know what to expect vs. the Bovine Pericardial Tissue Valves which have been around for 20 years now.

I agree with Oaktree. Your Doctor's have not given you a Good Reason for the CHANGE in your Gradient over the past 2 months. SOMETHING must be changing physically to cause this change in gradient (or so my engineering mind suggests to me). I also agree that if you do indeed have a "patient prosthesis mismatch", the surgeon is not likely to confess to that.

Getting your Disability approved is certainly an important priority. Hopefully that will eventually allow you to seek another expert opinion from a Major Heart Center, preferably before you undergo surgery for weight loss.

 

[Arlyss]

Small Annulus?

Small Annulus?

Hi Lisa,
I just wanted to mention the annulus size to you, to see if this is some information you can gather about yourself. The annulus is the circular area right around the valve. It's size is important because the new prosthetic valve must fit into this area.

Some people have a small annulus - my husband is one of them. When his BAV was replaced, his annulus was not enlarged and a quite small mechanical valve was put in. He was fortunate that the the smaller size did not seem to affect him, although looking back if we had known what we know today, we could have looked for someone with the skill to decalcify and enlarge the annulus then. During his second valve replacement, his annulus was enlarged with a pericardial patch and the area decalcified so that a tissue valve could be fitted. It was not low risk for him, but it was what was needed. Although it is not an unknown procedure, not every surgeon would have the skill to enlarge the annulus in this way.

You have my very best wishes as you seek help,
Arlyss

 

[roundsgirl]

Just back from seeing surgeon

Just back from seeing surgeon

Hey gang,
Well I just got back from seeing the surgeon. B/P 155/100 still high after new med. but we didn't address it. The lump I am feeling between the breast is in fact a hernia. He said they can repair it surgically, but he would wait to see if it gets worse of pops out and doesnt' move back etc. He thinks that could be causing my chest pain that radiates to my back, I guess he knows more than I.

Let me give you a quote from the letter he provided me in regards to the weight loss surgery. "On echocardiogram she has a high aortic trans-valvular gradient,despite a normally working 21mm tissue aortic valve prosthesis. This is most likely due to a valve size/body mass mismatch." OK so there it is in writing about the valve mismatch. He goes on to say he fully supports the recommendation for bariatric surgery.

When I asked him and his assistant was in there also, what is this stenosis, calification, scar tissue etc., what is it, his response is that it is a product of this whole valve and pressures issue. So what does that mean, it's like he is trying to get me to understand the amount of pressue on my valves and heart needed to supply the blood needed to rest of my body is under alot of pressure, which goes hand in hand with the gradients and stenosis. Does this make sense? He said by the size of my heart he would have used a 19mm valve replacement, but he knew that would be too small to give my body the blood supply that is needs, even said he had to work to get the 21mm valve in there.

OK so what do you think? I'm just as confused as I was when this all started.

Thanks guys for listening to me and giving me your advise.

Looking forward to hearing from you once again

Sincerely,
Lisa

 

[roundsgirl]

Oaktree, you are right on. The only difference in how you are explaining it and how he did on the phone last week except he used kitchen pipes in his version.
So does all that make sense with the stenosis and gradients?

 

[roundsgirl]

Yeah weight was the same, don't you know that's the first thing they checked.

I have tried to lose weight in the past, but obviously unsucessfully. Or if I did lose some I always put it back on and then some the same old story....

My problem is the exercising, I can't tolerate any physical activity, with my heart along with my knee, back and other physical problems. My cardio. told me he would not feel comfortable with telling me to exercise as my heart is under too much stress right now that in combination with the physical capibilities test he sent me for, which my heart readings were not good during those test per the cardio, etc.. hence the whole weight loss surgery approach.

Should I ask about the TEE, the Cardio or Surgeon?

 

[roundsgirl]

I just pulled and looked over the Echo in May but it doesn't have a blood pressure reading on it. It would be safe to say my blood pressure has given me trouble before as well as after the surgery, that's why they keep changing my meds.

I also got the letter from my Cardio. which also mentions valve/body mismatch, and when I look that up it says you will have high gradient numbers. But.....why the jump is still the question????

 

[Scooby06]

good question

good question

Oaktree, good thought.

As I looked at her update I thought the same thing. Many people have low bp following heart surgery, and it climbs as they heal. Your bp is currently poorly controlled, and this is elevating your gradient.

I knew you had PPM based on the EW valve EOA references, that is why I posted that after you and me PM'd

Weight loss will help as metabolic demand will decrease as BSA decresasses.

Good luck with this.

JH