Hi, I am new, would like your thoughts

[rbl1999]

Hi, my name is Rose, I am 59 and was diagnosed woth aorta valve disease last November, and am going to have to have aorta valve replacement. I have seen the cardiologist once and have a follow up appt with him this coming Tuesday and am seeing the surgeon right after on the same day. I just had another echo done last week did receive a call from the cardiologist saying it is a little worse and that we will talk on Tuesday. I would like to give you some of the results from the echo done in November and get your thoughts. Aortic root size shows poststenotic dilation. Ejection fraction is close to 60%. There is an increase in aortic flow with 3.3 m to 4m. The maximum gradient is about 50mm. Calculated valve orifice is about 0.9 sq cm with a continuity equation. There is tricuspid insufficiency with increase in the right ventricular pressure. Conclusion: Moderate to severe aortic stenosis with a bicuspid valve. I am feeling so so, my energy level has really decreased, I am tired, and get lightheaded when I first stand up.. I don't feel terrible, but from what I have been reading on these posts, I probably don't realize that I don't feel well???? I would appreciate advice from all of you, I have really been able to get so much good info from this forum, and I thank you in advance. What are the most important things I should ask these docs%???? THANKS!!!!!

 

[Ross]

Hi Rose, glad to see you posting and no longer lurking.

I'm not even close to good interpreting these results, but to me, surgery could probably wait a while yet. Lets give this a little time and see if tobagotwo or one of the others can decipher this a little better.

 

[bvdr]

Welcome, Rose! I lived in the Venice-Nokomis area just north of you for about ten years. I actually worked as an RN in the cardiac unit in Venice hospital many years ago. At that time we did no cardiac surgery. It has been more than twenty years and I have no idea what they do there now. I am 57. I went with a mechanical mitral valve but it wouldn't have made much sense for me to do otherwise since I was already on coumadin for atrial fib.

I wouldn't be surprised if you are much more symptomatic than you realize. I wouldn't be surprised either if it is recommended that you proceed with surgery. There isn't a lot of difference between the 0.8cm sq. where surgery is pretty much a given and the 0.9cm.sq. where you are now. The other thing to consider is that unless you have other unrelated issues, although that is relative since actually in the heart everything is related, it seems that your right heart is becoming affected and it would make sense to get this done while your heart is still functioning well and is strong.

Where are you planning on having the surgery? I would make sure that whoever does is has a lot of experience in his field.

 

[rbl1999]

Thanks so much for your responses, Ross and Betty... Betty, the surgery will be done at Sarasota Memorial, which I am sure you are familar with.. The surgeon is Dr. Thomas Kelly, I understand he was istrumental in setting up OHS at the hospital. I agree with you in that I probably am not feeling as well as I think. My cardiologist is Dr. Clayton Bredlau who I really like.. I am at the point that I am tired of constantly thinking about it, and I also agree with you in that I would rather do it while the rest of my heart is healthy. My stress test showed that my heart is very strong, I have always been an exerciser, I am still, but on his advice I am only walking... We have lived in Florida for 6 years, are originally from Maine... Thanks again.

 

[MarkU]

Hi Rose,
I had my aortic valve replacement done at Sarasota Memorial in December 2000, by Dr. Martin Beggs. Dr. Kelly has an excellent reputation and you are in good hands with him. You are correct in that he was instrumental in establishing the open heart surgery program at Sarasota Memorial.
My experience at SMH was very positive and I received excellent care. Please feel free to contact me if you have any questions that I might be able to help with.
Take care,
Mark

 

[Mary]

Hi, my name is Rose, I am 59 and was diagnosed woth aorta valve disease last November, and am going to have to have aorta valve replacement. I have seen the cardiologist once and have a follow up appt with him this coming Tuesday and am seeing the surgeon right after on the same day. I just had another echo done last week did receive a call from the cardiologist saying it is a little worse and that we will talk on Tuesday. I would like to give you some of the results from the echo done in November and get your thoughts. Aortic root size shows poststenotic dilation. Ejection fraction is close to 60%. There is an increase in aortic flow with 3.3 m to 4m. The maximum gradient is about 50mm. Calculated valve orifice is about 0.9 sq cm with a continuity equation. There is tricuspid insufficiency with increase in the right ventricular pressure. Conclusion: Moderate to severe aortic stenosis with a bicuspid valve. I am feeling so so, my energy level has really decreased, I am tired, and get lightheaded when I first stand up.. I don't feel terrible, but from what I have been reading on these posts, I probably don't realize that I don't feel well???? I would appreciate advice from all of you, I have really been able to get so much good info from this forum, and I thank you in advance. What are the most important things I should ask these docs%???? THANKS!!!!!

Rose,
It just so happens I was looking all this stuff up myself the other day.
Jet velocity readings of 4m indicate severe stenosis. Mean gradient (not maximum) readings of 50mm or more also indicate severe stenosis when coupled with a symptomatic patient (which you are.)
I found out after my surgery that the calculated valve area opening is just one number in conjunction with the other two, so I think you are real close to needing the surgery. Your ejection fraction is still real good; I was also able to maintain a high one up until the very end. The day before surgery it dropped down to 50%.

I would listen to what your surgeon advises. If he says go, but the cardio says wait, I would go with the surgeon.

I hope this helps.
Mary

 

[rbl1999]

Hi Rose,
Thanks so much for your response, Mark, it is nice to hear from someone who had the surgery at SMH... How are you doing since you had the surgery? It can all be so overwhelming, I am trying to keep a positive attitude!!!

 

[ALCapshaw2]

Welcome Rose,

It sounds like all your numbers are right at the threshold of indicating surgery. I am an advocate of EARLY Invervention (before permanent damage is done to the heart muscle and walls). IMHO, once you know surgery is needed to correct an active problem, I see NO BENEFIT in postponing it and risking further damage to your heart. It will NOT get better on it's own so you are well advised to consult with a surgeon. If he says it's time, I would heed his advice.

'AL Capshaw'

 

[tobagotwo]

So, you did have more changed than the valve, and have completed the transition from Mary to Mark...

Maybe just a typo...

Actually, Mary has pretty much covered it. Basically, if you're symptomatic (you are), anything under 1.0 is fair surgical game for aortic anulus size. My velocity was 4.0 when my AVR was done, although my peak gradient was somewhat higher than yours. My EF was 77%, which is a short-term increase in pumping efficiency indicative of ventricular enlargement (not a good sign). Remember, not only do you have stenosis, but you also have regurgitation at the valve, which team up to make it hard for your heart.

As far as symptoms, most people are shocked when they realized how badly they felt before surgery. They discover that because of how well they feel afterwards.

Best wishes,