Hi, I'm back , 10 years and still no surgery ..yet !

[kernow61]

Hi all,
I joined this forum around 2012 when I was trying to seek information regarding AVR due to bicupsid valve with moderate to severe regurgitation.

I am now 61 years of age, 5' 11"", 11.5 stone. I smoke <_10 cigs a day and drink moderately. I used to run 4 - 6 mile 4 x a week but due to hip problem have not exercised a lot in last 1.5 years. I am on my feet and active at work (12 hr shifts, 50+ hrs a week ).

My first stats in 2012 were:
EF = 60 -65 %
LVD = 64mm
LVS = 43mm
Ascending Aorta = 38mm
Aortic root = 39mm
Gradient = 20 - 25 nnHg

I have been on 6mth echos and have remained fairly stable for last 10 years.
I am asymptomatic and live an active life with no notable change to exercise tolerance (tiredness, breathlessness etc.).

Recently had MRI, and following echo (below) were similar in results.


My current stats ,2022, from last echo, a few months after MRI, are:
" Overall left systolic function is preserved. No evidence of left ventricular hypertrophy, the right heart is normal. Mildly increased forward flow, peak velocity 2.3, peak gradient 22, mean gradient 10, eccentric probably severe aortic regurgitation, difficult to assess with flow reversal in the aorta."
EF = 60 -65 %
LVD = 64mm
LVS = 49mm
Ascending Aorta = 32mm
Aortic root = 39mm

From recent CT angiogram:
" Calcium score of 66 for LAD and RCA.
Mildly elevated coronary calcification in proximal LAD resulting in <25% stenosis, left cicumflex is normal, mild plaque disease in mid RCA. No flow limiting.
The ascending aorta is normal, 34mm at sinuses of valsalva, sinotubular junction 32mm and ascending is mildly dilated 37mm. No significant extracardiac findings.

I used to run frequently but due to hip problems am now unable to so consultant suggested a recent CPET.

".. Recent Cardiopulmonary test was satisfactory, although suggestion of ST depression at peak excercise which resolved quickly within a minute of recovery phase."

Still not sure about having AVR surgery yet.

Any thoughts, (or breakdown of reports/stats !!) appreciated.

 

[pellicle]

Any thoughts, (or breakdown of reports/stats !!) appreciated.

well as its open to just thoughts (I'm not much chop at breaking down cardiovascular stats and leave that sort of interpretation argument to actual cardiologists) what I can say is that as you've mad it this far it looks like you are now in the territory when valve choice becomes simpler and you don't have to worry about longevity of the valve dumping you in "reoperation" in your 70's (for getting 10 years out of a valve at your age will be more "likely" than "dreaming". This is a good thing IMO.

I would say however that before you get that valve (and certainly after) stop smoking completely. Its identified in the predictors of early failure of tissue prostheses.
https://www.ahajournals.org/doi/10.1161/circ.136.suppl_1.20383

Results: VHD occurred in 428 patients (30.9%). After comprehensive adjustment, VHD (entered as time-dependent variable) was strongly and independently associated with mortality (HR: 2.18[1.86-2.57], p<0.001). Overall, independent predictors of VHD were diabetes (HR: 1.33[1.06-1.66], p=0.01), a MG ≥15mmHg at baseline echo (HR: 1.30[1.05-1.62], p=0.02), severe prosthesis-patient mismatch (HR: 1.85[1.12-2.87], p=0.02), and type of BP (stented vs. stentless BP, p<0.001). Interestingly, age was not a predictor. The VHD occurred early within <5 years after AVR in 181 patients, the predictors of this early SVD were: diabetes (p=0.01), active smoking status (p=0.01), renal insufficiency (p=0.01), post-AVR MG ≥15 mmHg (p=0.04) and ≥ mild transprosthetic regurgitation (p=0.04), and type of BP (stented vs. stentless, p=0.003). VHD occurred after 5 years in 247 patients, the predictors of late SVD were: female sex (p=0.03), use of coumadin (p=0.007) and type of BP (p<0.001).​

NOTE: a major "ouch" in the above is that it would seem that if your valve or valve surgery requires you to take warfarin then its an predictor for late SVD (not sure what defines late ... would it 5 years or 10 )

Best Wishes

 

[kernow61]

Thank you for your reply.

Might get another couple of years before surgery yet
Appointment with consultant next week. The bit in last echo report.."Overall left systolic function is preserved. No evidence of left ventricular hypertrophy, the right heart is normal."...sounds not too bad to me.

 

[carolinemc]

Hi all,
I joined this forum around 2012 when I was trying to seek information regarding AVR due to bicupsid valve with moderate to severe regurgitation.

I am now 61 years of age, 5' 11"", 11.5 stone. I smoke <_10 cigs a day and drink moderately. I used to run 4 - 6 mile 4 x a week but due to hip problem have not exercised a lot in last 1.5 years. I am on my feet and active at work (12 hr shifts, 50+ hrs a week ).

My first stats in 2012 were:
EF = 60 -65 %
LVD = 64mm
LVS = 43mm
Ascending Aorta = 38mm
Aortic root = 39mm
Gradient = 20 - 25 nnHg

I have been on 6mth echos and have remained fairly stable for last 10 years.
I am asymptomatic and live an active life with no notable change to exercise tolerance (tiredness, breathlessness etc.).

Recently had MRI, and following echo (below) were similar in results.


My current stats ,2022, from last echo, a few months after MRI, are:
" Overall left systolic function is preserved. No evidence of left ventricular hypertrophy, the right heart is normal. Mildly increased forward flow, peak velocity 2.3, peak gradient 22, mean gradient 10, eccentric probably severe aortic regurgitation, difficult to assess with flow reversal in the aorta."
EF = 60 -65 %
LVD = 64mm
LVS = 49mm
Ascending Aorta = 32mm
Aortic root = 39mm

From recent CT angiogram:
" Calcium score of 66 for LAD and RCA.
Mildly elevated coronary calcification in proximal LAD resulting in <25% stenosis, left cicumflex is normal, mild plaque disease in mid RCA. No flow limiting.
The ascending aorta is normal, 34mm at sinuses of valsalva, sinotubular junction 32mm and ascending is mildly dilated 37mm. No significant extracardiac findings.

I used to run frequently but due to hip problems am now unable to so consultant suggested a recent CPET.

".. Recent Cardiopulmonary test was satisfactory, although suggestion of ST depression at peak excercise which resolved quickly within a minute of recovery phase."

Still not sure about having AVR surgery yet.

Any thoughts, (or breakdown of reports/stats !!) appreciated.

stop smoking.

 

[ValveAdmin]

Welcome back!