how to make a new heart?

[Midpack]

Hi!

just a general remark about different techniques used for measurements in cardiology. The most common is, of course, transthoracic echo (cheaper, less invasive). And this is the standard technique that almost all consensus are based on. So, even if another technique proves to be more accurate, it doesnt change that much.

Example:
let suppose that some measurement, using transthoracis echo, begin to be a concern at say 50mm. All the studies that let to that cut off value were conducted using transthoracis echo. Now let assume that it is proven that transthoracis echo overestimates the real size by around 10% compared with a CT scan. This does not mean that the cut off becomes then 55mm. It would still be 50mm by echo (and probably 45mm by CT scan).

Regards

 

[dornole]

When I had a Stress echo it was done while exercising, FYI (not after). Like on a treadmill or stationary bike.

 

[Evgenii]

Hello everyone, in general, they calculated at the hospital that the regurgitation is severe and I need an surgery with a mechanical valve, who can comment on this data?


Aortic valve: bicuspid

Fusion of the ACL-LCL (type 1) with calcification of the suture and marginal calcification of the valve leaflets

The opening of the valves is slightly limited.

tvorok Maximum gradient on Av-58 mm Hg.

Average gradient on Av-31 mm Hg.

Max speed on Av is 382 cm/sec.

The diameter of the VTLZ is 2.3 cm.

AVA by flow continuity equation. 1.28 cm2.

Also, in all main positions, the holodiastolic jet of aortic regurgitation is visualized.

Vena contacta AP-0.5 cm (in the parasternal position).

PHT-210-230 ms.

in the four-chamber apical position:

PISA -0.7 cm.

EROA -0.33

Volume .aortic regurgitation 67 ml

Index KDR-25.3 mm/m2.

Conclusion

CHD: bicuspid aortic valve with the formation of a combined defect severe vortical

regurgitation moderate aortic stenosis

Mild dilation of the ascending aorta.

LV myocardial hypertrophy

The chambers of the heart are not dilated.

Contractility of the LV (59%) and RV is satisfactory

MR 0-1 st. Tr 1 st.

The calculated pressure in the pulmonary artery is increased to 28 mm Hg.

Fluid in the pericardium is not visualized.

 

[Chuck C]

Hello everyone, in general, they calculated at the hospital that the regurgitation is severe and I need an surgery with a mechanical valve, who can comment on this data?

The report actually says that your regurgitation is moderate, not severe.

In terms of your level of stenosis, that report would indicate that you are in the moderate range.

Average gradient on Av-31 mm Hg.

Mean pressure gradient is 31 mmHg. Your AS would not be classified as severe until it is above 40 mmHg.

The other two key metrics agree with this:

Max speed on Av is 382 cm/sec.

This is also moderate, in terms of AS. It would be considered severe once it goes above 400.

AVA by flow continuity equation. 1.28 cm2.

Also this is moderate AS. It would be severe once your AVA falls below 1.00 cm2.

So, you have moderate AS and moderate regurgitation. By itself, one of those would generally not be an indication for surgery. However, having both does complicate things. If I am understanding your translations from your previous posts, you indicated that one hospital has told you that it is time for surgery and other consults you have received have indicated that it is not yet time. Are you able to ask the hospital which says that it is time, why they believe it is time? Are you experiencing any symptoms, such as chest pain, shortness of breath or dizziness and fainting? Are you able to exercise the same as a couple of years ago? Usually, the indication for surgery would be being severe with symptoms. Usually people don't have symptoms in the moderate range, but with being moderate for AS and regurgitation, it would not surprise me if you are having some symptoms.

LV myocardial hypertrophy

That means that your left ventricle is enlarged. Usually more details are provided, such as LV wall thickness and LV mass. Depending on how severe your LVH is, this could be an indicator for surgery. It should be noted that LV enlargement is very common for individuals with AS or regurgitation, so that is really not surprising, but as to whether it would drive the decision to operate would depend on the level of LVH.

You should be able to have a discussion with the physician who told you that it is time for surgery and ask him for his reasoning. Did you not have a consultation to discuss these findings?

 

[Evgenii]

Are you able to ask the hospital which says that it is time, why they believe it is time?

PISA 0,7 см
EROA } 0,33
aortic regurgitation volume 67 мл
Regurgitant volume ≥ 60 ml/stroke


, .A decrease in the pressure gradient half-time (PHT), determined by the slope of the Doppler spectrum of AR, indicates a rapid equalization of pressure in the aorta and LV, its increase excludes the presence of severe AR. The boundary values for this indicator are as follows: >500 ms - for mild AR; <200 ms - for severe AR. It should be noted that severe diastolic dysfunction of the LV can lead to an overestimation of PHT. Against the background of taking vasodilators, PHT naturally increases due to a decrease in the transaortic gradient. Distinction between moderate and severe AR in this way is incorrect.

The PISA proximal flow acceleration method provides not only a qualitative but also a quantitative assessment of the severity of AR, which is based on three main indicators: the effective regurgitant orifice area (EROA); the regurgitant volume (RV) per cardiac cycle, which characterizes the degree of volume overload; the regurgitant fraction (RF, the ratio of RV to stroke volume, SV, of a given patient).

The first two indicators, according to numerous studies, have demonstrated the greatest prognostic value, especially when indexed to body surface area (BSA) [7].

In the color Doppler mode, the blood flow accelerates above the regurgitation orifice, changing color to the opposite when the Nyquist limit is reached in the form of a hemisphere. Successful visualization requires a decrease in the Nyquist limit to 25-40 cm/s. The choice of the cross-section in which the regurgitant flow is directed to the sensor is important, especially with an eccentric jet.

The radius ( r , cm) of the convergence zone is the distance between the VC of the regurgitant flow (or the leaflets of the incompetent valve if the VC cannot be visualized) and the first change in the color Doppler image (color change). Knowing the radius of the resulting hemisphere, the area of the proximal convergence zone PISA can be calculated.

Having data on the area of the proximal isovelocity hemisphere, the blood flow velocity at this level taking into account the Nyquist limit, and the maximum regurgitant blood flow velocity, it is possible to calculate the effective regurgitant orifice area (EROA).

 

[Evgenii]

That means that your left ventricle is enlarged. Usually more details are provided, such as LV wall thickness and LV mass. Depending on how severe your LVH is, this could be an indicator for surgery. It should be noted that LV enlargement is very common for individuals with AS or regurgitation, so that is really not surprising, but as to whether it would drive the decision to operate would depend on the level of LVH.

Left ventricular end-diastolic dimension 5.7 cm Left ventricular size index 2.526 cm/m2 End-systolic dimension 4.3 cm Left ventricular end-diastolic volume 168 ml Left ventricular end-diastolic volume index 74.468 ml/m2 End-systolic volume 69 ml Stroke volume 99 ml Ejection fraction 59% Interventricular septum 1.3 cm Left ventricular posterior wall thickness 1.3 cm Left ventricular myocardial mass 321.646 grams Left ventricular myocardial mass index 142.573 g/m2

 

[Evgenii]

You should be able to have a discussion with the physician who told you that it is time for surgery and ask him for his reasoning. Did you not have a consultation to discuss these findings?

he looked at my data and said that the heart was no longer working properly and that elective surgery was needed, and I saw the digital data later in the hospital discharge. The surgeon also said that I did not need the ozaki procedure since their team had already re-operated on several patients after ozaki. I also discussed the possibility of a mini-sternotomy.

 

[Lucker]

Regurgitant volume of 67 ml is well in the severe zone. LV is not enlarged, only the muscle has hypertrophy, this is good.
I think it is time.

 

[Evgenii]

Regurgitant volume of 67 ml is well in the severe zone. LV is not enlarged, only the muscle has hypertrophy, this is good.
I think it is time.

Do I understand correctly that in this case there is no need to look at the still normal ejection fraction? Is more than 50% considered from the stroke volume or the total volume of the ventricle?