how to read an Echo?

[ericaj]

Anyone help me interpret these readings?

Aortic Diameter: 2.4cm
Aortic valve opening: not listed ??
Left Atrial Diameter: 3.2cm
Right ventricular diameter diastolic: 2.1cm
IVS thickness diastolic: 0.7cm
LVI diameter thickness: 4.9cm
LVPW thickness diastolic: 0.7cm


..peak velocity across aortic valve 3.2 m/s yields a maximal gradient 41mmHg and a mean gradient of 23 mmHg. Moderate aortic regurgitation detected by color Doppler exam which is pervalvular with a pressure half-time 479 milliseconds. By continuity equation teh aortic valve area is 1.1 cm/s.

..estimated ejection fraction 60% range qualitatively

Aortic root diamter: 2.4
Ao vlave opening: 1.54
Lt. Atrium Diameter: 3.2
Mitral valve E-F slope 49
Mitral V. E.P.S.S.: 7

R.V diameter: 2.1
I.V.S thickness: .7
LV diameter (dias) 4.9
L.V diameter (syst) 3.3
Fract. shortneing: 33%

L.V.P.W. Thickness: .7
Ejection Fraction: 61%
(real time) : WNL

heart rate: 101-114
Rhythm: NSR tachy

LVOT diameter: 1.9
LVOT Peak Velocity: 1.1
AoV Peak Velocity: 3.2
AoV Gradient: 41
AoV Area: 1.1
A.1 PHT: 479
A.I Rating: MOD

whew sorry thats so long. I am just curious for a basic understanding of what all those numbers mean. And is it possible for an valve disease to get better over a years time?

thanks,

Erica

 

[Ross]

http://www.echobyweb.com/htm_level2_eng/normal_parameters_tt.htm

 

[tobagotwo]

Nice link, Ross!

 

[ALCapshaw2]

Hello Erica,

My understanding is that surgery is generally recommended when your aortic opening is reduced to 0.8 sq cm or less. At 1.1 sq cm, my guess is that your cardiologist will 'monitor' your condition (regular echos, probably once a year...personally, I would prefer every 6 months because things 'can change' rather rapidly once the valve begins to deteriorate).

Another indicator is when your heart chamber sizes begin to increase or the walls thicken so compare these numbers with your next echo. Permanent Damage CAN result from too much enlargement so it is a good idea to watch these parameters. Unfortunately, surgeons are more attuned to this risk than many (most?) cardiologists.

'AL'

 

[Mary]

Website link

Website link

Ross,
Just went to the link and I can't understand that either! I have different abbreviations on my echos than what are listed. For example, I know about the mean aortic pressure gradient, but what about the instantaneous pressure gradient? My mean is low, but the instantaneous is considerably higher.
Everytime I have had an echo, my EF has increased. The tech told my husband that the EF is just an educated guess with no hard evidence to confirm the numbers.
Erica, that might be why it appears your echo is showing improvement. The pressures are the only number that they say are really accurate. What abbreviation shows the instantaneous pressure gradient? Can anyone help with that?
Mary

 

[Ross]

This is where I would say to have the Doctor discuss this in detail with you. I don't know enough about it to even begin making suggestions. The only sure thing that I know is that echos change from one to the other, so a Catheterization may be needed or TEE for more accurate information gathering.

 

[tobagotwo]

Meaning of Echo Results

Meaning of Echo Results

It really takes an echo technician or a trained doctor to interpret the results. Most of us are neither of those, including me. As such, anything we bring to the table about them is basically unsubstantiated opinion.

On occasion, a real echo tech has wandered through the site, but I don't know who that is.

I've never heard of valve disease improving over time. My understanding is that it is always worsening, although it may do so almost imperceptibly at some stages. More likely, it is nearly stable, and the difference is in the quality or interpretation of the echo readings.

I have two of my own readings from 2000, done six months apart, that truly appear to be from different people. One showed a valve opening of 1.1cm², the other showed 1.8 cm². One showed a mean gradient of 31mmHg, the other, 7mmHg. The one that looked better was done six months after the worse-looking one. The echo tech and equipment make a substantial difference. These were done by different techs at different facilities.

Your valve opening was calculated at 1.1 cm², which is in line with the pressures I've seen within that range of valve opening. It would still be rated as "moderate" at that size. As Al pointed out, the valve opening is one of the criteria used to determine criticality. The smallest "normal" valve opening is 1.5 cm² on the listings I've seen. At anything under 1.0 cm², the cardiologist may have you looking for a surgeon. My observations, which may well be flawed, would indicate that below 1.0 cm², the echo tends to overestimate the opening size and underestimate the level of calcification. That would likely put you into the .8 cm² range that Al referred to. As an example, when my echo showed my valve size at .96 cm², the cardiac catheterization showed it at .76 cm².

The pressures are another important clue to severity. As I understand it, the pressure is usually given in two measurements. One is called maximum, peak, or instantaneous, and reflects the highest amount of pressure recorded, which would be the amount of pressure it takes your heart to push open that increasingly inflexible, calcified valve to get the blood started through it. The mean gradient is the average amount of pressure required to move the blood through the valve for the whole duration of the heartbeat (a single pump). The measurement is done in millimeters (mm) of mercury (Hg), like barometric pressure is measured for the weather report.

The standard seems to be that the pressure is considered "severe" when the mean gradient goes to 50mmHg. I believe that is very high, and my impression is that most people are operated on before the number gets that high.

For comparison, your mean was 23mmHg, your max was 41mmHg. Three weeks before surgery, my mean was 45mmHg, and my peak 68mmHg.

There are other measurements that indicate the extent to which your heart has enlarged in response to the extra work it is doing. There is a range of "normal" to these sizes, but to move from one end of the range to the other has to indicate an issue that should be looked at, even if you remain technically in the normal range. It requires more than one echo report to trend the sizes, though. None of the measurements that I can check appear to be outside of the normal range, but I am not qualified to reassure you that they are acceptable for your heart.

I am also at a loss for what some of them mean. I am confused by the difference between "Ao valve opening: 1.54" and the "AoV Area: 1.1." This is one of the reasons why it is best to get information from the source technician or the doctor.

Best wishes,

 

[yankeeman]

Yankeeman

Yankeeman

Thank you Tobagotwo/Bob H for the information on the interpretation of Doppler gradients. Your analysis confirms my suspicions and will lead me to take the symptoms more carefully when they increase.

 

[Mb]

Dear Ross and Others:

This post interested me, as we got a copy of my husbands report last week.

There are some additional numbers on his echo that do not show up on the link you provided, Ross.

For example:"

His left atrium is dilated (48mm)
There are actually three dimensions givem. tThe second is 46mm and the third is 57mm, measured from different angles. His EF is 70%. Severe tricuspid insuufficiency. The superior/inferior RA dimension is 57mm. His right ventricle is dilated, measuring 47mm at the base.

Is there a link for these measurements, and what they mean? Any help out there?

Mb

 

[tobagotwo]

Tea Leaf Reading

Tea Leaf Reading

There isn't much here to work with, and I am not a tech or a medical professional. So, take this with a large grain of salt (or potassium chloride, if you're salt-free)...

The numbers looked odd, as they're usually related in centimeters, not millimeters. For consistency with what's in my head, I will put things in cm, so multiply every number by 10 to equate it to your husband's echo.

A normal atrium is likely in the 1.0cm to 4.0cm range. My first echo showed a left atrium of 3.5cm. The rest, from a more accurate tech, showed 4.0cm, then 4.3cm, then 4.9cm as it enlarged. Your husband is shown at 4.8cm, with the full internal dimensions being 4.8cm x 4.6cm x 5.7cm. The three measurements are the length, width, and height of the right atrial chamber, it appears to me.

The enlargement could be part of a heart failure syndrome, as the ejection fraction is a little high for someone with heart issues, especially hypertrophy (enlargement).

Possible causes for the right atrial dilation include some prescription drugs, thyroid issues, backpressure from a leaky tricuspid valve, atrial fibrillation/rhythm problems, or a combination of these. Or something else entirely, of course.

The post says severe tricuspid insufficiency, but doesn't say if it is caused by regurgitation (leakage), which I'm assuming it is, as that makes the most sense with what's given. This is possibly the cause for the right ventricular hypertrophy, as the ventricle is working extra hard to feed the pulmonary artery (lungs). Much of what the heart is trying to push through the pulmonary valve is leaking back to the right ventricle from the right atrium through the tricuspid valve.

Finally, the right ventricular measure (probably an "end" measure) of 4.7cm doesn't sound high, depending on whether it's a diastolic or systolic measurement.

There isn't too much to tell from that schnibble of data, and it probably didn't help much, but at least it was cheap...

Best wishes,

 

[Mb]

Oh, Bob:

Sounds like you know what you are doing. Let me give you the full scoop. My husband has -2- St. Jude Valves. Aortic and Mitral. He is in a-fib. Post surgery, he did not recover as well as we would have liked, and when he went for the six month echo, that tech indicated his tricuspid regurgitation was severe. He had a TEE done about a year ago, and that indicated that the regurgitation is from the atrial enlarging, widening the opening of the valve to the point where it leaks. Now it also does not close completely. He has back flow into the hepatic veins. The medial lateral right atrial dimension is 53mm. Trace pulmonary insufficiency. Right ventricle is dilated measuring 47mm at the base. Peak AV gradient is 43mmHG. Mean is 23mmHG. Left ventrical cavity size is normal, but there is borderline left ventricular hypertrophy. In addition to the other facts provided above, do you have any additional input?
Also, when do they seriously consider doing a tricuspid annuloplasty?
He is symptomatic. Takes 120-160mg of lasix, dig, atenenol, etc. He has exertional limitations, as you can imagine. - Marybeth

 

[tobagotwo]

Grain of salt, Marybeth. Remember the grain of salt...

Has your cardiologist ever discussed ablation, with regard to addressing the atrial fibrillation and maybe putting a damper on the hypertrophy-and-heart-failure cycle, at least left-side? Some rhythm-related ablation procedures can even be done through catheterization.

Best wishes,

 

[tobagotwo]

Your husband's aortic valve is giving mild+ stenosis gradients. I don't know if that's partly from the enlargement or goes along with the valve type. That could be part of the left ventricular hypertophy, although it could also be from the left side having to do some of the right side's job.

It could even be left over from before surgery. The left atrium dilation could also be a leftover. You would need to look at his pre-surgical echoes (including the oldest one he has), to determine whether his heart is growing or stabilized.

I don't know what the criteria are for tricuspid annuloplasty. If you're concerned, it may be second opinion time.

I hope you find a path to follow. If the sizes are growing, waiting won't work over the long haul.

Best wishes,

 

[Mary]

Bob,
Please don't start charging a fee! If you do, remember you work for Ross, so you'll have to bill as a consultant.

 

[tobagotwo]

Don't worry, Mary: you know I'm not a professional, and won't become one. As I look into things out of curiosity or a desire to help, I learn more and more, though. Someday, I'll be up to "ignorant" level.

And we all know, there's never a fee for speculation...

(Just for the record or new folks, I don't really work for Ross or the site - it's a running gag. I say this so that people reading this casually will know that I don't speak for the site in any way: I'm just another loud-fingered member.)

However, Ross does control my vacations...

Best wishes,

 

[Mary]

. As I look into things out of curiosity or a desire to help, I learn more and more, though. Someday, I'll be up to "ignorant" level.

Bob,
You're too modest. Your curiousity and desire to help is what makes this forum so great. You know more than many health professionals.
Sincerely
Mary

 

[Mb]

Hello:

Thanks for the input.

The echo report says" The transmitral and transaortic gradients have increased. The degree of tricuspid regurgitation has increased to severe". Of course, as stated previously, we had already thought it was severe.

The left atrium and the right atrium are dilated from the a-fib, as I understand it. (Remember he is in chronic a-fib, 24/7) - As the right atrium has dilated, it has enlarged the tricuspid opening, now to the point where it no longer closes completely.

Yes, his Dr. has talked about pacemaker/ablation. For three years. However, he is sort of wishy washy about it, and my husband is defintely against it. He feels he does not want to be pacemaker dependent. It does not get rid of the a-fib anyway, according to the Dr., and will serve only to give him sinus rythm, thereby improving the quality of life. His Dr. treates him somehwat carefully, as he has some of the most strange things happen. Most recently he came down with purple toe syndrome from the coumaden, three years after starting to take it. It is a rare side effect to start with, and most often happens to folks within the first three weeks of starting the medications. He has gotten infections from shots, where he had to get IV 's of antibiotics. Gross hematuria, etc. etc. etc. - seems like he is somewhat sensitive to everything!

You have been a doll, giving your opinion, obviously educated from prior research. My understanding that he now has primarily right sided heart failure, from the tricuspid/a-fib situation. The left side was damaged from the mitral/aortic regurg., from the rheumatic fever he got when he was 19. I believe I am rambling here. Again, your input would be most welcome. I just really wish I knew what the prognosis was. -Marybeth