Mechanical Aortic Valve Gradients

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Jeff Lebowski

Well-known member
Joined
Mar 23, 2024
Messages
82
Location
İzmir/TURKEY
Greetings

On 27 March 2024, I had AVR surgery and my aortic valve was replaced with a St. Judes valve. Since then, I have been examined by different cardiologists about 5 times. All of them said that my valve works very well and there is no problem, and I have no complaints.
I already check my INR values every week with the test I do at home.

Anyway, two days ago I went to a public hospital in the city where I live to have a monthly INR laboratory test. (There are no Coumadin clinics in Turkey, you can get tested by making an appointment with a cardiologist at a public hospital. While I was there for the test, I also had echocardiography done by the doctor (he was a young cardiologist, it was the first time I was examined by him). In fact, my own cardiologist, whom I have always been examined by, told me that it would be enough to be examined every six months, but I wanted to have my echocardiogram checked again while I was there to be examined.

Normally, cardiologists perform a detailed echocardiography examination for at least 5 minutes, but this friend looked at it in a hurry in about 1 minute and said that the gradient of my mechanical aortic valve was 7 mmHg (if I do not remember wrong) and that this value was below the specified range.

Since he was not completely sure of his examination, he sent me for a computerised tomography which would show the full image of my heart valve.

I told him that I had been examined about five times by different cardiologists over the past four months and none of them had mentioned such a problem, but the young doctor insisted on the CT scan, which would expose me to a lot of radiation.

I would like to underline here that all examinations and examinations in state hospitals and university hospitals in Turkey are free of charge within the scope of social insurance, which is of course a good thing, but the worst part of this is that doctors unnecessarily refer patients to many scans and imaging examinations. Without asking the patient how many CT scans he or she has had during the year, many high-radiation X-rays are taken in series.

The fact that a young doctor wanted these tests in such an unnecessary way on a matter that he was unsure of aroused my suspicion, frankly, and I did not have that CT scan. They are using patients as test subjects!

This is the biggest problem, the doctor tells you something, you are not sure of the doctor's competence, but when you do not have the test he asks you to do, you have a doubt.

I will not change my doctor again, I think it is best to always go to the same cardiologist.

Note: I think that even the 7 mmHg measurement made by the cardiologist in question may not be accurate, and even this value is within the normal range according to the research I did on Google.
 
How about sending your latest echo test results/report to your main cardiologist and see what his/her thoughts are on the need for a CT scan? How does this measurement compare to you prior echo's? And if the 7 mmHg measurement is accurate, what action might they take, if anything?
 
the gradient of my mechanical aortic valve was 7 mmHg (if I do not remember wrong) and that this value was below the specified range.
I also have a St Jude mechanical. My mean pressure gradient is 8 to 9mmHg from all my follow up echos, most recently 3 weeks ago. 7mmHg seems totally normal. Also, what they should be alarmed about is high gradients, not low. Generally, lower is better.

Nobog probably knows more than anyone else here on this issue and I would take his words as gold on this subject.
 
First off, there is no "value (was) below the specified range" - low is always good and then it depends on 1) valve size, 2) beat rate, 3) flow rate. Without knowing details this sounds entirely normal.

Have a beer - you're fine.
thank you, And what is the upper limit of the gradient?
 
thank you, And what is the upper limit of the gradient?
Without knowing the valve size and position (maybe you mentioned aortic) there is quite a range. A large mitral valve will probably never go over 3 or 4, a small aortic could be 40 or higher. Unless pannus or something out of the ordinary happens, the EOA (effective orifice area) will never change for a mechanical valve. This does not mean that there cannot be small changes in pressure drop (gradient), as mentioned, beat rate as well as flow rate will change that number.
 
I was examined by my cardiologist today, my aortic valve gradient was measured as 25 mm Hg in echocardiography. 6 months ago, my aortic valve was replaced with a mechanical St. Judes valve. Obviously, I have no problems with my heart, thank God. Because my aortic valve gradient value was 25 mm Hg, I had a telephone conversation with the professor who was my cardiovascular surgeon. He said that this is a normal value for patients who have had their aortic valves replaced and that there is no need to worry.
ı found some values about this on internet

I am waiting for comments from people in a similar situation, thank you
 

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Because my aortic valve gradient value was 25 mm Hg, I had a telephone conversation with the professor who was my cardiovascular surgeon. He said that this is a normal value for patients who have had their aortic valves replaced and that there is no need to worry.
When you say 25mmHg, are you talking about mean pressure gradient or max?

Usually the focus is on mean pressure gradient. I also had a St. Jude mechanical valve. My mean pressure gradient was about 9mmHg 6 months after surgery and since then, about 42 months ago, it has remained about the same. What size valve did they put in?

This study classified patients into 3 cagetories after AVR, stratified by pressure gradient. They had low as <10mmHg. Medium 10mmHg to 19mmHg and high as >20mmHg.

The good news is that in follow up, out to 10 years, there was no differences in mortality between the 3 groups.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904035/
 
Usually 5 minute echo? Are you talking EKG/ECG but that's only electrical. My echos take almost 30 minutes. How someone does a 1 minute echo? I guess they just narrow it down to the valve and ignore the rest of the heart.
 
My echos also take approximately 30 min or more. My latest a couple months ago said my aortic valve peak gradient is 11nHg, the mean aortic valve gradient is 6mHg. My valve was placed during a 3rd surgery in 2009.
(Carbomedic top hat mechanical)
 
are you sure about this?
It probably depends on the patient and situation. From memory, my usual monitoring echos were taking about 20 min. This is not a precise number. What I do remember with certainty, is that the last one before the surgery was definitely longer, about 40 min. The operator cryptically mentioned that she "took many pictures".
 
Today I was examined by a professor cardiologist who specialises in mechanical heart valves. He measured my aortic mean gradient as 14 mmHG and the peak gradient as 24 mmHG.
He said that these values are normal for people with mechanical heart valve replacement.
My aortic root diameter is measured as 42 mm. I hope it does not expand more, and it would be very bad for me to have a second operation for it.

He recommended Amoxicillin tablets for my six-month dental check-up, but he especially said that if the tooth cleaning process to be performed would not be too bloody, it would be better not to cut Warfarin.

Otherwise, in order to reduce the INT value below two, you have to cut the Warfarin, return to the needle and start the Warfare to bring the INR value between two and three again.
He said it would be a hassle for me.
I will see the dentist this Friday and if the dental plaque cleaning process will not be very bloody, I will inform her that I do not want to stop Warfarin.
 
Today I was examined by a professor cardiologist who specialises in mechanical heart valves. He measured my aortic mean gradient as 14 mmHG and the peak gradient as 24 mmHG.
He said that these values are normal for people with mechanical heart valve replacement.
My aortic root diameter is measured as 42 mm. I hope it does not expand more, and it would be very bad for me to have a second operation for it.

He recommended Amoxicillin tablets for my six-month dental check-up, but he especially said that if the tooth cleaning process to be performed would not be too bloody, it would be better not to cut Warfarin.

Otherwise, in order to reduce the INT value below two, you have to cut the Warfarin, return to the needle and start the Warfare to bring the INR value between two and three again.
He said it would be a hassle for me.
I will see the dentist this Friday and if the dental plaque cleaning process will not be very bloody, I will inform her that I do not want to stop Warfarin.
Cleaning, you will not need to stop taking your Warfarin. Only for dental procedures. And you still need to premed before and take the recommended doses after the cleaning, to prevent infection to the heart.
 
Today I was examined by a professor cardiologist who specialises in mechanical heart valves. He measured my aortic mean gradient as 14 mmHG and the peak gradient as 24 mmHG.
He said that these values are normal for people with mechanical heart valve replacement.
My aortic root diameter is measured as 42 mm. I hope it does not expand more, and it would be very bad for me to have a second operation for it.

He recommended Amoxicillin tablets for my six-month dental check-up, but he especially said that if the tooth cleaning process to be performed would not be too bloody, it would be better not to cut Warfarin.

Otherwise, in order to reduce the INT value below two, you have to cut the Warfarin, return to the needle and start the Warfare to bring the INR value between two and three again.
He said it would be a hassle for me.
I will see the dentist this Friday and if the dental plaque cleaning process will not be very bloody, I will inform her that I do not want to stop Warfarin.
I had my teeth cleaned yesterday and tested shortly thereafter. Just got the call from the coumadin lab and it came in at 3.2. I didn't change warfarin routine at all and there was no blood coming from my gums.
 
He recommended Amoxicillin tablets for my six-month dental check-up, but he especially said that if the tooth cleaning process to be performed would not be too bloody, it would be better not to cut Warfarin.
my dentist has often remarked that if he didn't know I was on warfarin he wouldn't be able to tell. Now this is not to say that he does not have other clients on warfarin; but yet they bleed more.

So, would this mean that their INR is not as well controlled as mine? :unsure:

Would their "test monthly at the lab" have anything to do with that? :unsure:

Would their risk of a bleed go from "insignificant and nobody noticed" to "hospital visit" :unsure:

But I think the answers are yes, yes and yes.
 
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