Mild left ventricular hypertrophy

[Paleowoman]

I had my annual echo, two years after AVR, last week at which the cardiologist was very pleased as the pressure gradient was stable. The echo technician hadn't had time to give him the readings but had told him the pressure gradient. I got the report and full measurement sheet day before yesterday and I discover that actually my peak pressure gradient is now 38 mmHg (was 33mgHg right after surgery) and that there is now some "mild left ventricular hypertrophy". I never had any degree of left ventricular hypertrophy prior to surgery at all so am not best pleased I have some post surgery ! I contacted the cardiologist but he says he isn't concerned about it. However I am, and wonder what could cause this. Has this happened to anyone else post surgery ?

 

[JulienDu]

Hello Paleogirl

If I were you, I would also not be pleased and that a cardio says there is no worry but give no explanation is not enough. As you said, you never had that before so you are perfectly right to enquire more as I m not sure that hypertrophy of a ventricule is something "normal", of course ventricule can expand and reduce.

What is your mean gradient ?

 

[Paleowoman]

Hi Julien - the mean gradient is 19 mmHg. The cardiologist implied that the hypertrophy is because I'm "small" for my heart size - which I don't go with since I'm the same size I've always been and never had this before ! My heart and new valve are functioning okay though, and I've not got any symptoms. Cardiologist did say I could have another echo in six months instead of twelve if I wanted (put the onus on me), but I know that these things change slowly so twelve months is actually better to see changes, unless I get some symptoms of course. My valve is small, 19mm, so I looked up prosthesis-patient mismatch but can't really tell from my own research if that is applicable to me or if it would have any kind of impact.

 

[JulienDu]

As you know I dont have the knowledge, I merely try to see what I would do if I were in your case.

I guess the mean gradient did increase too ? What was your mean gradient before operation ?

I would not be satisfied by the answer like you. If you did not have that before, why now ? I would go seek other advice, do you know also if they had to do Root Enlargement to fit your valve ?

Maybe it is normal situation after getting a new valve, I guess more experience forum user will tell us more.

 

[Paleowoman]

No root enlargement done. My mean gradient before surgery was 38 mmHg.

Thanks for your input Julien - I know none of us are cardiologists, but it's good having each other to mull things over with.

 

[JulienDu]

You must have done your own research but found this article that explains the left ventricule hypertrophy from Mayo Clinic, a very well respected institution.
http://www.mayoclinic.org/diseases-c...n/con-20026690

 

[dornole]

Thought this was interesting from the link Julien posted as I know how active you are - possibly the defects of your heart prevented this from occurring before, but post-surgery your heart is responding to training in this not-necessarily-bad way? Esp since mild.

• Athletic training. Intense, prolonged endurance and strength training can cause the heart to adapt to handle the extra workload. It's unclear whether this athletic type of left ventricle hypertrophy can lead to stiffening of the heart muscle and disease.

Also re: gradient, my guy always makes point to note the heart rate present during this measurement. Could there be any difference there for you? No idea if 33 to 38 is a significant difference.

It'd be nice to have a cardiologist who'd explain a little more . . . but guess that's just one of many factors you have to weigh in terms of you you choose to work with.

 

[Paleowoman]

Yes I had thought of the training I do, in fact that's what I first thought of - it would be a nice thing if it were that as that is actually benign. I can't understnad the pressure gradient though, but maybe they're not connected ? My blood pressure is okay, higher than it was pre-surgery when it was always low, and sometimes the diastolic pressure is higher than I think is good, but the cardiologist was fine with it. I will have to push him for more answers.

 

[JulienDu]

Yes the worst thing when you have a minimum of a brain is to stay in the dark. Like you I hate not to understand a situation even when somebody tells me everything is fine, and it is very likely that it is nothing as your cardio said cause you never had hypertrophy when your mean gradient was much higher. Anyway good luck in your findings !

 

[Paleowoman]

Well I'm very glad that a) the forum is back up working thanks to Hank, and b) that a doctor from Edwards Lifesciences telephoned me today after I emailed Edwards about my pressure gradient. The doctor told me that a pressure gradient of 38 mmHg is at the upper limit of normal for the valve I have but that it is still "normal" - the pressure gradient can vary for any number of innocent reasons. He also talked with me about the mild ventricular hypertropy which would also be normal after having a high pressure gradient pre surgery. He did advise that if I ever feel extra tired out of the ordinary to see my cardiologist and get the valve checked (in addition to my annual checks). And he said I could contact Edward Lifesciences if I ever I wanted about the valve. So I feel a lot happier about this now.

 

[cldlhd]

I was told my left ventricle was slightly enlarged before surgery and at my one yr follow up they told me it's back down in normal range. As for the working out when I was younger I lifted weights ,played basketball etc.. and more than one GP wrote my murmur off as "athletes heart".