New echo results

[themalteser]

Hi All,

Can you please tell me how would you feel if you received this letter from your cardiologist. My wife and friends keeps telling me that they will not worry....

I have good ventriuclar function with a fractional shortening of 49% and left ventricular dimensions of 48mm in diastole and 25mm in systole. There is no significant ventricular hypertrophy. The aortic valve has three cusps, two of which are larger than the more anterior cusp which makes it a functioning bicuspid aortic valve. There is relatively mild aortic regurgitation and the ascending aorta is dilated. the peak Doppler velocity across the aortic valve was around 1.7m/sec representing insignificant stenosis. There was no evidence of coarctation of the aorta with a descending aorta velocity of 1.5m/sec. The sinus of valsalve measurement was quite difficult to image but was around 44mm. The ascending aorta measured 34mm.

This represents mild further increase in the aortic root diameter. (42mm last echo and the images are not clear, how can he be for certain that there is a mild further increase???)

He told me not to worry and carry on as normal. I asked another cardiologist opinion, and said the same, not to worry!

 

[Mentu]

The best thing to do is call your cardiologist and discuss your concerns. You should also see in the report the area of your aortic valve given in cm2 and the average and max pressure gradient. As I understand it, the area of the valve orifice along with the pressure gradient across the valve are more significant for understanding the state of the stenosed valve. Those are important numbers to know. In the past echocardiograms have been considered much less accurate than the more direct measurements of a heart cath, however, my last echocardiogram/heart cath comparisson was almost identical. You might just ask "How do you define mild?"

Larry

 

[scott.eitman]

I suggest trusting your Cardio or you could go nuts.

To me, the questions to ask has to do with the prognosis? What does not worry realy mean? At this rate, will you ever need surgery? If so, what is the best guess?

Heck, even when my Cardio said you need surgery this year, I figured December would be good (use vacation time from this year and next year) ...well I couldn't make it until August and he told me so in April, when I asked.

Scott

 

[Johan]

I think you should believe your cardiologists (you obtained a second opinion, which is a good thing) and both agree that there is no immediate concern. In the past when my measurements were all classified as mild I walked out of the Doctors' rooms with a spring in my step, knowing (or believing) that I had a reprieve until the next echo. I would then get on with my life and forget about the whole thing. This repeated testing went on for many years until the medical experts informed me, and I could see for myself in their reports, that all measurements have now moved into the severe catagory and that it was time for the AVR. Through all the years I consulted with at least 2 cardiologists and eventually also two surgeons, so my suggestion is that you continue with getting second opinions.

As Larry said the effective valve area and the mean and peak pressure gradients over the valve are useful in classifying aortic valve stenosis. You give one measurement, that I do not often see on this forum, which was also used, amongst others, in my case to determine the status of the valve, namely the velocity of blood flow over the aortic valve. The narrower the valve opening (stenosis) the higher this velocity. My cardio told me that a reading of above about 4.0 m/sec is another indicator for surgery. My was 5.4 m/sec. Your 1.7m/sec is way below the cut-off point.

The other thing my cardio harped on was dilation of the left ventricle, a sign that the heart is working too hard against a significant gradient. You don't seem to have that.

Maybe you should follow your friends' and wife's advice not to worry......