L
Leah
Nah, it's always good to be flexible with definitions...
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Nah, it's always good to be flexible with definitions...
ALCapshaw2
Well-known member
"Old School" Cardiologists like(d) to wait for 'symptoms' which to my mind means that Damage is being done to the Heart Walls and Muscles.
Surgeons like to FIX the problem BEFORE there is Permanent Damage.
I've become a believer that "Sooner is Better", at least for first and second surgeries where risks are Low, especially before age 60 or so.
Nationally, there is a 1% Risk of Mortality and 1% Risk of Morbidity for first time surgeries in patients under age 60. The Risk of "doing nothing" is usually Death within a few years.
If you are showing signs (symptoms) already, it's time to go Surgeon Shopping, either with the recommendation of your Cardiologist (a good place to start) or on your own if you have a special interest (valve type, procedure type, etc.).
Bottom Line: Find a surgeon who has lots of experience in the Procedure YOU will need.
'AL Capshaw'
Surgeons like to FIX the problem BEFORE there is Permanent Damage.
I've become a believer that "Sooner is Better", at least for first and second surgeries where risks are Low, especially before age 60 or so.
Nationally, there is a 1% Risk of Mortality and 1% Risk of Morbidity for first time surgeries in patients under age 60. The Risk of "doing nothing" is usually Death within a few years.
If you are showing signs (symptoms) already, it's time to go Surgeon Shopping, either with the recommendation of your Cardiologist (a good place to start) or on your own if you have a special interest (valve type, procedure type, etc.).
Bottom Line: Find a surgeon who has lots of experience in the Procedure YOU will need.
'AL Capshaw'
symptoms vs. SYMPTOMS
symptoms vs. SYMPTOMS
symptoms vs. SYMPTOMS
ALCapshaw2;321682 If you are showing signs (symptoms) already said:Thanks, Al.
Being new to finally getting serious about my valve issue, I am confused (more than normal) There are symptoms and there are SYMPTOMS. The signs I have I've ignored for four years are difficulty with hills and steps, occasionally getting winded, palpitations, etc. Last year I mentioned some of this stuff to my cardio and he responded "you're 58, you're getting older, and you've put on 20 pounds." Well, I figured, I guess I'm guilty!
Seriously though, I don't get dizzy and I have not fainted. Nevertheless, I sense a concensus from some really knowledgeable people here that I ought to run the situation by a surgeon of my choosing. Why not?
Jim
ALCapshaw2
Well-known member
There are several good reasons to start the Surgeon Selection Process early:
1 - To avoid having to select a surgeon from a gurney in an ER somewhere which will greatly limit your choices, i.e. to some surgeon who operates at whatever hospital you landed at and who has an opening in his schedule.
2 - You may want to interview more than one surgeon to find someone you 'feel comfortable with', i.e., so that you are 'prepared' when the time comes.
3 - To have the Timing and Type of Surgery defined by the guy who will actually be performing the operation. The job of your Cardiologist is to make a diagnosis and recommend a treatment plan. Medications can 'postpone' surgery (but may allow damage to progress).
Only a Surgeon can FIX a valve problem (i.e. Repair or Replace a defective valve). IMO, Surgeons have a better perspective on WHEN to proceed for the Best Outcome.
4 - It would not be out-of-order for you to ask your Cardiologist for his recommendation of surgeon(s) for you to interview. Just tell him you want to "Be Prepared" beforehand.
If he resists, you can do your own search. You will need copies of your Echocardiogram and Angiogram (Cath) Test Reports AND Films / CD's / DVD's. Doctors and Hospitals are required to provide those to patients by law. They may charge a copying fee, but usually waive such charges if it is going to another Doctor. You will need to sign a "Medical Release form".
Good Luck in your Quest.
'AL Capshaw'
1 - To avoid having to select a surgeon from a gurney in an ER somewhere which will greatly limit your choices, i.e. to some surgeon who operates at whatever hospital you landed at and who has an opening in his schedule.
2 - You may want to interview more than one surgeon to find someone you 'feel comfortable with', i.e., so that you are 'prepared' when the time comes.
3 - To have the Timing and Type of Surgery defined by the guy who will actually be performing the operation. The job of your Cardiologist is to make a diagnosis and recommend a treatment plan. Medications can 'postpone' surgery (but may allow damage to progress).
Only a Surgeon can FIX a valve problem (i.e. Repair or Replace a defective valve). IMO, Surgeons have a better perspective on WHEN to proceed for the Best Outcome.
4 - It would not be out-of-order for you to ask your Cardiologist for his recommendation of surgeon(s) for you to interview. Just tell him you want to "Be Prepared" beforehand.
If he resists, you can do your own search. You will need copies of your Echocardiogram and Angiogram (Cath) Test Reports AND Films / CD's / DVD's. Doctors and Hospitals are required to provide those to patients by law. They may charge a copying fee, but usually waive such charges if it is going to another Doctor. You will need to sign a "Medical Release form".
Good Luck in your Quest.
'AL Capshaw'
From your original question, aortic stenosis (narrowing) and aortic regurgitation (leakage, insufficiency) usually do go hand-in-hand. If there's calcification, it tends to cause both.
This is to due to the apatitic growth around and on the valve. It's usually called calcification, although the actual mineral is apatite, which is largely constituted of calcium and phosphates, and is the stuff that bones and teeth are made of, as well as being what grows unbidden on our valves. It has something of the appearance and crustiness of the minerals that grow on showerheads in may areas of the country.
The mineral growth takes up room in the aorta, causing narrowing through blockage, referred to as stenosis. It then will grow at the base of the valve leaflets, blocking them from opening all the way, and on the leaflets of the valve themselves, rendering them inflexible. In the process of doing this, it also often manages to block the leaflets from closing all the way, or impedes them from interlocking. So, there's leakage (regurgitation), because the seal is no longer complete.
Regurgitation alone can happen with valves that develop an inability to close well (such as worn bicuspid valves) or even valves that develop into weakened tissue (called myxomatous tissue) that doesn't hold together well or keep its proper shape.
Even those regurgitant valves usually develop apatitic calcifications over time, and may develop some stenosis before they are replaced. Regurgitation is sometimes termed insufficiency, because it causes an incomplete (insufficient) fill of the aorta, but insufficiency is more of a result than a cause.
Best wishes,
This is to due to the apatitic growth around and on the valve. It's usually called calcification, although the actual mineral is apatite, which is largely constituted of calcium and phosphates, and is the stuff that bones and teeth are made of, as well as being what grows unbidden on our valves. It has something of the appearance and crustiness of the minerals that grow on showerheads in may areas of the country.
The mineral growth takes up room in the aorta, causing narrowing through blockage, referred to as stenosis. It then will grow at the base of the valve leaflets, blocking them from opening all the way, and on the leaflets of the valve themselves, rendering them inflexible. In the process of doing this, it also often manages to block the leaflets from closing all the way, or impedes them from interlocking. So, there's leakage (regurgitation), because the seal is no longer complete.
Regurgitation alone can happen with valves that develop an inability to close well (such as worn bicuspid valves) or even valves that develop into weakened tissue (called myxomatous tissue) that doesn't hold together well or keep its proper shape.
Even those regurgitant valves usually develop apatitic calcifications over time, and may develop some stenosis before they are replaced. Regurgitation is sometimes termed insufficiency, because it causes an incomplete (insufficient) fill of the aorta, but insufficiency is more of a result than a cause.
Best wishes,
Well, if you have stenosis, it helps to know what the valve opening area is. If the aperture area is less than 1 cm², then it's within the operable range. Some cardiology practices are honing that down to .75 cm or .6 cm, but that's agressively holding back, and I don't know that they could show any value for that, other than the delay of surgery (and its risks) for a short time.
It does also raise the chances of having permanent damage to the heart. Examples would be when it doesn't go back to its original size and may develop other leaks due to being mishapened, or stiff areas on the ventricle wall that fail to pump as vigorously as the cells around them.
Another indicator is the pressure gradient across the valve. Mild stenosis produces a gradient in the 20s (mmHg). By the time it gets to the 50s, it's severe and operable.
Another thing they'd look for is left ventricular hypertrophy, and enlargement of the wall, septum, and sometimes the atria. While there are magic number for hypertrophy measurements (LVEDD 5.7 cm, LVESD 3.9 cm, Post Wall 1.1 cm, LVIV Septum 1.1 cm, left atrial diameter 4.0 cm), if you have a record from earlier echoes, it can help to compare the numbers with the doctor, to see how much things have expanded, even if they don't go over the theoretic line.
Having symptoms doesn't mean having all the symptoms. Fainting (syncope) is actually not that common. The importance is in knowing you do have some, and what they are (SOB, palpitations, dizziness, fainting, angina).
Best wishes,
It does also raise the chances of having permanent damage to the heart. Examples would be when it doesn't go back to its original size and may develop other leaks due to being mishapened, or stiff areas on the ventricle wall that fail to pump as vigorously as the cells around them.
Another indicator is the pressure gradient across the valve. Mild stenosis produces a gradient in the 20s (mmHg). By the time it gets to the 50s, it's severe and operable.
Another thing they'd look for is left ventricular hypertrophy, and enlargement of the wall, septum, and sometimes the atria. While there are magic number for hypertrophy measurements (LVEDD 5.7 cm, LVESD 3.9 cm, Post Wall 1.1 cm, LVIV Septum 1.1 cm, left atrial diameter 4.0 cm), if you have a record from earlier echoes, it can help to compare the numbers with the doctor, to see how much things have expanded, even if they don't go over the theoretic line.
Having symptoms doesn't mean having all the symptoms. Fainting (syncope) is actually not that common. The importance is in knowing you do have some, and what they are (SOB, palpitations, dizziness, fainting, angina).
Best wishes,
Call me irresponsible, or stupid, or whatever, but here's what I still don't quite get, even after the great explanations above.
My murmur is congenital...I knew about it since I was a kid. It did not develop hand in hand with AS. It was there from the beginning..."benign," I suppose, but there none the less.
Thus, the way I'm trying to understand my situation is: later in life AS on top of a long existent congential leaky valve situation, and the implications of whatever extra stress that puts on the LV, which I'm lead to believe is at this point enlarged.
Please excuse my ignorance and/or confusion...I'm trying to comprehend what I'm dealing with.
Jim
My murmur is congenital...I knew about it since I was a kid. It did not develop hand in hand with AS. It was there from the beginning..."benign," I suppose, but there none the less.
Thus, the way I'm trying to understand my situation is: later in life AS on top of a long existent congential leaky valve situation, and the implications of whatever extra stress that puts on the LV, which I'm lead to believe is at this point enlarged.
Please excuse my ignorance and/or confusion...I'm trying to comprehend what I'm dealing with.
Jim
If you have a bicuspid aortic valve, it may have made a murmur since day one. It can take five or six decades before it starts to cause a problem. They wouldn't seem in synch.
If you don't have a bicuspid valve (or even if you do), whatever is causing the murmur may put no strain whatsoever on your ventricle or any other part of your heart.
The left ventricular enlargement is an expected companion of the valve disease, and is likely not caused, or greatly exacerbated or involved with your congenital murmur, since there seems no time connection, and it doesn't seem to have been there before the valve issue surfaced. I would not consider that whatever the murmur is from is affecting the current situation unless your cardiologist has actually stated that it is.
Best wishes,
If you don't have a bicuspid valve (or even if you do), whatever is causing the murmur may put no strain whatsoever on your ventricle or any other part of your heart.
The left ventricular enlargement is an expected companion of the valve disease, and is likely not caused, or greatly exacerbated or involved with your congenital murmur, since there seems no time connection, and it doesn't seem to have been there before the valve issue surfaced. I would not consider that whatever the murmur is from is affecting the current situation unless your cardiologist has actually stated that it is.
Best wishes,
Thanks, Bob, for all the info...very helpful. I'm waiting to get a copy of the last echo results from my cardio. Then I'll know some of the numbers.
Jim
Jim
L
Leah
And it would be valuable to clarify whether you do or don't have a bicuspid aortic valve. That would answer some of your questions here (about the relationship to the murmur) but also would suggest issues to stay on top of such as any enlargement of your aorta (higher incidence in people with bicuspid valves). Good luck!
Leah
Leah
nancym
Well-known member
I am 58 and have congenital aortic stenosis. Although I have been asymptomatic, I have been told that I will need a replacement, and the sooner the better. I have seen two surgeons where I live (Pittsburgh), but have not been thrilled with either. I just had a consultation with a cardiologist at Cleveland Clinic, who recommended a surgeon there--Dr. Pettersson. Does anyone have any information about him? I know I will be having surgery in the fall, and I really think it's important to have a rapport with your surgeon. Do you all agree? Thanks for this site--it's been really helpful to me.
aussigal
Well-known member
Just thought I would try define "murmur" for you...its the different from normal sound your heart beat and blood flow makes. There are lots of differnt types of murmur all which point to different types of issues with the heart and valves. There is a site somewhere that has sound files of different murmurs but I havent got the link handy. My own murmur was always a wishy-washy sound so my heart never had the regular sounding beat to it, it kinda had a backwash if you know what I mean. I had a Bicuspid valve before surgery and 2 of my kids have the same thing.
Welome to the world of VR.com.
Welome to the world of VR.com.
ALCapshaw2
Well-known member
Nancy -
Dr. Pettersson is a World Class Surgeon, very highly respected, who has operated on several of our members. He also seems to be well liked by his patients.
Do a "Search" (see the blue line at the top of the page) for "Pettersson". Also do a Google Search for "Dr. Pettersson" and you will find lots of information.
There are many well known surgeons at Cleveland Clinic.
You will get more 'attention' to your posts if you start a New Thread with an appropriate subject line rather than posing questions in a 'Response' to someone else's post.
Click on the appropriate Forum, then click on "New Thread" to start a new thread.
'AL Capshaw'
Some numbers
Some numbers
Well, I finally got a copy of my latest two echo reports. Thanks to this forum and the very knowledgeable people here who have been so generous, I can make some sense out of it. My current valve area is 1.1 to 1.4 cm2, peak pressure gradient 36mm, mean 20mm, there is borderline LVH. Everything else (mitral, etc.) looks good and the av is tricuspid. Last year the valve area was 1.79 cm2 and the pressure gradient measurements were 34/19, so there is some progression, like the cardio said. Looks like I probably have some time yet but I think I might go for an echo every six months if the insurance will cover it.
Jim
Some numbers
Well, I finally got a copy of my latest two echo reports. Thanks to this forum and the very knowledgeable people here who have been so generous, I can make some sense out of it. My current valve area is 1.1 to 1.4 cm2, peak pressure gradient 36mm, mean 20mm, there is borderline LVH. Everything else (mitral, etc.) looks good and the av is tricuspid. Last year the valve area was 1.79 cm2 and the pressure gradient measurements were 34/19, so there is some progression, like the cardio said. Looks like I probably have some time yet but I think I might go for an echo every six months if the insurance will cover it.
Jim
