Notes from my second opinion consult

[ks1490]

Hello,

I just came back from my consultation from another cardiologist whom I visited for a second opinion on my regurg condition. There seem to be some very knowledgeable and experienced people in these forums, I wanted to run these numbers by you and get a sense of where I stand - I know that my results are not normal, but to date I still have no symptoms and wanted to get a sense of how far away I may be from surgery. The doctor tells me it's possible that I could stay at these measures for some time, there's no telling over what time frame they may worsen, but I want to get a sense of how seriously I need to start looking at my options.

I would also like to ask you if there are other measures that I should be asking my doctor about (I see references to things like BAV in other posts, I still don't know what alot of these things mean). He seemed to think that these are the key dimensions to focus on.

Ejection Fraction: 55% measured by echo
Left Ventricle End Diastolic: 6.1 measured by echo
Left Ventricle End Systolic: 4.1 measured by echo
Aortic Root: 5.1 measured by catscan

I'm currently taking Coreg and Norvasc, he thinks these are fine. I've also been on a serious diet, have lost 25 pounds since Christmas and he thinks that can only help. He thinks that my dialated aortic root is probably the culprit, that it may have been genetic or has been slowly dialating over time and that the regurgitation is a more recent phenomenon which is why it was only picked up recently at age 38. Should surgery become necessary, he thinks I would have to have both the aortic valve and the aortic root replaced.

Many thanks for any feedback.

 

[Tom F.]

I cannot comment on the numbers you posted, there are others here that can much better than I can. However, if your regurgitation is due to a growing ascending aortic aneurysm, which is an expansion of the size of the aorta, you will need to have the aortic root replaced. However, a growing number of us have avoided having the valve replaced by having a valve sparring procedure done. This repairs, and does not replace, the aortic valve. Most here have a BAV, a bicuspid aortic valve, and they generally have to go. But if your valve anatomy is normal or near normal, ask your doc about a valve sparring procedure. If he looks at you like he does not know what you are talking about, get another doc !

 

[ks1490]

Thanks, Tom. Forgot to mention that he said my valve is tricuspid. Thanks for explaining what BAV is!

 

[Tom F.]

Then you may be the perfect candidate for that valve sparring surgery. For more on it simply google "aortic" and "valve sparring". The surgery was developed by Dr. Tyronne David, and hence it is called a "David" procedure. You may have to search for docs that know it well, which means a major heart center hospital. But the result is you keep your valve. Now there is a risk of a need for a re-op., but its a risk only. And on the net you can see several reports that seem to show that the surgery thus far is quite durable.

 

[Phyllis]

You might want to acess this article which includes a section on valve sparing surgery on the aortic root:
http://www.ctsnet.org/sections/clinicalresources/adultcardiac/expert_tech-18.html

 

[aussigal]

I would like to add a little about the size of your aortic-root...

at 5.1cm it is certainly getting-up-there as my Cardio would say

BUT if you have no other bad things happening like a BAV and Stenosis or regurgitation ...they usually allow these to go up to 5.5 before they electively operate...
so although its probably not at critical point yet it will come one day....
these things have been shown to grow on average 0.1cm or 1mm ( there are 10 mm's in a cm ) per year

As long as thats the only thing wrong I would reckon you have a bit of time up your sleeve to get yourself into the best possible health for the OP> which is what it seems like you are doing...

the fact you have a tri-cuspid valve is good..
BAV's are more dodgy and usually get operated on at a smaller size.

I as uneducated as I am feel you are under good care with a team who know what they are doing...

you possibly also have a couple of years to do some research

I look forward to reading more of your sucesses

 

[ks1490]

Update - I went in for another echo, I had been asked to wait 4 months. Unfortunately, it appears that my heart is getting bigger. Different tech measured this time, numbers now up to the following:

Left Ventricle End Diastolic: 7.0 measured by echo
Left Ventricle End Systolic: 4.5 measured by echo

I have a call with the doctor tommorrow, the tech just gave me these results. The doctor had said that surgery wasn't necessary until the systolic reached 5.5, but that he would want to act once he saw a clear trend.

If anyone has any feedback, I'd appreciate it, I'm not sure how to intepret it. I'll here from the doctor tommorow, but just wanted to share for now, feeling a little vulnerable right now.

 

[CCRN]

Suggestion

Suggestion

Since you asked.....here's the suggestion:

Get a SURGEON's opinion. Seems like your cardiologist is waiting for you to get to the symptomatic stage which may not be the best thing with your root being so large.....as the nice girl from Australia so gently told you. Your problem will eventually have to be addressed by a surgeon so, what the heck, pick one out and see what he/she thinks. I was followed by BOTH my surgeon and cardiologist for several months before my procedure. The cardiologist wanted me to wait longer.....the surgeon said it was a go, I went and it probably is why I'm in such good shape now...less than one year post op and able to pass the Air Force physical fitness test. Believe me, you want to deal with this while you are healthy. You will like the result much better.

 

[tobagotwo]

There is enough variation in echo technique that the latest echo may not actually indicate as much of an increase as it appears. I like the notion of finding a good tech and sticking with her, to enusre you're measuring apples to apples as much as possible.

It's important what the numbers started out as. Do you have results from an echo done a year or two ago?

I vote with CCRN. Not all damage gets undone. The longer you wait, the more likely you will have some permanent damage. Cardiologists often ignore it because they feel it is "controllable," and keeps you from having surgery as soon. Of course, they're not the ones who would be living with it. I would ask a surgeon what his thoughts are.

Best wishes,

 

[mtkayak]

Never hurts to get a third opinion. I would want a surgeons opinion as well. I was asymptomatic as well. My cardiologist recommended surgery and the surgeon agreed. They thought it would be better before I had symptoms and that my recovery would be faster. Stay healthy (other than your condition) before surgery.