Odd Question : )

[DavesMom]

Hi all,

I recently had a stress echo and have an appointment with the cardio at the end of the month after it came back abnormal.

There is one thing I'm curious about. The report says that my now 8-year old mechanical valve is well seated with no rocking motion noted. Woo hoo! The report then goes on to say that "cannot accurately assess aortic valve regurgitation due to shadowing by the prosthesis."

So my odd question is what would cause the prothesis to cast a shadow??? Was this probably just an error by the tech? He's head of the echo lab and said he'd been there 14 years so certainly isn't inexperienced. Of course the paranoid part of me is thinking this means there's some kind of problem.

Also, there's been a lot of talk about aneurysms here lately. When I had my AVR the surgeon also repaired an ascending aortic aneurysm. Once you've had aneurysm repair can you develop another one?? If I recall correctly the cardio said I was born with a unicuspid valve.

Hope everyone is well!!

Cheers,
Michelle

 

[geebee]

Not sure what exactly is meant by shadowing unless it is a technical term for the "noise" the mechanical valves make during an echo. The valve "noise" prevents some detail that an echo might otherwise allow with one's original valve. I think it is unlikely that the term indicates a problem.

 

[Nancy]

My husband had problems throughout his life getting any kind of good results with echoes, due to shadowing. Most of the time, no matter WHO was doing the echo, they couldn't see any of the 4 valves. I used to think that it was tech error or inability, and we "fired" several techs, and only allowed the most experienced ones. Even they had a hard time and became very upset when they couldn't get a good reading. He was termed technically difficult.

So, yes, it can be a problem.

As far as I am concerned, echoes to determine valve viability for my husband, were a complete waste of time and money.

 

[Lisa in Katy]

I remember the tech mentioned shadowing during one of my echos, but I think it was from a particular view and when he moved the wand, the valve became more clear. I can imagine that anyone with more than one mechanical might have a real problem. This is what I found online:

The sewing ring and support structures of mechanical and bioprosthetic valves are strongly echogenic and may prevent vegetation detection within the valve apparatus or its shadow.

 

[davidfortune]

The mechanical valve reflects sound much more strongly that biological tissue. This strong reflected sound is hard for the sonogram to "see" through. Think of shining a bright light through a white sheet to see into a room. Then place a mirror in the middle of the room behind the sheet. The mirror will reflect the light much more strongly, making it hard to see other objects close to the mirror.

In the realm of sonography this reflection is called an "acoustic shadow". It makes the area near the super reflective mechanical valve almost impossible to see because the reflection from the valve is so strong (or bright) - hence the term shadowing.

It is normal with mechanical valves. Nothing you can do about it. This is not a technician error or an equipment problem. This is just due to the acoustical reflective properties of mechanical valves.

 

[sue943]

When I had my last echo a few weeks ago the technician mentioned the two valves making it difficult to get a good echo because of 'noise'.

 

[MrP]

When I had my AVR the surgeon also repaired an ascending aortic aneurysm. Once you've had aneurysm repair can you develop another one??

Yes, another aneurysm may develop on the remaining aorta. After resection of an ascending aortic aneursym, it is not uncommon in BAV patients for another one to develop on the transverse part of the arch and prior to the innominate artery, in the arch itself, or even in a carotid artery in the head. Less common is a second one in the proximal descending aorta or descending aorta.

In my situation, my ascending aortic aneurysm did not affect results of my stress test. My coronary arteries are "squeeky clean" which is not uncommon in BAV patients, as we sometimes also inherit some type of protection against plaque buildup in our coronary arteries despite high cholesterol.

Although your native aortic valve was unicuspid, you also had an ascending aortic aneurysm which makes me think you have similiar, if not the same, connective tissue disease as bicuspid patients. And if this is the case, I'm hoping you also are protected against coronary blockages.

 

[DavesMom]

Hi,

Thanks to everyone for your replies. I was just curious as I've had an annual echo for the past eight years and never had a problem with a shadow. Scary to think that you can develop another aneurysm.

Well. I'll see what the cardio says when I see her at the end of the month. Nothing like getting an abnormal test result and having to wait six weeks for an appointment. : ) And it'll probably turn out to be nothing!

Cheers,
Michelle