Pressure gradient across valve? mitral valve, echo

[mom2angel]

Hi all,
Had my yearly cardiology checkup last week. In the past couple of years my Dr. just started mentioning "the pressure gradient." I have never heard of this before. In past years, I've been told "everything looks great, come back in a year." But, I think it just started looking different in the past few years. , so now he mentions it. In the past 7 years, I have had 3 pregnancies, internal bleeding twice, and 3 blood transfusions. I put my heart through a lot in the last 7 years
Anyways, I'm just wondering exactly what the pressure gradient means. I found a site that talks about the aortic pressure gradient, so now I understand the basics of it. Just wondering what other people on this forums pressure gradient is.
I have a St Judes mitral valve. I have no idea of the size of it. I got it in '93 as a teenager before internet existed in my town, so I don't have a lot of info on it. A site I found listed different normal numbers for different sizes, so that didn't help much.
My dr. said the pressure gradient is a 2 and he'd like it to be a 1 1/2. Does anyone know what those numbers might mean. Thanks

 

[dornole]

I have mitral valve issues too. Had moderate to severe stenosis corrected with a balloon so I still have my own valve. Now I have mild stenosis with moderate regurgitation.

I am in a similar situation of just having been told "umm . . concerning" after 11 years of "see ya next year." I go back in June for a recheck. One of the things I've determined is that I need to get much more educated about my numbers! I didn't even ask for those last time, I was so startled.

Due to stenosis and twin pregnancy I had a crummy pressure gradient before my procedure (caused congestive heart failure, pulmonary hypertension) but I honestly don't remember what the number was. I remember the valve area which was 1.2 cm squared. Low being bad for valve area, high is bad for gradient.

Not much help but I'll be thinking about you and curious any info you get. Did they put you on more frequent follow-up?

 

[Duffey]

Have you thought about getting a copy of your last echo? Besides listing your measurements, it also lists the parameters for normal values.
Usually there's a mean pressure gradient and peak pressure gradient value when judging aortic stenosis but I don't know about the mitral valve.

 

[dornole]

I remember now, mean gradient on my mitral was 7.5mmHg when bad. I don't know what it is now.

 

[mom2angel]

Thanks for the replies. I think I will ask for a copy of the echo, and maybe some past echos, next time. I've never received a copy of my echos, so I have nothing to compare. I mainly would have liked an explanation. What has my gradient been in the past? When did it become a 2? Can it be lowered by exercise and healthy living, or is it always going to be a 2 because of the valve I have?
He didn't really give me any advice or much of an explanation, but you guys have helped. Next year I will ask for more. He said it's a 2 but he'd like it to be a 1 1/2. But he said that as long as it's not causing me any problems and I hear a strong click, then it's okay. He told me to come back in a year, like normal. I've always been on a 1 year schedule, except the 2 times immediately following my deliveries. Those two times I was told to come back in 6 months. There was still some extra blood volume from pregnancy, so something didn't look right, but I was never told any details. Both times, things looked fine after the next 6 month checkup.

 

[Lynlw]

I can't really help much, but I thought for a native mitral valve gradient somewhere around less than 5, I dont know if this is one of the sites you found but it has the "normal" gradients for the different brands of valves, it would help to know what size your valve, but should give you a rough idea http://www.echopedia.org/wiki/Normal_measurements_of_mitral_valve_protheses

It is a good idea to get copies of your echos and ask if it has changed slowly over the years or this was the first time it increased altho it might just be echos arent exact,
and if there is changes for the other things that would go along with pressure gradients increasing. Pulmonary gradient normals are much higher, so it is easier to see if there are big increases, so sorry i cant help more

Instead of waiting a year, you could call the Cardiologist office and ask

 

[mom2angel]

How does everyone know the size of theirs? When I was young, I was told there was a child size and an adult size..lol I had both of my surgeries as a minor and pre-internet days, so I think my parents just went with whatever the Dr. suggested. But, I just pulled out my heart valve patient identification card. I still have my card from 1982, too. I can't believe I didn't lose it over the years! My card from '93 (current valve) has the serial number and the model number. Not sure if that will help, but I'm going to research the model number to see if it tells me a size. Then, that chart will help me a lot. Thanks Lyn!

 

[dick0236]

How does everyone know the size of theirs?

Since you know your model and serial number, you should be able to contact the mfg. and get the size.

 

[mom2angel]

after a little research, I think it is a 25mm valve. On that chart that is linked above, it says the mean gradient for a 25mm is 2.5 +/-1. I guess that doesn't make sense to me. I would think 2 would be better than 1.5 if 2.5 is the mean. I don't know.
Is this something that can be changed through healthier living? Diet/exercise? thanks

 

[dornole]

I'm always asking if healthy living can help and getting no answer from cardiologist - I figure the lighter I am, the less blood has to push through there? - but I doubt it's really helping the valve issue. Still, I think overall health can't hurt. I did lose 40 pounds since my procedure and am more fit than I have ever been.

Taking care of my gums and being vigilant about strep are the only things I do that I think actually might help. But that's because of my rheumatic history.

 

[mom2angel]

I did a little more research last night, and found some better articles. I'm right there with you on the understanding of healthy living. It looks like it probably won't change the narrowing of the valve, but it's still good for everything else. I'm at a healthy weight and active in a body pump class 3 nights a week. But, I'm still 12 pounds heavier than I was before my last pregnancy. So, I could definitely stand to lose those 12 pounds and be a little more active on the other 4 days a week. This cardiology report is giving me some motivation to try to get back to pre-pregnancy weight. The weather is going to start warming up soon, and my daughter is 1 1/2 so she is getting more independent. That makes it a little easier to get outside and get active.

I agree that the lighter you are, the easier it is on your heart. Congrats on losing 40 pounds! that's something to be proud of.

 

[mom2angel]

thanks for the answers. I called the Dr.s office and asked for my report for this year's and last year's appointments. They are going to mail them to me today. Being able to see the numbers and compare them to last year will answer a lot of my questions.

 

[dornole]

Hey I just started doing Bodypump in January! I have never stuck with lifting before and now I love it!

Good luck with your medical records, hope they help with understanding what's going on. I'm gonna call for mine also. I'm still hoping the last echo was just operator error, myself. : ) We'll see in June.

 

[mom2angel]

Glad you are enjoying Bodypump. We had class tonight. It was a killer on the arms. Sounds like we have similar issues with the mitral valve. Hope your appointment in June goes well. I should be getting my records in the mail tomorrow (if they went out today). I'm excited to get to read what the Dr. said. This is the first time I've ever asked for the records, and I've been doing this for 32 years.
I had pneumonia about 4 years ago, so I am prone to chest congestion. So I decided that I am going to do a breathing (nebulizer) treatment every day for a week. And, I am going to walk at least 1 mile on the treadmill every day. Today was day 1, and I did both. If I can rule out the chest congestion, and lose a few pounds, maybe the shortness of breath will go away. Then I can rule out something serious with my heart.
I hope you can get your records too, and the results are good

 

[mom2angel]

got my reports today. They sent this year's and last year's, as I had requested. I am happy to see that there were no changes from last year to this year. But, since I only went back 1 year, I don't know when the numbers changed. I'm okay with that for right now.
My report:
inflow velocity: 2.0m/sec
mean gradient: 10mmHg
E/E' ratio suggests LV diastolic dysfunction

Any help with that last part would be greatly appreciated. Obviously LV is left ventricle, but I do not know what E/E' ratio means. I will do a little research now.
Thanks in advance

 

[Midpack]

got my reports today. They sent this year's and last year's, as I had requested. I am happy to see that there were no changes from last year to this year. But, since I only went back 1 year, I don't know when the numbers changed. I'm okay with that for right now.
My report:
inflow velocity: 2.0m/sec
mean gradient: 10mmHg
E/E' ratio suggests LV diastolic dysfunction

Any help with that last part would be greatly appreciated. Obviously LV is left ventricle, but I do not know what E/E' ratio means. I will do a little research now.
Thanks in advance

Hi!
I was told by my cardiologist that some degree of diastolic dysfunction is common as we get older. The heart muscle becomes a little stiff (with age) and somewhat affects the heart diastolic function (that is, when the ventricle relaxes to get filled).

On the other hand, my suggestion is not to google too much about it (diastolic dysfunction). If your cardiologist didnt mention it, trust him and beleive it is not something important. Internet ALLWAYS makes anything look serious. And i talk from experience!!

 

[mom2angel]

Thanks midpack.
I agree with the internet making everything look bad.
did a little research and found the definition of diastolic dysfunction. Then I remembered my Dr. talking to me about that last year or the year before. He told me that my heart doesn't relax the greatest, but that's from the issues I had when I had to have my valve replaced initially. So, that put my mind at ease. I'm satisfied, and done worrying about it. Nothing has changed since last year, and what I have was explained to me awhile ago. I'm not having any real symptoms, so I'll go about my life like I was before

The report was interesting, since you never really get to see what is written about you. It said that my hematoma from my C-Section 19 months ago was still present. That actually makes me feel good. It's not all fat in that belly Some of it is still hematoma and should get smaller with time. He also stated in both reports that he recommended against future pregnancies. We are done having kids, because of the heart issues, but I thought it was interesting that it was all in the report.