Questions I should be asking...

[eibina]

About 11 years ago I was diagnosed with Asthma (then age 48) and was referred to a pulmonologist. A few years later, he heard a heart murmur and I had a echo that inidicated a aortic valve with senosis. However, the treatment was to just get an echo annually. During the late winter time-frame, it was discovered that I didn't have asthma but that a disease (sarcoid) was the actual problem. All but one of my asthma meds were stopped and I was put on steroids. All asthma symptoms disappeared and have felt absolutely great ever since. In Sep, in preparing to resume a running routine that I had had prior to the 'asthma,' in a 'walk fast' mode I got a pain in the middle of my chest. I backed off, and it went away. I contacted my pulmonologist who thought it might have been a pulmonary problem because I had just started taking a lower dosage of the steroid. I met with him last month and he recommended that I see a cardiologist to ensure it wasn't heart related. Of course, you all know what was found or I wouldn't be on this website. On 12/12, my echo showed a gradient of 6 where previous ones have been a 3. (I now know to ask what was the size of the opening.) On 12/14, I had a card. cath performed and no blockages were found. They did find an artery that feeds the right side of the heart was in an incorrect position (congenital) and would probably be bypassed when during the valve surgery.

Of course, like the rest of you, I am now trying to learn all about what will happen to me. Except for that instance of minor pain 3 months ago, I have felt the best I have felt in 11 years. I don't get shortness of breath, am able to walk up 4 flights of stairs, shoveled snow last week, etc.

I met briefly with a surgeon following the cath procedure. I am now preparing myself to meet with him again and want to know just what questions I should be asking. He has recommended a mech. valve because of my 'young' age.

Besides asking what was the size of the opening of the present valve, what other questions would those of you with experience recommend my asking, and why?

FYI, I am a very positive person with a great sense of humor. People say I don't see the "glass half empty or full, my glass is always overflowing." Therefore, I am not stressed about what willl be happening; but I do like to make 'informed decisions.' Thanks for any help.

 

[Curtsmum]

Just wanted to say welcome and to wish you luck, i'll leave the questions to the others all the best Paula x

 

[Mary]

About 11 years ago I was diagnosed with Asthma (then age 48) and was referred to a pulmonologist. A few years later, he heard a heart murmur and I had a echo that inidicated a aortic valve with senosis. However, the treatment was to just get an echo annually. During the late winter time-frame, it was discovered that I didn't have asthma but that a disease (sarcoid) was the actual problem. All but one of my asthma meds were stopped and I was put on steroids. All asthma symptoms disappeared and have felt absolutely great ever since. In Sep, in preparing to resume a running routine that I had had prior to the 'asthma,' in a 'walk fast' mode I got a pain in the middle of my chest. I backed off, and it went away. I contacted my pulmonologist who thought it might have been a pulmonary problem because I had just started taking a lower dosage of the steroid. I met with him last month and he recommended that I see a cardiologist to ensure it wasn't heart related. Of course, you all know what was found or I wouldn't be on this website. On 12/12, my echo showed a gradient of 6 where previous ones have been a 3. (I now know to ask what was the size of the opening.) On 12/14, I had a card. cath performed and no blockages were found. They did find an artery that feeds the right side of the heart was in an incorrect position (congenital) and would probably be bypassed when during the valve surgery.

Of course, like the rest of you, I am now trying to learn all about what will happen to me. Except for that instance of minor pain 3 months ago, I have felt the best I have felt in 11 years. I don't get shortness of breath, am able to walk up 4 flights of stairs, shoveled snow last week, etc.

I met briefly with a surgeon following the cath procedure. I am now preparing myself to meet with him again and want to know just what questions I should be asking. He has recommended a mech. valve because of my 'young' age.

Besides asking what was the size of the opening of the present valve, what other questions would those of you with experience recommend my asking, and why?

FYI, I am a very positive person with a great sense of humor. People say I don't see the "glass half empty or full, my glass is always overflowing." Therefore, I am not stressed about what willl be happening; but I do like to make 'informed decisions.' Thanks for any help.

I just read your post on the other thread, so came back to look and see what you had originally posted. (That's why I'm so late getting here!)
At your December 12 echo, you say the gradient was 6. I think you might mean that your AVO was .6--down from a 3.0. Mean gradients have different ranges with a peak gradient being consierably higher. The heart cath I had the day before surgery showed my mean to be 51. If you have a copy of your echo, you might want to recheck your figures.

As far as questions go, I would ask him why he considers 59 to be young for having a tissue valve. You might face replacement again, but then, you might not. As we age, we typically pick up more health issues that can sometimes complicate treatment when combined with coumadin. My mother experienced that when she developed cancer at age 61. I'm not promoting either a mechanical or a tissue valve, but I would ask the surgeon why he is making that recommendation.

The other major concern I would have is when he wants to schedule your surgery. If indeed your aortic valve opening is at .6, it should be pretty soon. You should ask what physical restrictions you might have until surgery. I would guess that you shouldn't be shoveling snow anymore this winter!

And finally, I think that you posted on a Friday and that is a bad day to get answers to posts. I was gone all week-end and I imagine many others were too.

Now that I'm back, I would like to say, "Welcome" and "Merry Christmas!"
Mary

 

[eibina]

Gradient was 6, opening is .89

Gradient was 6, opening is .89

I'll admit this all new to me. From what I udnerstand, the 'gradient' has to do with the velocity of the blood through the valve. I am having another echo because it appears to me that there is a lot in the findings that has to do with the technician's abilities. Additionally, in reviewing my past 6 years worth of echos, the opening size had varied from .8 in 2002 to up as high as 1.2 in 2003 and now down to .89. But, the cardiologist and the surgeon say the primary reason for the surgery now is the high velocity of the blood. Obviously, I am seeking additional opinions. Thanks for your input.

 

[Mary]

I'll admit this all new to me. From what I udnerstand, the 'gradient' has to do with the velocity of the blood through the valve. I am having another echo because it appears to me that there is a lot in the findings that has to do with the technician's abilities. Additionally, in reviewing my past 6 years worth of echos, the opening size had varied from .8 in 2002 to up as high as 1.2 in 2003 and now down to .89. But, the cardiologist and the surgeon say the primary reason for the surgery now is the high velocity of the blood. Obviously, I am seeking additional opinions. Thanks for your input.

You need to have a copy of your echo so you can see the results.
I'm looking at a copy of an article from 2/28/2002 in the New England Journal of Medicine that shows the correlation between aortic-valve area and mean gradient.

When the aortic valve area is 4cm2 you expect a mean gradient of abut 1.7 mmHg. If your valve opening was 1.2, the mean gradient is normally less than 26 mm Hg. At 0.8 AVA, the mean gradient will show a corresponding number of 41 mm HG.

When you say the echo reports a gradient of 6, that just doesn't calculate.
As the opening narrows with stenosis, the gradient rises correspondingly.

If the report says the jet velocity is greater than 6.0 m/s, then it would indicate severe stenosis, but your valve opening doesn't reflect that. I would find out what measurement they are citing when they say a 6.0.

 

[hensylee]

I didn't have any answers for your original post, but should have come in to welcome you to VR. Glad you brought up the lack of response because this site is nearly always on the ball with answers, or comments. Maybe it's the busy season, but still not excusable. Forgive us.

Welcome to VR and keep on reading all you can. An educated heart patient is what we all want to be.

And Merry Christmas. Please keep us posted as things move forward - or backward.

 

[bvdr]

Hi and welcome to our forum. Don't worry about having broken some protocol since you didn't. When I visit this site I sometimes only have time to read a few of the posts and then when I return another time I tend to go back to the posts I had read to see how the person is doing. I'm sure there was no slight intended .

As Mary suggested, do get copies of all your test results. You may already have done that. The numbers and the way you are using them are not in the way we typically hear of aortic valve measurements and therefore is causing some confusion as to how to respond. If you haven't already found the reference forum section of this site then go to it and check some of the areas that refer to echo measurements.

As to questions to ask ......ask him what he is looking at on you echo and of what significance it is. It sounds like you are having symptoms and that is a sign that surgery is not too far off. I don't know how your sarcoidosis affects you valve issues but I would think it complicates it somewhat.

Please forgive any delay on answering your questions and I'm glad you posted again before going away disappointed. I think you will find this web site an on-going source of information and encouragment as you go through this whole process.

 

[Ross]

Just an interjection here: Get copies of ALL of your MEDICAL RECORDS!!!!

Very important to you and for future use.

 

[ALCapshaw2]

Gradient actually refers to the "Pressure Gradient" across your valve(s), i.e. it is the difference in pressure measured at the input and output sides of your valve.

There is a well known equation in Fluid Dynamics that relates pressure gradient to velocity. Basically, the smaller the valve opening, the higher the pressure gradient and the higher the velocity through the valve. My Echocardiogram Reports give the typical range of values for each measurement for comparison with my actual measurement. I like to keep my echo report numbers on a spread sheet so that I can look for *changes* in each parameter which I feel is a better way to interpret the results.

Bottom Line: Pressure Gradient, Velocity, and Valve Opening are all related. Doppler Echo's measure velocity and calculate the other numbers. Pressure can be measured by cardiac catheterization. Each parameter has a 'normal range' that cardiologists compare with your readings to assess where you stand.

Hope this helps.

'AL Capshaw'

 

[susieq14]

Good luck at your appointment with the surgeon! I'm a novice here so cannot offer any solid advice except to reiterate that you get copies of all your test results and to perhaps bring someone with you to the appointment so you have another pair of ears listening in case you miss something. I'm sorry that you didn't get many answers right off the bat - I felt the same way after I first posted.

Take Care!
Sue

 

[eibina]

meet with different surgeon

meet with different surgeon

I am now scheduled to meet on Wed, 12/28 with a different surgeon to get a second opinion. He is planning to do a transesophageal echocardiogram to get a better look. It appears he has some questions about the numbers from my most recent echo test too. I left him my full medical record and a digital copy of the card. cath for his review.