Reading latest echo

[Marguerite53]

Hello all.

I always love your help disecting these reports so if any of you have any time or interest, I'd love your feedback. I'm still dealing with the frustration of whether to go beyond the cardio's current opinion which is to wait for a surgeon's appointment, or press on. At this point, I'm literally looking at my calendar and thinking that when I go in (at her request) 3 months from now, that will be soon enough to press on about the surgeon. And it will be perfect timing for me (I really want to get through my daughter's volleyball season, and getting her college applications in without thinking about it all too much. That all ends in early November). I really am feeling better with the spironolactane and I don't think I'm in an emergency situation. Obviously I'll watch for changes, etc.

These reports all come from different places and it is so frustrating to compare them when the stuff is all written in different ways and different places!! But we all have these frustrations and you are helping me wade through them and learn.

Thanks very much.

Marguerite

From August 2004
Interpretation:
1. The aortic valve is abnormal. There is increased density of the aortic valve consistent with calcification or fibrosis. The Doppler flows show a peak velocity across the valve of 4 m/sec. for a mean gradient of 37 mmHg. The estimated aortic valve area is 0.95 cm2 consistent with moderate aortic stenosis.
2. The left atrium is a normal size by M-mode measurement but is mildly enlarged by 2-D views.
3. The mitral valve has mild increased density. Mild mitral regurgitation is seen.
4. The left ventricular chamber size is normal. Concentric left ventricular hypertrophy is seen. There is evidence of moderate diastolic dysfunction. The overall ejection fraction is normal at 60%.
5. The right heart is of normal size. The tricuspid valve is visualized, and mild tricuspid regurgitation is seen with a peak reverse gradient of 22 mm with an estimated pulmonary artery systolic pressure of 32 mmHg.
6. The pulmonic valve appears normal
7. There is no significant pleural or pericardial effusion. The inferior vena cava is borderline enlarged.

Conclusion:

1. Moderate aortic stenosis
2. Left ventricular hypertrophy with evidence of mild diastolic dysfunction
3. Borderline mild left atrial enlargement.


6 months ago, February 2004

Chambers: Global left ventricular systolic function is normal with estimated left ventricular ejection fraction of 60-65%. No segmental wall motion abnormalities were seen. There is diastolic filling pattern abnormality in the form of E to A reversal. No intracardiac thrombus or masses or obvious chamber dilatation is seen.
Valves: The mitral valve is morphologically normal without mitral valve prolapse or mitral stenosis and there is trivial mitral regurgitation. The aortic valve is possibly bicuspid and is heavily calcified with restriction in leaflet mobility. Peak velocity through the aortic valve was 3.6 meters per second with peak gradient 53, mean gradient 29 mmHg . LVOT diameter provided at 2.5 cm which is probably an overestimate. LVOT velocity provided at 0.9 meter per second with LVOT/aortic valve velocity ratio of 0.23. Claculated aortic valve area is about 1.2 cm2 which I think is somewhat of an overestimate due to large LVOT diameter provided. The patient overall appears to have moderate aortic stenosis which appears to be practically unchanged from august 2003.no aortic insufficiency is present. There is trace tricuspid regurgitation.
Miscellaneous: There is no pericardial effusion. Mild concentric left ventricular hypertrophy is present.
Conclusion:1. Normal left ventricular systolic function with normal chambers.
2. Possibly bicuspid aortic valve with moderate aortic stenosis.
3. Mild left ventricular hypertrophy.

 

[Mary]

I think they look at the pressure as much as anything. The 36mm is still good. That maybe why she's putting you off a little while.
I'd wait the three months.
Mary

 

[Marguerite53]

I'll ask about the pressure, thanks!

I'll ask about the pressure, thanks!

Mary, thanks. I had a quick visit with my PCP, GP, whatever you call them, today. She was very reassuring. She's young and interested and attentive -- I really value my growing relationship with her. Good chemistry. We looked at the echo from one year ago and that one was 1.0. So the 1.2 was off, probably. So, since a very very qualified cardio read the most recent echo I'm going to stick with the notion that I'm not really progressing downhill very rapidly. I'm still going to get a surgeon's referral in December. Today's doctor thought that was certainly within reason at this point.

Well. Waiting sucks. Whatever!!

Marguerite

 

[tobagotwo]

Chamber Size changes

Chamber Size changes

Indeed it does. The waiting is the worst.

You have heavy calcification on your arotic valve, and are beginning to develop thickening (probably calcification) on your mitral valve. Before surgery, that described me as well. Now my repalced aortic is fine, but my mitral is slowly continuting to calcify as time progresses. So, you have my sincere sympathy about that.

I think the thing I would be focusing on is the actual chamber sizes. When they are declared "normal" in size, it only means they are within a range. However, you may have started at the bottom of that range and progressed to the top of the range, which for you would be a major change, even though the size is officially "normal" or "slightly enlarged." This was how it progressed in my heart. The sizes are usually available on the test results. The progression should go back as far as you can, so you can plot the changes. If there are significant changes in chamber sizes over time, you would want to point them out to your doctor, as they tend to only look at whether the sizes are in the range.

Considering your level of calcification, the declaration of left ventricular hypertrophy, left atrial enlargement, the increasing regurgitation of the mitral valve, and the beginning of tricuspid regurgitation, the appearance (to my nonprofessional eye) is that the heart is changing shape, which would mean a need for greater recovery after the replacement. If not heeded, it could eventually mean incomplete return to normal size after the replacement. The vena cava enlargement mentioned may be related to backpressure from the tricuspid regurgitation.

Your pulmonary artery systolic number is 32, which would put you in the mild pulmonary hypertension group (if I remember correctly and if it is correct). I suspect that that number frequently comes up incorrectly high on echoes, though.

You have a possible bicuspid valve, so if you also have high blood pressure, you might want to ask your cardio to extend the echo to check for aortic coarctation, which sometimes goes along with that.

I am glad that you're feeling good. I don't think you're an emergency case, either, but I am happy that your doctor is bringing you in again in three months. I suspect that .95cm² is an overestimation, based on your calcification. Also, heavily calcified valves seem to be in traditionally worse shape than the numbers indicate.

I hope this isn't gloomy or harsh, as it isn't intended to be. Between volleyball and college applications, your time will fly, Marguerite. Enjoy it, as you really miss them when they leave.

Very best wishes,

 

[Marguerite53]

Always look forward to your replies to everyone!

Always look forward to your replies to everyone!

Thanks, Bob.

No, not too much doom and gloom. Information that I need to hear can never be gloomy and yours is very helpful to me as I stretch my meager medical background and try to understand all of this. I suppose the bit about the calcifying mitral valve struck me with the most disappointment (for both of us!) but it is reality and better uncovered than left to simmer unnoticed. I just can't believe that doctors are so numb and silent about all of this.

I keep thinking that February would be a great month. Our oldest graduates college in early May, youngest daughter graduates high school in mid June. Middle son doesn't get home from college until late June, but probably will get himself an apartment (working to get in-state tuition at Univ. of Washington) and not be home at all. We're all flying down to LA for the college graduation in May and I suspect I'd be well over any travel hurdles by then. I don't want to wreck everyone's summer. (especially if my oldest comes home for awhile before grad school -- I have missed him so incredibly much -- only saw him for a week this summer -- so I know what you mean). If I get it done in Feb. and all goes well, I'll be in better shape next summer than I was this summer. I have a feeling I will be one of those people who is just amazed by how bad I used to feel.

So, listen to me......like I'm ordering a pizza -- uh, I'd like to have that ready by 3pm on the 14th please......

Anyway, I'm looking into those numbers. Thank you so very much for taking the time to think about mine.

Marguerite

 

[Raverlaw]

Marguerite-

My surgery was February 20. By early April I was well enough to vacation in North Carolina with the family (visiting Bryan B and his folks, as well) and by the end of April I could chaperone my daughter's class on a week long trip to Yosemite, with no problems. I had a great summer, and hiked and climbed with no problems.

With your calendar, I think that February gives you plenty of time to get well again, even if you progress a little more slowly than I did. Good luck