Reports are Back...Help!

[carlapv]

Hi everyone,
I just received the reports back from the TEE and Cath. Could any of you help me understand the significance of some of the results?

1. Mitral valve doming. Leaflets are thickened, but not markedly calcified. Mild thickening of the subchordal apparatus. Mean gradient across the valed at a heart rate of 55BPM was 6.5 MMHG.
2. Mitral valve area 1.1 which is consistent with mitral stenosis (moderate).
3. Evidence of mitral regurgitation directed anterolaterally. (Moderate)
4. No Aortic stenosis, moderate aortic regurgitation.
5. Mild tricuspid regurgitation.
6. Systolic pulmonary artery pressure is elevated, estimated at 45 MMHG.
7. Pulmonic valve not well visualized.
8. Normal left ventricular cavity size. Wall thickness, motion and systolic function. Ejection fraction approximately 55%.
9. Left atrium is is moderately dilated at 5.0cm in diameter.
10. Aortic root and proximal ascending aorta are normal in size
11. Descending aorta is normal in size with mild atheromatous disease.

This all sounds so ominous. I have an appointment with my new surgeon on Monday the 15th to discuss when he thinks surgery should be. I would still like to wait until the new year.

My new surgeon is Dr. Robert Guyton, Chief of Cardiovascular sugery, Emory University Hospital. Anyone ever heard of him?

Thanks for your help!

Carla

 

[bvdr]

Hi Carla,

My take on your tests is that the mitral valvoplasty that you had done years ago is not doing the trick anymore. The mitral stenosis of 1.1 and the moderate mitral regurg may exclude you from another valvoplasty and you might find yourself very soon with a new valve. The mean gradient isn't bad but your heart rate was rather slow and you were totally at rest. Your left atrium has enlarged as a compensation to propel your blood through a stenotic mital valve.

I see that you have the moderate aortic regurg. as well. My tests all showed that but when I had an echo in July it only showed it to be mild. On the intra-operative tee I was told it was very very mild and my aortic valve was left untouched.

Your tri-cuspid regurg may be correct itself when your mital valve is replaced and your pulmonary artery pressures may as well. My pulmonary artery pressure was about the same as yours but my valve area was 1.3.

We are within a year of each other in age and both have rheumatic heart disease.

This is by no means a professional interpretation but just the way I am reading your results.

I just had my mitral replaced and I do feel relief of many of my pre-op symptoms. I wish the very best for you Carla, Please let us know how your appointment goes.

 

[carlapv]

Thanks Betty,

I really do appreciate your response. I have been keeping up with you and your progress and I hope I will do as well as you. It is all so very intimidating. My emotions are on a roller coaster. One day up and the next down. I am trying very hard to be brave and I can put on a really good front to the world but inside I am scared to death. I think I will feel somewhat better after I talk with the surgeon and see what he thinks.

Thanks again and take very good care of yourself.

Carla

 

[Christina L]

in the same boat

in the same boat

Hi Carla,

I want you to know that I am feeling the exact same way as you. I have not yet had one heart surgery, but that is going to change soon. I am waiting to be scheduled for mitral valve repair or replacement. I have known this for about 1-1/2 weeks now and although I am not crying my eyes out 24/7 any more, I am still up and down - had a crying jag this afternoon. I am sleeping better but wake up early in the morning and of course the first thing on my mind is my upcoming valve surgery.

Please feel free to privately E-mail me with any of your thoughts as I probably have the very same ones. It is rough because no one really understands except the other people on this board - family and friends try to understand but they have no clue. A person does feel very alone. I think for me, this is a time that God wants my complete attention for the first time in my life. I always thought He/She had my complete attention, but until now, I was only halfway giving it.

Go with your feelings and don't hold anything in - I think that helps also - to work through this initial stage of shock/grief, etc.

Chris

 

[Ross]

God does have a way of getting your attention. In my case, the first time he put the smack down on me and the second, he humbled me. You both know that we have gone through everything your feeling and thinking, so if you need to vent, we are here.

 

[Christina L]

thanks Ross

thanks Ross

Thank you, Ross. You are too sweet, as are all on this board, from who I feel such compassion and sincere empathy for what I am going through.

God bless you all.

Chris

 

[Susan Allen]

Hi you guys,
I just want you to know I was in th same situation a few short weeks ago. The constant crying is under control but anything can set me off. I will tell you one thing though - I met with the surgeon yesterday and he was wonderful. We were on the same wave length and by the time I got to my car I felt like the greatest weight was lifted off my shoulders. Today I got a call that my surgery is scheduled for Oct. 16th. Although I am really scared (and had a good relieving cry) it's weird to say but I actually feel better. No more research on what valve - my choice is made and so is my back up plan. I feel good about my surgeon and got to talk to a patient who had the Ross Procedure done by him. She was an emergency RP - a long time marathon runner who contracted an infection during pregnancy. She said she has never felt better.
I am no expert and I need you guys and the rest of the board for support. Just get a time when you feel calm and do the research - don't over do just as much as you can digest without getting upset - that's what I did in the beginning. Be sure to take time away from it.
Good luck and God bless
Susan

 

[bvdr]

Susan,

Congratulations on finding a surgeon you are comfortable with and on getting a date. It does help to have some framework in which to work doesn't it? Which valves are in your plan?

 

[ALCapshaw2]

Hello Carla,

First, I would ask for an appointment with your cardiologist, telling him you want an explanation of the test results. If he can't see you in a reasonable amount of time, then perhaps you can get his nurse to help you. If that fails, your Primary Care Physician might be able to help.

I see you have a lot of issues but most of them are described as mild or moderate. At those levels, regular tests and monitoring are the usual protocol so I expect you will be able to wait awhile. Again, this is a question for your doctor(s).

Your Ejection Fraction is in the normal range at the low end which should not be a cause for worry. Since your heart size and wall thicknesses are normal, this indicates you do not have permanent heart muscle damage. When these indicators begin to change, that is a good sign that surgery is probably warranted. The surgeons like to operate before permanent damage is done. If they get in early, small changes in those parameters often return to normal once the valve is replaced.

FWIW, medical adjectives seem to follow the following pattern in intensity:

No / None
Trace
Mild
Moderate
Severe
Critical

You can check the ratings of hospitals of interest at HealthGrades.com I 'believe' Emory University Hospital is a good heart hospital. Perhaps one of our members from Georgia can give you more information.

Best wishes,

'AL'

 

[Susan Allen]

Hi you guys,
Betty I have picked the Ross Procedure and have researched it tremendously - my backup plan is a mechanical valve. I am 42 years old which puts me in a odd age. If I were to go to a porcine or bovine valve chance are I would need at least 1 maybe 2 more surgeries and my surgeon recommended not to have a homograft (never discussed why because I didn't think that was for me anyway).
Al the website you gave to check on hospitals was very good and I feel confident about the one I am going to. It gives great comparisons.
Just one more thing to add - Carla ask questions until you are satisfied. I've come to the realization that these doctors work for us - we're there customer and if they can't make us happy - find someone who will. I know it's hard cause I let my card. get away with general answers and I got a surprise - never really knew how serious I was till now it's surgery time. You can bet I ask and ask and ask now.
Take care all.
Talk to you soon.
Susan

 

[Susan BAV]

Hi Susan - I am so glad you found a surgeon who listened to you, ran the tests, read the results, etc.! I hope everything goes very well for you! Best wishes, ~(another) Susan

 

[carlapv]

Thanks everyone for your replies. I know that I should be more assertive with my card. I chose him because of his technical knowledge and the fact that he had a keen interest in my particular case. He asked me actually rather than me choosing him. He reallhy knows what he is doing but his bedside manner sucks. He is nice to look at but I think he believes that I some how am not capable of understanding anything but the basic information. I have heard that the surgeon I have chosen is much better.

Thanks again,
Carla

 

[Susan Allen]

Hey Carla,
Sounds like my card. - and yes my surgeon was sooooooo much better and treated me like I had a brain. Believe me you will feel a lot better when you talk to him.
Keep your chin up
Susan