Transesophagel echo - HELP! Prosthetic valve leaks.

[Mb]

Hello everyone.....

My husband is scheduled for a tricupisid annuloplasty and pacemaker insertion on January 24th. We saw his surgeon last week, for the second time. He already sports two St. Jude mechanical valves, aortic and mitral.

He was scheduled for the TEE today, as his previous echos have shown an increase in the gradeint across the mitral valve, and some regurgitation, unable to quantify by standard echo. So, at the end of the test the Dr. came out and told me that they had to re-do the test, with a different machine. They were unable to accurately determine the situation with the valve with the unit they were using. They have rescheduled the test for Friday. He said the shadowing (even with the TEE) did not allow for an accurate determination. Has this ever happened to anyone here who has mechanical valves?

Marybeth

 

[Karlynn]

Do you mean the inconclusiveness of the TEE? Or the valve leaking?

 

[geebee]

My understanding is mechanical valves create a lot of noise which makes a TEE not as useful. When I was in the hospital recently for suspected endocarditis, I kept hearing the nurses tell me I was scheduled for a TEE since that is what they use for diagnosis. However, my cardio said he cancelled the test (that the ER doctor had scheduled) because the mechanical valve was too noisy to "see vegetation".

Perhaps that is what is going on with your husband.

 

[Mb]

Thank you both for your responses.

What I am wondering about, is if anyone has had a TEE have to be redone because the Dr. could not "see" what was going on? I did ask him if he could see the leak, and he replied in the affirmative. He doesn;t know how much it is leaking though, or where it is leaking, as he coould not "see" what was going on. They are going to use a different machine on Friday.

Geebee, I don;t think they are suspicious of endocarditis. He does not have any of those symptoms. They are looking into the leak, to determine what the problem is, as if they have to repair something there, they can do it at the same time as the tricuspid repair. Then three days or so later, they will install the permanent pacemaker.

Marybeth

 

[davidfortune]

mb,

What about a 64-slice CT scan. I know that the 64-slice CT can create a 3-D picture for the docs. It also can provide detail on valve leakage and coronary artery condition (in some cases). I'm not saying that this would necessarily be the most conclusive at this point. I'm just thinking that it may be worth discussing with the Doc.

Less invasive that an angiogram and no sedation like a TEE.

At least you might want to discuss it with the docs.

Good luck.
David

 

[Mb]

Dear David:

Thank you for your comments. This was actually brought up last week when we were at the surgeon's office. He was to speak with the cardio about using that test, particularly with reference to the coronary arteries, which they obviously also want to have checked out prior to the surgery. The cardio and he think it would not be a comprehensive test, at least for that, as the shadowing from the two prosthetic valves would hamper the test results. I am not sure, now that I think of it, if perhaps he has more shadowing than most.......I do think the dual valves could be the reason.

These prosthetic valves have saved his life, in combination with the meds he is taking, and I am grateful for that. However, now they seem to interfere with an accurate diagnosis. The TEE is the "gold standard", and obviously the first one just did not work.

I am truly hoping the second one shows the apparatus properly, and they can determine why he has this leak, and it's severity.

Frankly I am praying for just a normal mild leak, like so many others here have. It is just that while they are in there, repairing the tricuspid valve, and then installing the pacemaker, they want to "fix" ANYTHING that may be an issue. So, Friday it is.

Again, thank you to everyone for any assistance/information you might be able to provide.

Marybeth