Tricuspid Valve with no Calcification

[Stowegirl]

My story is that 2 years ago I was referred immediately to a surgeon because an echocardiogram showed my valve size to be critical. I saw the surgeon and he wasn't convinced so ran another lot of tests which showed me being moderate severe with a valve size of 1.1cm. He wanted to be sure so I also had a TEE.
Appointments became 6 monthly and then September just gone the valve size was 0.82cm and EF of 43% so he regarded that now is the time.
Subsequently I had a CT scan and an angiogram. The angiogram showed there to be no blockages. However the CT scan showed me to have a tricuspid valve with no calcification and now Im totally confused. What is causing the valve size to diminish? My original findings were when I was 58.
Any ideas whats going on because Ive read alot of things over the two years, it was thought I might have had fused leaflets maybe but not confirmed and now it looks otherwise. I thought I kind of understood it all.
Im fairly asymptomatic. I do get a bit breathless when walking but some of that is because Im in alot of pain from arthritis following a car accident. It also prevents me exercising too much. Otherwise I have no chest pain, I am not dizzy nor do I pass out. I can lay down and breathe perfectly well.
In the meantime I am still waiting to hear what is happening to me.

 

[tom in MO]

Pain from a car accident and arthritis will not make you breathless.

Many of us were asymptomatic before our operation. I had a bicuspid valve with stenosis and was asymptomatic. The fact that patient symptoms are insufficient to judge valve replacement time is why they monitor your valve with echos and CT scans. As my cardiologist told me to convince me I needed a valve replacement within the next two months: "Don't wait too long, you don't want to suffer the syndrome known as sudden death."

 

[rich01]

I don't have time to read this article right now, but it looks like it might have the answer to your question.

https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.117.007146

 

[Stowegirl]

Pain from a car accident and arthritis will not make you breathless.

Many of us were asymptomatic before our operation. I had a bicuspid valve with stenosis and was asymptomatic. The fact that patient symptoms are insufficient to judge valve replacement time is why they monitor your valve with echos and CT scans. As my cardiologist told me to convince me I needed a valve replacement within the next two months: "Don't wait too long, you don't want to suffer the syndrome known as sudden death."

Thank you for your comment. Im not saying that the breathlessness is from the car accident. Im just adding that regarding the arthritis I have because Im in alot of pain when I walk which kind of takes my breath away if you get my drift and I have to stop alot rather than keep going. What I am more confused about is that my surgeon has now said now is the time and yet Im not hearing any more and its been nearly 6 months.
I think we assumed I had a bicuspid valve as it seem something Ive been born with. But the CT scan has shown a tricuspid valve and no calcification.

 

[pellicle]

I think we assumed I had a bicuspid valve as it seem something Ive been born with. But the CT scan has shown a tricuspid valve and no calcification.

I"m a little lost here, there is a valve called the tricuspid valve and the Aortic valve is tricuspid in morphology but not called "the tricuspid valve".

Which valve are we talking about?

 

[Stowegirl]

This is interesting, thank you. Nobody has ever mentioned the Tricuspid atall in past reports. I need to check this. But then I guess why would they mention it now? I really need a follow up appointment which Im still waiting for.

 

[Bryan B]

I think we assumed I had a bicuspid valve as it seem something Ive been born with. But the CT scan has shown a tricuspid valve and no calcification.

I'm just making an educated guess here, but the way I read this statement the surgeon expected to see a bicuspid (2 leaflets) AORTIC valve with calcification, and instead saw a tricuspid (3 leaflets) AORTIC valve with no calcification. I don't think he was talking about the actual TRICUSPID valve itself. But I agree a follow up appointment to get all this sorted out would be in order.

 

[Protimenow]

The way I've interpreted the thing about bicuspid valves is that they're a genetic abnormality. The aortic valve is supposed to be tricuspid. Some of use are born with defective tricuspids, or actually born with bicuspids. The genetic abnormality that gives us the bicuspid (instead of tricuspid) may also cause weakened structures outside of the heart, increasing the likelihood of nice things like aortic dissection and other great life threatening events. Although the cardiologists don't mention these risks, the repeated diagnostic exams, I think, aren't just to determine the status of the heart but, perhaps, but may also be assessing heart functino as a warning that other structures may be failing.

If an echo shows that you have a tricuspid valve without calcification, this actually sounds pretty good. However, I wonder if the test was read correctly.

 

[rich01]

This is interesting, thank you. Nobody has ever mentioned the Tricuspid atall in past reports. I need to check this. But then I guess why would they mention it now? I really need a follow up appointment which Im still waiting for.

I made a mistake after my 2nd echo. Since there was a question whether I had a bicuspid or tricuspid aortic valve, those were the 2 terms I was familiar with. On the report, it said I had mild stenosis of tricuspid valve, but the report showed moderate stenosis of aortic valve. I thought they had made a mistake, as they just handed me the report and never explained it.

It wasn't until I started doing my research that I learned they were actually 2 different valves.

 

[Stowegirl]

The way I've interpreted the thing about bicuspid valves is that they're a genetic abnormality. The aortic valve is supposed to be tricuspid. Some of use are born with defective tricuspids, or actually born with bicuspids. The genetic abnormality that gives us the bicuspid (instead of tricuspid) may also cause weakened structures outside of the heart, increasing the likelihood of nice things like aortic dissection and other great life threatening events. Although the cardiologists don't mention these risks, the repeated diagnostic exams, I think, aren't just to determine the status of the heart but, perhaps, but may also be assessing heart functino as a warning that other structures may be failing.

If an echo shows that you have a tricuspid valve without calcification, this actually sounds pretty good. However, I wonder if the test was read correctly.

It would be useful if somebody would call me in for an appointment to find out what is actually happening but what kind of other structures do you think might be failing? Ive spent 2 years looking into bicuspid valves and now I am totally confused.

 

[pellicle]

Ive spent 2 years looking into bicuspid valves and now I am totally confused.

there really isn't much to be confused about, I'd say that as long as we're looking at the Aortic valve then its simply a matter of insufficient medical imaging data. Its hard to make a good image of something moving when there's not enough light, and beating at 70 times a minute its moving quite a bit.

 

[Stowegirl]

Okay. So Ive got the report. It says
CT Aorta - Tricuspid AV, no LVOT calcification
Make any sense to anyone?

From the echo it says
Normal RV size and systolic function
Severely dilated LA
Severe AS. AVA 0.82cm

 

[Paleowoman]

Tricuspid AV stands for tricuspid aortic valve
LVOT stands for Left Ventricular Outflow Tract - so there's "no calcification" in your left ventricular outflow tract.
RV stands for Right Ventricle
LA stands for Left Atrial
Severe AS - AS stands for aortic stenosis
AVA - aortic valve area.

The report should also tell you your mean and peak Pressure Gradients - those are important to know.

Do get in touch wth the cardiac department at Kings and with your GP and do let us know.

 

[Stowegirl]

Tricuspid AV stands for tricuspid aortic valve
LVOT stands for Left Ventricular Outflow Tract - so there's "no calcification" in your left ventricular outflow tract.
RV stands for Right Ventricle
LA stands for Left Atrial
Severe AS - AS stands for aortic stenosis
AVA - aortic valve area.

The report should also tell you your mean and peak Pressure Gradients - those are important to know.

Do get in touch wth the cardiac department at Kings and with your GP and do let us know.

So the CT scan doesn't mention the AV atall, just the echo does that. Does that sound unusual? Seems to talk only about the Tricuspid Aortic Valve (is that still the same and is it saying no calcification? Is this changing the diagnosis and thats why IVe heard no more? I know I need to follow this up but there seems no urgency.

 

[Paleowoman]

So the CT scan doesn't mention the AV atall, just the echo does that. Does that sound unusual? Seems to talk only about the Tricuspid Aortic Valve (is that still the same and is it saying no calcification?

Your CT does mention your aortic valve, it says it's a tricuspid aortic valve.

Your echo should tell you your pressure gradients - what are there ?

 

[Stowegirl]

Your CT does mention your aortic valve, it says it's a tricuspid aortic valve.

Your echo should tell you your pressure gradients - what are there ?

Of course you are right re the tricuspic aortic valve. I have been querying it because I think we thought it might be bicuspid. It its normal with no calcifcation I am totally confused as to why it is a problem. Im not sure about pressure gradients. What I do have is as follows:
ECHO; borderline dilated LV, mild to moderate LV dysfunction. Normal RV size and systolic function.Severe AS (PG 54 mmHg, MG 29mmHg. DI 0.24 AVA 0.82cm squared)
CT AORTA: Tricuspid AV, no LVOT calcification
AA 425cm squared, 21 X27 mm, derived 23mm
Sinuses 29x27x26mm
LMCA 11.6mm, RCA 17mm

Does any of this mean anything to you.

 

[pellicle]

Of course you are right re the tricuspic aortic valve

just keep in mind, this is only about your Aortic valve

there are a couple of ways Aortic valves can be, proper way to have three leaflets, called tricuspid (not to be confused with the other valve in the heart which I previously showed in a diagram called "The Tricuspid Valve"). The less than ideal way the Aortic valve can be is bicuspid (which is a congenital defect, or mistake in formation).

There is no mention if the valve itself is calcified ...

 

[Bryan B]

It its normal with no calcifcation I am totally confused as to why it is a problem.

I think the problem that still exists is this: Severe AS. AVA 0.82cm

Although the CT scan showed that you do not have a bicuspid aortic valve, the echo showed that your aortic valve does have severe stenosis. Usually when the AVA (aortic valve area) drops below 1.0cm it's getting close to time to replace the valve and yours is at 0.82cm (normal AVA is 3.0-4.0cm). I don't know as much about stenosis as some of the other members here (my issue has always been regurgitation...leaking), but I do remember reading other members saying that around 0.8cm seemed to be the "magic number" for when surgeons tend to recommend surgical intervention.

 

[pellicle]

the echo showed that your aortic valve does have severe stenosis.

and as far as I know, a stenotic valve is usually calcified ... even if its not detected in imaging.

If anyone knows of other ways please do post

 

[Paleowoman]

ECHO; borderline dilated LV, mild to moderate LV dysfunction. Normal RV size and systolic function.Severe AS (PG 54 mmHg, MG 29mmHg. DI 0.24 AVA 0.82cm squared)

The pressure gradients across your aortic valve are PG (peak gradient) of 54mmHg and MG (mean gradient of 29mmHg).

Your presure gradients would appear to indicate 'moderate stenosis' but your aortic valve area would appear to indicate 'severe stenosis'. I write APPEAR because these are all numbers from calculations done in the echocardiogram and can be influenced by several things: the echo equipment, and angle of the thing the echo technician holds, and the echo technician's skill. In my pre-surgery echo the echo technician gave two different measurements of my aortic valve area as he calculated it using two different forumulas. Your echo technician should also have mentioned if there was calcification. You mentioned earlier that your Ejection Fraction (EF) was low, another factor. And 'Severely dilated left atrial (LA) is another important factor.

You say you had a TEE - that would have given a more accurate picture of your aortic valve and would have said the valve area size and if anything was wrong with the valve which does not show up on echo.

You definitely must get in contact with the hospital and with your GP. The hospital should have sent a report to your GP with copy to you. The report would not have simply been a set of numbers from the echocardiogram and CT scan as GP's cannot interpret these numbers, they have to be interpreted by a cardiologist/ cardiac surgeon.