Ventricular function and size after AVR for regurgitation

[Silver Bullet]

I'd like to hear from folks who had aortic valve surgery for chronic severe aortic regurgitation: what were your (1) LVEF (2) LV end diastolic dimensions and (3) LV end systolic dimensions before and after surgery? How close to normal did your ventricles look after surgery and what was the time course of recovery? Thanks in advance for sharing.

 

[Silver Bullet]

Ok, I'll get the thread partially going. My pre-op values are: LVEF around 0.60; LV ed-systolic dimension 44 mm; LV end-diastolic dimension 66 mm.

I'll follow up with the post op values in the NY.

 

[AZ Don]

I have not been referred for surgery yet, and my Cardio tells me I could go for years, but I think my numbers say that I'm getting close. LVEF: 45, LVESD: 47, LVEDD: 61. 2.5 years ago my BAV was well functioning so it was spared during my aneurysm repair. Started leaking right after.

 

[Northernlights]

AZ Don, is there a reason your Cardio hasn't referred you for surgery? An EF below 50 is a class 1 indication for surgery in severe regurgitation, even if the left ventricle dimensions haven't reached the cut- off numbers; and cardiologists are generally pretty anxious to move quickly, before the drop in EF becomes irreversible, as it makes quite a difference to post-op outcomes.

 

[AZ Don]

Northernlights, A couple. First, my regurgitation has only been classified as moderate, not severe. I know the numbers listed above are important but there are a lot of other measures and I don't have a good understanding of them. Second, the Cardiologist says that my heart is functioning better than the numbers imply. Not sure how he determines that but he is a highly rated and respected Cardiologist. Consistently listed as one of the best in the region. Still, my next appointment will be with a surgeon, to get another opinion and if I'm getting close then I might as well start getting to know the surgeon by doing follow-ups with him. Due to insurance changes I can't go back to my prior surgeon.

 

[Northernlights]

AZ Don, to have those sorts of EF / ventricular dimension numbers with only moderate regurgitation does sound as if a second opinion is a good idea, or at least a bit more explanation of the discrepancy from your cardiologist!

 

[MethodAir]

Some are in heart failure with an EF of 55%+. And the typical echo only tests EF at rest (some elite cyclists have low resting EFs). Point is, the numbers do not always tell the whole story.

 

[Lisa2]

Northernlights, A couple. First, my regurgitation has only been classified as moderate, not severe. Still, my next appointment will be with a surgeon, to get another opinion and if I'm getting close then I might as well start getting to know the surgeon by doing follow-ups with him. Due to insurance changes I can't go back to my prior surgeon.

Don, I like your thought process of having your follow-ups with the surgeon and getting to know him. I have been doing something similar for a year now. I've seen the surgeon that I think will replace my homograft 3 times now - 12/2014, 05/2015, & this week. He is a 4-5 hour drive away from where we live; but, it has been worth it to me. My EF has been hovering around 50% for the past year and my mean gradient is still on the low end of moderate. So this homograft is holding up very well. Dr. Davies thinks he will be able to replace just the aortic valve and not have to do the root but of course he won't know until he gets in there He wants to see me in 6 months (again).

I have also been following up with my cardiologist. He has been my doctor for about 16 years and I value his care and professional opinion. I saw him yesterday to review the results of my echo from UAB and I get the impression that he doesn't want me to continue going there every 6 months. He said he orginally sent me to UAB beause he knew Dr. McGiffin (now retired and back in AU) and that Pensacola now has an excellent surgeon and that I can just stay right here when it's time. I'm still processing that. Multiple opinions are good but I have also developed a level of comfort with Dr. Davies. The good news is that it's not something I have to decide right now. Almost 12 years with this homograft and life is good.

 

[AZ Don]

FYI, Just wanted to post a follow-up after meeting with a surgeon today. He said virtually the same thing as my Cardiologist: my heart is functioning better than the echo numbers imply. I'm not a candidate for surgery now and he even said that surgery is not inevitable. In the past I made a few efforts to try to decipher more than a couple numbers from the echo, but it seems like every echo I get, even from the same provider is in a different format with different acronyms. In any case, these Dr's are seeing more than I'll ever see so I think I'm done trying to decipher the numbers. Two highly rated Dr's are saying the same thing and that's good enough for me. The surgeon referred me back to the Cardiologist for follow-ups which is fine with me.

 

[pellicle]

excellent news

FYI... I'm not a candidate for surgery now and he even said that surgery is not inevitable..

 

[Heart Of The Sunrise]

EF 45 before surgery...post surgery 60+..1 year post surgery LV size returned to normal!

 

[AZ Don]

excellent news

Yes, thanks!

 

[Silver Bullet]

EF 45 before surgery...post surgery 60+..1 year post surgery LV size returned to normal!

What a great result! Did you have aortic regurgitation pre-op?

 

[Silver Bullet]

I had an echo just before surgery, and the update on my pre-op values is:
LVEDd = 67-70 mm (severely dilated)
LVESd = 44 mm
LVEF 0.60

My post op day 7 values are
LVEDd = 57mm (upper normal)
LVESd = 46 mm
LVEF 0.48

I'll update these in 3-6 months, during which I expect improvement in my LVEF to normal and further reduction in the size of my LV.

 

[ashadds]

I had an echo just before surgery, and the update on my pre-op values is:
LVEDd = 67-70 mm (severely dilated)
LVESd = 44 mm
LVEF 0.60

My post op day 7 values are
LVEDd = 57mm (upper normal)
LVESd = 46 mm
LVEF 0.48

I'll update these in 3-6 months, during which I expect improvement in my LVEF to normal and further reduction in the size of my LV.

I have mild to moderate aortic stenosis , BAV , trivial regurgitation

LVEF = 62
LVESD = 4.21
LVEDD = 6.42

This was from an echo 4 years back ....My cardiologist was not concerned , told me to follow up in 4 years ...going this december...and also getting a second opinion most probably ....my stenosis is mild-moderate and regurgitation is trivial...so confused why the LV is moderately dilated (64-68) moderate dilation , ( > 69 severe dilation)