What does it all mean? Test results

[Naomi]

Hi everyone! I need some help with my test results.

4/4/06 Echo
LVIDd: 5.40 cm
LVIDs: 3.20 cm
IVSd:0.70 cm
LVPWd: 0.70cm
LA: 3.10 cm
AO: 2.90 cm
Fractional Shortening 41%
Normal LV size and function
Moderate to Severe aortic insufficiency
Bicuspid Aortic valve
Everything else says normal

4/27/06 TEE
The aortic valve was bicuspid with fusion of the right and left coronary cusps. There was mild calcification with particular prominent calcification at the base of the raphe between the left and right coronary cusps. There was mild prolapse of the aortic valve cusp with an eccentrically-directed jet of aortic insufficiency, which was directed anteriorly toward the anterior leaflet of the mitral valve. The overall degree of AI appeared to be moderate to moderatly severe with AI jet high to LV outflow tract ratio of 40% to 50%. The valve opened normally and there was no evidence of stenosis.
All other comments said things were normal.

8/1/06 Cardiac MRI
I don't have the results yet but got a card in the mail yesterday that says "Cardiac MRI shows leakage across valve is not as bad as on the echo. Will discuss at time of follow up appointment."

So I guess what I'm looking for is
1) What do these results really mean?
2) What should I be asking my cardiologist at my next appointment? (8/24)
3) Why would the MRI show something different than the TEE and which should I believe?
4) At what point do I insist that this be fixed? What numbers do I watch, how bad do the symptoms have to get, etc?

Any help would be appreciated. Thanks!!

 

[Ross]

I'm no pro in reading these, but from what I do understand, surgery is down the road a ways yet. Looks like you'll be in the waiting room for a while longer.

 

[susieq14]

Hi Naomi,

Sorry but I can't help you with your results. I'm still learning about my valve problem which is different from yours. I have the same questions that you do every time I have another follow-up test and cardio appointment. I hope someone stops by to help you. I can definitley empathize with you about the waiting around part - it is very frustrating to say the least. How was your MRI experience? I just had my first cardiac MRI in May and did not like it at all. It was very small in the tube and I had to ask to come out before they even started. Hope it is not a regularly scheduled test.

I wish you well and hope your appointment next week goes well.

Take Care!
Susie

 

[Naomi]

Thanks Ross & Susie.

The MRI experience was fine. I just kept my eyes closed and tried not to think about how tight it was in there. I actually caught myself falling asleep (okay I was snoring) near the end so it wasn't too bad.

I guess I'm just frustrated by this whole thing. I've spent the last 4 months kind of up in the air with no real answers so I'm hoping that he finally actually tells me something on thursday. I'm just ready for a plan of action rather than just doing more tests. On a positive note, he told me to start excersizing last time I was there, just to see what would happen, and I've started to feel better! I had been getting out of breath halfway up a flight of stairs and sometimes just walking across the house. I was to the point that I thought surgery was probably needed so I'm glad to be feeling better and better everyday. I feel pretty stupid though if my problem was just being out of shape.

If anyone has any thoughts on the results I've posted so far, I'd still be interested in hearing them!! Otherwise I'll let you all know what I find out on Thursday.

 

[mntbiker]

Moderate to Severe aortic insufficiency
Bicuspid Aortic valve

I can't comment on the rest of the results but I can say from experience that the two above are more then enough reason for SOB especially going up stairs. The stairs were really my single largest complaint pre-surgery.

The weekends are slow so hang in a bit longer.

 

[MrP]

Naomi,
I'm no expert either but want to share a few thoughts with you. First, measured aortic insufficiency (regurgitation) is subjective and ranked on a scale of 1 to 5 with a 5 being severe. From experience I know that moderate/severe AI will make you short of breath, and exercise will get you in better shape and possibly mask the problem...you're able to tolerate AI more if you are in better shape. Walking helps a great deal, and especially over weeks and months on a consistent basis. This will also better prepare you for surgery down the road. Second, your left ventricle disytolic (LVID) is indeed within "normal" range but at the high end of the normal range. My understanding is the normal range is 3.7 - 5.6cm. Since you have insufficiency (regurgitation), your left ventricle compensates for this over time by increasing in size and wall thickness (hypertrophy). This is in accordance with Laplace's Law (physics). So while "normal" the left ventricle needs to be carefully monitored to ensure it does not enlarge too much and become severely damaged, as your left ventricle cannot be replaced like your bicuspid valve. Once your valve is replaced the LV will no longer continue to enlarge. Finally, the MRI trumps the echo but remember the degree of AI is still subjective. Also, ask your cardiologist about the measured size of your aortic root and ascending aorta...how does this size compare with the diameter of the rest of your aorta...arch and descending aorta? Symptoms from aortic insufficiency are usually palpitations and shortness of breath from the extremes of exersion. The heart has to work harder to overcome the regurgitation but there's a reduced flow of oxygenated blood nevertheless....you get tired more quickly. If you have aneursymal dilation of your ascending aorta, you may or may not start having symptoms such as chest pain....sometimes sharp.
Best,
MrP

 

[aussigal]

Hi Naomi,

I am of the opinion that its better to get fixed before your heart starts to compensate for your valve leakage...I believe this helps minimise further problems later in life...maybe this is something you could discuss with your Cardio.

Good luck with your appointment (and remember all your questions)...we will be expecting an update cos we like to know how everyone is going .

 

[Ross]

Thanks Ross & Susie.

I feel pretty stupid though if my problem was just being out of shape.

No way honey, there is a problem, but it's just not ready for surgery at this point, given those results. It's definately in the future. You can count on it, so plan accordingly.

 

[Naomi]

Thanks for the thoughts. I appreciate it! I'm getting my list of questions ready and I'll let you all know how it goes tomorrow!

 

[Naomi]

Well my appointment went well! He said the MRI showed the regurgitation at 2+ (moderate) with the regurgant fraction at 22%. The LV measurment was 5.6, he said that was the high end of normal but okay for now. The Aortic Root and Arch looked good at 2. something (I didn't write it down but I'll get the reports for my records). So he recommended another echo in 6 months! I asked him how soon surgery would be needed and he said "It would be ideal if we could wait 10 years. We'll just have to wait and see." I feel like he handed my life back to me!

 

[susieq14]

Good news Naomi!

I'm glad that it was not as bad as you were expecting; although I'm sorry you still don't have definitive answers for what lies ahead. That is where I'm at and frankly it is driving me crazy!!!! I don't like this lets wait and see attitude - I like to have more concrete answers if possible. I hate to even suggest this but would you consider getting a second opinion? I am toying with this myself. I was diagnosed exactly 2 years ago and when I am in his office I have total confidence with my cardiologist but then for the next 6 months as I wait and wonder and worry for my next echo & appointment it all disappears!

Take Care!
Susie