would this bother you at all?

[chrisc]

An experience which bothered me a bit and I don’t know if I am overreacting or if it is warranted.

Had echo in 2011 showed a normal aortic root. Questioned the Cardiologist because the echo reminded me that years earlier someone mentioned the root was enlarged. Cardiologist dismissed my inquiry despite asking several times. Just told me ‘well it’s normal now,’ In 2012 had a another echo which showed enlarged root (what I expected though).

Went to another Cardiologist (same practice)and had him read the echo images from 2011 and it showed the enlarged root (same reading I expected). He was unsure where the normal reading came from in 2011.

Do Cardiologists usually read the echo’s or just go with what the tech states?

I have also requested copies of all my images now. Do you keep them for your personal records or not?

 

[Rachel]

Yes, if that happened to me, I'd be bothered by it.

During my first trip to a cardiologist, he told me that my echo showed a 5.2cm ascending aortic aneurysm, but then later he said it was a typo saying to me: "Don't worry about it, you won't have surgery on this for at least another 20 years from now." But he wouldn't or couldn't tell me why it was a typo and what exactly the measurment was.

I was pretty upset so I went to someone else who did a CT scan and MRI and got a reading of about 5.0cm. I had surgery 3 months later and the thing was in fact 5.2cm.

Did your cardiologists tell you the size of your enlargement? I would find out exactly what those numbers are and always get copies of everything.

Rachel

 

[chrisc]

Did your cardiologists tell you the size of your enlargement? I would find out exactly what those numbers are and always get copies of everything.

Rachel

4.2 via echo (2004, 2011 and 2012). 4.3 via CT w/o contrast in 2012. appears to be stable at this point...

 

[dick0236]

Do Cardiologists usually read the echo’s or just go with what the tech states?

I have also requested copies of all my images now. Do you keep them for your personal records or not?

My cardio reviews the echo images along with the tech. I always request a copy of the cardios report that he sends to my PCP, but I have never asked for the images. I am sure this is troubling to you, but cardios interpret what they see...or think they see, at a particular point in time. I checked my recent echos:
9/22/10 - aortic root 4 (enlarged)
9/28/11 - aortic root 3.7 (hi-normal)

I guess it is possible to have a reading that goes down from year to year as these tests could have variances due to tech technic or other "outside" influences. I have to trust my cardio that he knows what is going on with me. If not I have to find a new cardio. I have had this happen a couple times in recent years with young cardios. I now have one older than me and am comfortable with his judgement.....'cause he still "doctors" based on medical experience and not necessarily what a machine shows.

 

[Bill B]

In most group practices, the reading of the echos is rotated among the cardiologists in the practice. So, you can get different interpretations depending on who does the reading. Techs should not never read and report findings to patients. They are only trained to perform the testing and record the numbers. In fact, the tech should never make any comment to you of their opinion about your echo. They can tell you what they are measuring but should never say anything about the results.

 

[chrisc]

In most group practices, the reading of the echos is rotated among the cardiologists in the practice. So, you can get different interpretations depending on who does the reading. Techs should not never read and report findings to patients. They are only trained to perform the testing and record the numbers. In fact, the tech should never make any comment to you of their opinion about your echo. They can tell you what they are measuring but should never say anything about the results.

to clarify, the tech didn't give any info. curious how i got a 'normal' reading and then another doctor brought up the same images from that report, took a measurement and got a different reading. we are talking 3.7 vs 4.2...

 

[VegasBAV]

I get a lot of very inconsistent and nonsensical echo results from year to year. If you believe them, then my right ventricle went from 1.2 cm to 2.2 the next year to 1.9 and now 1.7. My left ventricle (diastolic) has gone from 5.2 to 4.6 to 5.0 to 4.7 to 5.5. Aortic root? 3.1 then 3.8 then 3.1 now 2.7. And so on.

 

[BionicBuddy]

I get a lot of very inconsistent and nonsensical echo results from year to year. If you believe them, then my right ventricle went from 1.2 cm to 2.2 the next year to 1.9 and now 1.7. My left ventricle (diastolic) has gone from 5.2 to 4.6 to 5.0 to 4.7 to 5.5. Aortic root? 3.1 then 3.8 then 3.1 now 2.7. And so on.

Jeez. I wonder if that type of discrepancy ever happens regarding mitral and aortic regurgitation? Have you had those kind of discrepancies with your atrial sizes? AVA measurements? pressure gradient measurements? Are you having the echos done on the same machine by the same people, or on different machines?

I ask because my husband might be in a similar situation.

 

[pgammo]

This is extremely alarming. I have my AVR on Friday and I may, too, be in a similar situation.

 

[BionicBuddy]

This is extremely alarming. I have my AVR on Friday and I may, too, be in a similar situation.

Hi, pgammo. Just remember that people who are chatting on this forum are not cardiologists nor are they cardiac surgeons. They are people like you and I who are trying to make sense of things and numbers and everything else. If an AVR was recommended for you, then someone must have had some darn good reason to do so. It probably wouldn't be a bad idea to ask those who are managing your health, more questions for reassurance.

 

[Jkm7]

A second opinion is often very helpful.
Maybe it might be a good idea to consult a surgeon for his/her opinion.

 

[ElectLive]

Well, I understand the frustration and concern, have been there myself, and certainly can't explain away some of the anomalies mentioned, but a few things to remember:

An echo is inherently imperfect. The technology is imperfect. The technician is imperfect. The patient's body is imperfect. Even worse, everything becomes even more imperfect after valve replacement. Now, after an echo is done, the review and follow-up can be imperfect too, although that is not inherent, that in a perfect world would/should be fixed. That's where the real problem is.

Now, that's the bad news, is there good news? Well, I'd sure like to think/hope so. Our cardiologists and surgeons are highly trained in doing far more important things than reading an echo report. So, while they may not fully absorb an echo report or question it when they should (and it does happen all the time) they do at least (well, the majority of the time anyway) utilize all the other diagnostic methods and tools at their disposal to make sound decisions when they need to be made. If they don't, time for a second opinion.

For reference, here is what the Valve Disease Guidelines have to say about the accuracy and importance (or lack thereof - both cases) of an echo:

"Lastly, although handheld echocardiography can be used for screening purposes, it is important to note that its accuracy is highly dependent on the experience of the user. The precise role of handheld echocardiography for the assessment of patients with valvular heart disease has not been elucidated. As valuable as echocardiography may be, the basic cardiovascular physical examination is still the most appropriate method of screening for cardiac disease and will establish many clinical diagnoses. Echocardiography should not replace the cardiovascular examination but can be useful in determining the cause and severity of valvular lesions, particularly in older and/or symptomatic patients."

"Depending on the specific clinical circumstances, transesophageal echocardiography (TEE), cardiac magnetic resonance, or cardiac catheterization may be indicated for better characterization of the valvular lesion."

"It is important to note that Doppler ultrasound devices are very sensitive and may detect trace or mild valvular regurgitation through structurally normal tricuspid and pulmonic valves in a large percentage of young, healthy subjects and through normal left-sided valves (particularly the mitral valve [MV]) in a variable but lower percentage of patients."​

Ok, Chris, back to your initial post, yes it is frustrating, and unfortunately, it happens a lot, but this is what I try to do: expect the unexpected with each new echo, always request and keep a copy, educate yourself enough to understand the basics and hopefully recognize suspicious findings, then ask your cardiologist any and all questions you might have, which of course will ensure that it is actually being reviewed.

 

[BionicBuddy]

ElectLive, please don't ever stop posting. That was a brilliant response. You have no idea how valuable your posts are to people who are reading this forum that are looking for clear, rationale and intelligent information and opinions, on which to take further action regarding their own decision-making processes. If you're not in the medical profession, then you're the most well-researched and informed lay-person on this forum (IMHO).

Thank you. Thank you. Thank you.

 

[chrisc]

ElectLive, I must echo BB as you post some very detailed and comprehensive information which I (and likely all here) found invaluable. You are one of the contributors to this forum where I have found myself searching for your posts regardless of exact relevance to my situation. While all I can say is thank you, it is sincere.

I must say, I am less concerned with the readings that vary echo to echo, and more concerned that a second cardiologist read THE SAME echo and measured 4.2 opposed to 3.7, which leads me to believe the first cardiologist never even looked at the echo from 2011. The tech may have incorrectly measured 3.7 and that was that. Interestingly enough, the second cardiologist stated that if used correctly, an echo can be very accurate and informative. He sat with me for a while and showed me all the images; while I forgot the actual term he describe the area where the root transitions to the ascending aorta. My root, while dilated still shows a clear taper into the ascending aorta. According to this cardiologist as the severity of the aneurysm increases, the clear transition from root to AA becomes blurred (that narrowed tapered area balloons also). He says he monitors that transition point in addition to the overall measurement. For me, since the AA, arch and DA were all upper normal and normal his recommendation was yearly echo opposed to CT and MRI/A. His justification was that with the echo and a proper tech the freeze framing is very good. The CT and MRI/A will still blur a bit due to the fact you are imaging a moving target as the heart and aorta move…

Thoughts?

Thanks again for all your efforts on this site!

 

[Madsometimes]

My root measurements often varied fom year to year. My cardiologist told me that in my case there were two main reasons. The first is that there is a plus or minus variation of 0.2 cm, so a reading of 4 cm could actually be between 3.8-4.2 cm. In my case, my aortic root was slightly oval in shape because of my BAV, so the techs needed to be careful to measure in the same place from year to year. This didn't always happen, so my numbers jumped about a bit.

 

[ElectLive]

Bicuspid Buddy - Wow, with such a warm reception, I couldn't possibly leave now.. :redface2: Thanks so much for your kind words, that is really great to hear. I used to post more, actually, but in the absence of time nowadays, I have to pick my spots. But I am just trying to do what so many others have done around here...pay it forward. I'm not in the medical profession, though, nor did I stay at a Holiday Inn Express last night. :biggrin2: Truth be told, when I was told I needed surgery, I knew next to nothing about any of these things discussed here daily. But I have endless curiosity and am a voracious reader and that combined with some inspiration and good guidance (VR.org and my surgeon) makes research and self-education pretty easy.

My surgeon, whose father is a legend in cardiovascular physiology and wrote in entirety one of the most important medical textbooks around, amazingly welcomed and encouraged questioning and second-guessing, and even gave me a recommended reading list of sorts for his own diagnosis. So, everything sort of evolved from there. I still knew very little when I joined here, but just checking in regularly is another easy way to learn more. I've been equally thankful and inspired by the diverse knowledge shared by others (tobagotwo, Lynlw, Bill B come to mind among many others) during my time here and one of the great things is that everyone always brings their own area of expertise.

While on the topic, for anyone interested, nearly every medical condition and available procedure in our lives has some form of Consensus Guidelines that are readily available for review, and they truly represent the expert opinions in the field. Add to that the fact that most clinical publications point out their own limitations and cite available related sources of information, then there is a goldmine of learning available for those with the curiosity and willingness to read more. Of course, there are dangers too...it is very easy to think you know more than you really do, to lose sight of the "forest", so to speak, after reading all these "trees". So you do have to be careful.

But anyway, thanks again, and I bet you will continue to find equally valuable information from many others the more time you spend here.


Chris - Thanks so much to you as well, it does mean a lot. Yes, my first post didn't really address that specific issue. Reading your description, I would certainly be more inclined to trust the second cardiologist, as you seem to be already doing. You are exactly right that the first cardiologist may never have looked at the 2011 echo, although as Bill B pointed out, it should have been reviewed by at least one cardiologist in the practice. Probably the term you're trying to remember, where the root transitions to the ascending aorta, is the sinotubular junction.

I've seen a Cleveland Clinic webchat on aorta disease that discussed monitoring methods, as well as read the Guidelines, and they are generally in agreement. Echo monitoring of the root, particularly at your size, sounds perfectly reasonable. For reference, with echo, there can be less consistency and accuracy of monitoring at the ascending aorta, so CT may often be recommended there earlier, but not always. The Guidelines do specifically say that an echo accurately visualizes the root and given how less invasive it is to other alternatives, is the usual practice for those with aorta disease only at the root. Now, if the root approaches the surgical threshold, though, CT or MRI are used to provide the more detailed information for surgery. Finally, not for you, but just a FYI, CT or MRI are pretty much required at any point for diagnosis and monitoring of aorta disease at the descending aorta.

 

[ElectLive]

...the techs needed to be careful to measure in the same place from year to year. This didn't always happen, so my numbers jumped about a bit.

Yes, probably one of the leading reasons why measurements differ, not in the exact same place. Another big one: not properly perpendicular to flow.