Z score? +4-- Is it important?

[delvalle6]

Getting info out of my doctor's office is akin to pulling teeth. My son has a "z score" of plus four. I am not sure what that means. I read an article that said that the ross procedure was to be done when the "z score" reaches 3...but it was an article regarding older youths and adults. The cardiologist has now said that his stenosis is "moderate" yet they discuss surgery. The say the insufficiency is "moderate". They are concerned about the ventricular enlargement. I was told that his ventricle was 44.5mm. <<sigh>> It's the not knowing and the waiting that drive us insane isn't it.

 

[geebee]

I am not sure about the Z score but I had my first OHS with mitral valve issues described in the reports as moderate. Turns out the surgery should have been done even earlier. "Moderate" is still well along in the range of things so I would think surgery is in your son's near future.

 

[Ross]

If the z score I think of when mentioned is it, 4+ is severe regurgitation, 3+ is moderate, 2+ is mild and 1+ is trace.

I'm in the boat of those that waited too long and I know have a permanently enlarged left ventricle and slightly dysfunctional also, so you do not want to wait!

 

[tobagotwo]

He also has a double-whammy of stenosis and regurgitation. One makes it harder for the blood to get through, the other loses the fruit of the heart's harder work. When these two things are working with each other against the heart, the overall result is not moderate.

Earlier is better than later. Avoiding damage now saves trying to deal with it permanently. I know surgery's a risk, too. But it's not like he has a choice to avoid surgery altogether, regardless.

Best wishes,

 

[delvalle6]

Wow. I am definatley getting a second opinion. I had asked the dardiologists office to give me the results of Sammy's echo... they said he had a peak velocity of 3.3, a Ca. mean greadient of 26, the ventricular size was 44.7mm and the z score was +4. So... even though I am well versed in medical terminology... this is all greek to me. And after this the RN who gave me those stats said that the surgery wasn't imminent and it was "no big deal". If I could have reached through the phone....
So I pull up this site
www.ingentaconnect.com/content/gmed/2003/00000013/00000003/art00006
In its conclusion it states "The increase in the ratio of left ventricular end-diastolic radius to the thickness of the posterior wall in diastole would suggest that there is disruption of left ventricular short axis architecture and myocardial contractile function when intervention is postponed....Our data would suggest that recovery of left ventricluar function is less likely when the left ventricular z-score has reached the value of 4, and that, ideally, intervention should be performed whent the z-score approaches or exceeds 3.
So..I feel better after talking to you guys about getting a second opinion. I would love to wait and never have him get the surgery..but I also don't want him to have permanent ventricular damage. It sounds like six of one, half dozen of the other to me.

 

[delvalle6]

Sorry, that link didn't take you all the way to the article... this one does.

http://www.ingentaconnect.com/searc...8&year_to=2005&database=1&pageSize=20&index=1

 

[mbfleth]

How old is your son and how is he feeling?

 

[delvalle6]

My son is four years old. He tires easier than his twin, and he tends to get more lethargic when he is ill than his brother, but everyone is different, so it is hard to tell if what he is feeling is normal or not. He doesn't complain of chest pain, but he isn't one to complain. I used to call him my "asymptomatic baby" because he wouldn't show my any signs of his illness until it was time to hospitalize him. Giovanni (his twin) will have a fever and be ill for a few days, on the last day he will get worse, but Sammy will practically stop breathing and have to be hospitalized. Sometimes I think our children are supposed to see if they can find the limits or our sanity.

 

[Andrew'sMom]

i had the same questions about the z score thing a few months ago and i found a thread on the ccf heart forum that semi-explained it. i will try and find that link for you, but my understanding of it is that the z score represents the number of standard deviations above the normal expected value expected for your son based on his age/weight/body surface area claculations. that may or may not be correct ... that is how i understood it. there is very little info out there if you google "Z score" and i am not sure how it all relates to insufficiency and mild/moderate/severe categorizations, other than the high the Z score, the greater the problem. I am going to go look for that link. i will post it when i find it. good luck!