Can anyone explain what my numbers mean?

[67walkon]

This is similar to Katie's post. I put these numbers in a different area, and maybe this one is more appropriate.

I was diagnosed with a bicuspid aortic valve maybe 4 or 5 years ago. I'm 57 now. From 2005 to 2007, the degree of stenosis went from mild to moderate. Today, I got the results from my latest echo, but other than the cardiologist telling me the stenosis is moderate and there are no restrictions on my activities, I can't interpret the report.

"aoritc root is mildly dilated up to sinotubular junction".
"estimated LVEF: 60-65%"
"Aortic stenois, moderate-the peak gradient across the AV is 50 mmHg witha mean gradient of 30 mmHg-The calculated aoritc valve area by continuity equation is 1.0 cm square."
"There is no significant gradient across the LVOT."
"Mild pumonary systolic hypertension with estimated PSBP-37 mmHg, assuming RASBP of 10 mmHg."

What does all this stuff mean? I gather from reading up on it here and elsewhere that my aortic stenosis is pretty well progressed toward needing valve replacement, but I don't yet have any symptoms. I am very, very active and have no problem with hard, prolonged aerobic work like riding a bike 50+ miles or playing basketball.

Thanks.

John

 

[catwoman]

John:

I'm sure someone will come along who can translate the numbers into "laymanese."

Have you looked at the References forum here? There's a link to an article about echoes.

Have you asked your cardio for a consult with a surgeon? Some people think surgeons are overly knife-happy, but they sure don't want to operate needlessly. A surgeon wants to get in BEFORE the heart is damaged.

Some people do not exhibit symptoms of heart valve problems.
My husband says he isn't having any symptoms, but the heart cath done last Thursday indicated his left atrium is becoming enlarged. We have appointments on 3/26 & 4/16 with surgeons, to get him into surgery while a mitral valve repair is still very feasible.
With BAV, you're probably not looking at repair. But you sure don't want to wait until you have symptoms.

 

[ALCapshaw2]

Based on your effective valve area (1.0 sq cm) and gradients, you are definitely headed towards Valve Replacement Surgery and it is NOT too early to start interviewing Surgeons. Let the surgeon make the call as to WHEN to proceed.

My Cardiologist uses 0.8 sq cm as his 'trigger' for recommending surgery. I don't know the exact numbers for gradients for recommending surgery, but your numbers are Significant and should certainly be monitored.

Note that MANY people with BAD valves say they experience NO symptoms so that is not a good measure. Valve disease is a Plumbing Problem. Let the Number be your Guide.

Also note that Aortic Stenosis can progress RAPIDLY. One of the favorite sayings on VR.com is "The Worse it gets, the FASTER it gets Worse". Most surgeons prefer to operate BEFORE you heart enlarges to the point of Permanent Damage so for Aortic Stenosis, "Sooner is Better" when it comes to Valve Replacement Surgery.

FWIW, it took 2 months for me to meet my surgeon and schedule surgery. I believe I got there "just in time" since the surgeon put in a 'Balloon Pump' the night I arrived to 'help my heart' before surgery. I do NOT recommend waiting for symptoms to worsen!

Also note that First Time Surgeries for patients under age 60 are HIGHLY Successful with only a 1% risk of stroke and 1% risk of mortality vs. 100% risk of Death if you do Nothing!

'AL Capshaw'

 

[Susan BAV]

I think your numbers would indicate you probably need to have another test, one with greater accuracy and more specifics. Those echo numbers are not engraved in stone, though they can keep a pretty good track of decline, when compared with previous test results.

 

[tobagotwo]

Some thoughts about your numbers and diagnostic snippets. I'm not a medical professional, so think of it as kind of a tea leaf reading...

Mildly dilated aortic root: this isn't a bad thing, especially considering the recent information we've had on life expectancies with mildly dilated aortas. Basically, it seems to often have a link with a genetic makeup that's less prone to coronary artery disease. When you have your AVR, ask the surgeon if he is considering stabilizing it, to avoid post-surgical expansion that sometimes occurs, and can misalign a carbon valve so that it rubs or even cause leakage in a tissue valve through distortion of its shape.

LVEF is longhand for Ejection Fraction, which is fine in your case. 60%-65%of the blood that is in your left ventricle is pumped out in a typical beat of your heart. Normal range is about 45% to 65%, except for extreme atheletes.

The pressure of the blood passing through your aortic valve opening is on the high side of moderate. Peak pressure means the pressure of the blood as it goes through your aortic valve when the squeeze of the LV begins and forces the valve open. Mean pressure is the average pressure of the bloodflow through the aortic valve opening throughout the course of one heartbeat.

One cm is the bottom of moderate for valve opening size. You're fair game for surgery at .9 or below, especially if you're showing left ventricular hypertrophy (muscle enlargement of the ventricle due to stress from the stenosis or regurgitation) or any kind of symptoms.

This is not a good time to be stingy about what constitutes a symptom. It's not a good thing to let the process go too long, so be generous with yourself and your doctor about symptoms like shortness of breath (SOB), angina - which can feel like many things, including just an occasional, slight tightness at the top of your throat, or for women, jaw pain - general fatigue, or heart palpitations, especially noticeable at night.

The Left Ventricular Outflow Tract is the path that blood takes to the aortic valve from the left ventricle. When the septum, which is a muscle wall inside the heart that separates the right and left ventricles enlarges in concert with the left ventricle, its growth narrows that outflow tract. That creates pressure across (within) the LVOT. You don't have significant pressure there, and that is good in terms of indicating that you don't have advanced hypertrophy, and that your ventricle still probably has good flexibility.

Mild Pulmonary Hypertension: a couple of things here. PH is a higher-than-normal pressure between the right ventricle and the left atrium, meaning all of the blood vessels that flow to and through the lungs. Standard echoes are notoriously poor at gauging PH, so the measurement is automatically questionable. Many people with aortic stenosis do develop secondary PH, and it usually goes away after the valve is corrected or replaced. Again, going too long before surgery can make this a lifetime companion, with the PH becoming primary PH, which is manageable, but not currently curable.

I would look to see if there is some atrial enlargement associated with the PH. Check the sizes over the last few echoes. Atrial enlargement often doesn't go away after surgery as completely as ventricular hypertrophy. You should also check your left ventricle sizes while you're looking at the echoes, as a progression over several years of echo tests.

In general, exercise is beneficial to PH. However, intense exercise at this point will likely speed up ventricular hypertrophy. You should not be doing any heavy weight lifting. With a 1.0cm AO, it's sensible to consider that you shouldn't be lifting anything that makes you grunt. Be careful to breathe through anything moderately heavy that you do lift. This is especially important if you do have secondary PH. Consider the difference in the size of the valve your heart has to force blood through with every pump. From three or four centimeters squared, down to one.

You're probably not ready for surgery for a while yet, but I would expect within a year you'll be a much more likely candidate. The progression accelerates. My own simplification of the stenotic valve cycle is: the worse it gets, the faster it gets worse.

Best wishes,

 

[67walkon]

Thanks, all.

Bob, I am still totally asymptomatic. This morning, I rode my bike a bit over 25 miles before work. I was battling a 20+ mph wind, which was mostly a cross wind, and averaged about 15.5 mph. My average heart rate was 107 and my highest rate was 135; both are pretty good for a 57 year old male with no heart problems.

I wasn't told to watch the weight lifting, but I am going to. Nothing more than 1/2 my body weight, from what I have read.

My guess is that over the next year, maybe a bit less, maybe a bit more, I will see some problems when I exercise. My biggest concern right now is that I will experience sudden symptoms and be rushed to surgery without having a chance to line up the best surgeon.

But the beat goes on! This site is great!

John

 

[tobagotwo]

With your activity level, I'm not surprised that you are asymptomatic. The reason that it's important to have symptoms (or a really good cardiac diagnostician) is that many cardiologists will sludge along and not take action as long as you don't present with symptoms. Some seem to think you must be all right if you're not showing symptoms. They're mentioned in the literature.

The problem is that the very physically fit (you and Soilman, for examples) can go the whole distance without recognizing symptoms. I have read of a number of cases of bike racers (sound familiar?) who have been brought to the hospital after suddenly and entirely unexpectedly fainitng at a meet. They are examined and found to have extremely severe stenosis, and are shocked to find themselves whisked away to open heart surgery, sometimes directly from the emergency room, with the surgeon later telling them how very close to death they were.

When it starts to get close, go by the numbers. Don't go by how you feel. Your body's muscles have been trained to reduce their oxygen requirements dramatically. Perfect for riding, running, or training. But they won't give a peep of pain as your heart finally becomes unable to send enough oxygenated blood to keep your brain awake. The muscles are so trained that the brain becomes the weakest link, which is why the cyclists go halfway through the race and then simply faint in midstride.

Watch your numbers: aortic opening, LV size, atrium size, aortic pressure gradient. Be aware of any palpitations, and any shortness of breath or minor tightness in your throat, chest, shoulder, or back. To train, you've taught yourself to ignore pain. Now you'll need to learn to listen again. For a while, anyway.

Be well, John,

 

[67walkon]

Thanks, Bob. Apparently like a lot of others here, I worry too much sometimes and not enough other times. I do monitor my heart rate when riding, so I would think I would see some gradual increases in my exercise heart rate as the condition worsens, but I don't know.

One of my real concerns, other than just dropping dead from this, is that I'll have some severe symptom, get rushed to the ER and have whoever is on duty perform emergency surgery. I would prefer to be involved with choosing the surgeon and I would definitely want to have some say so in what kind of valve, etc., was used.

I'll keep trying to learn more. Thanks.

John

 

[perkicar]

Welcome!

Welcome!

John, you're definitely ahead of the curve and we're glad to have you join us! This is a great forum--so helpful in understanding all that med-talk that we see in reports. Even as a nurse I don't always comprehend what I read, although now that I've been through surgery I feel like I have a pretty good working understanding of valve "stuff".
I was told I needed to start thinking seriously about valve replacement after a TEE (transesophogeal echocardiogram) showed my valve area as 0.8 cm2 and my gradient at the cut off for "really high". I'm thinking it was 80? I went to Cleveland Clinic for my work up, didn't plan on having surgery there but felt very comfortable with the level of care I received and how they taught their patients. At the time of surgery I was down to 0.6 cm2 and was having symptoms--shortness of breath on exertion, and tightening in my chest on exertion. I'm SO glad I had it done.
BTW, I assisted the docs on a TEE at the bedside for one of my patients earlier this week. One of the most interesting views was a looking down view of the aortic valve--you could see all the leaflets and it's movement. Way cool!