gradient

[mjd414]

Hi all,

I had my aortic valve replace 07/14/04 with a 23mm porcine valve. I was very fortunate to have virtually no problems from the time I was in the hospital until now. Due to a change in insurance, I started with a new cardio doc who took the typical first visit stuff and he reviewed the info from my prior cardio doc. At the end of that office visit I was a train wreck waiting to happen because the new doc seemed concerned about the gradient reading of 76 which was from my echo taken in 12/06. My EKG was fine and I have been asymptomatic since the operation. The new doc wants me to take another echo in June, which will be 6 months since my last one.

I called my old cardio doc in a panic and he told me to calm down because the gradient level, taken by itself means nothing. He said as long as I am feeling OK, which I am, not to focus on anything other than doing what I have been since the operation. He also said he never mentioned the 76 reading because he knows I am a type A person who would freak out for no reason.

Any thoughts on this story would be greatly appreciated.

 

[Ross]

Take his advice. There isn't anything you can do about it, so live your life to the fullest without worry. Hopefully the next echo will produce excellent results. I don't put a lot of stock in echos anyhow. They're only as good as the tech taking them and there are some pretty poor techs out there.

 

[mjd414]

Thanks for the quick reply. Since my last posting, I spoke with my original cardio doc and he told me not to worry about the reading because it means nothing as a stand alone fact. As long as I feel good, which I do, he said not to focus on the reading. I have an echo scheduled for 6/22 and we'll see what that shows.

Thanks again for your comment and advice!

MJD414

 

[tobagotwo]

I have to agree with Ross about this. As my cardiologist said, "Well, they're certainly not going to replace it right now." A salient thought. Enjoy the freedom for what it is. Remember, you weren't aware of it until you were told about it, so it doesn't seem to be actively affecting you.

I also have high gradients. Enough so that my valve company was alarmed and urged me to seek second opinions. In my case, it's not a valve-size mismatch or a valve brand or type issue, it's the force of my heartbeat. I would (and will) have this issue no matter what valve I use. I'm not showing any signs of enlargement or any symptoms, but the gradient is definitely there. Despite that, my valve is working perfectly, and my heart is essentially fine.

I have an aggressive heart. The force of the pump is greater than the normal range, and although that sounds great, that isn't really a good thing. Not a horribly bad thing, either, but not as good as it could be.

For me, I would guess it probably means I will have reduced valve life, as this is pretty demanding on the valve structure. Probably for you as well. How much? No one knows. I'm thinking it will cut 2-5 years off the expected valve life. I'm willing to be surprised, though, if it wants to go longer. Or it may bring heart enlargement, even before the valve begins to wear out.

There are drugs. Larger doses of Beta Blockers or Calcium Channel Blockers. But they would seriously impact my life, leave me without energy, tired all the time, disspirited. Almost like having the heart disease anyway.

As long as the heart seems unheeding of it, I'm not of a mind to sacrifice myself to it. Besides, we develop a tolerance to the good effects of these drugs. If I need them later, I don't want their effects to be all used up on me, and force me into taking amounts that have more side-effect potential than ameliorative capability.

Relax. Enjoy where you are, the fact that you're alive, and that everything's working fine for the now. Remember: when you didn't know, it didn't matter.

Be well,

 

[mjd414]

gradient

Bob H

I can't tell you how much I appreciated your reply to my thread. I was driving myself crazy and I even faxed the new cardio doc a list of follow up questions because I have not been able to work or sleep since that May 8th office visit. I would not have sent the fax to the doctor had I read your fax first. You are so right........I was fine before the visit and nothing has changed so I am going to move forward and not worry myself to death.

Thanks again for taking the time to write a reply. I remember when I was getting ready for the operation in 1004, I was on this web site every day and night soaking up information and it helped me so much in the hospital and then at home.

You take good care and thanks again for the great advice!

 

[Arlyss]

A Consistent Gradient Versus An Increase in Gradient

A Consistent Gradient Versus An Increase in Gradient

Perhaps it would help to mention that increases in gradient over time are something to investigate further.

Here is a paper published in March 2006 that is excellent regarding this subject.

http://bicuspidfoundation.com/Evaluation_of_Prosthetic_Heart_Valves_Van_den_Brink.pdf

In the section about aortic prostheses, it mentions that the same type and size valve will have different gradients in different people and suggests a baseline be done after surgery. This is a great idea, so that there is knowledge of what the pressure gradient is when the valve is new and presumably working without problems.

It goes on to say that an increase in the mean gradient (above the baseline in that person) of 20 mm Hg pressure should be investigated.

I suggest that everyone keep track of the mean gradient for their prosthesis with every echo they have. Get copies of all reports and note the mean gradient given for the valve. If there is an increase as mentioned above, it should be checked further.

My husband's mechanical had an increase in the gradient across his mechanical aortic valve over time, without him experiencing any symptoms. The pressure dropped after his stroke - some of the valvular strands (whose presence was unknown then) impeding blood flow broke off and went to his brain.

I cannot go back and undo what happened to my husband, but I hope this will help someone else. I hope it might save their brain.

Best wishes,
Arlyss

 

[Arlyss]

Peak versus Mean Gradient

Peak versus Mean Gradient

I should also mention that echo reports show two different gradients. The peak and the mean. It is the mean gradient that I have been told is significant.

Best wishes,
Arlyss