4 weeks post-op

[leecrowley]

Hello everyone,

I'm a little over 4 weeks post-op from my Ross Procedure, and everything is going very well. I feel great most of the time. I went back to work today for half-days for a little while. My only complaint is sternum problems, and even that seems to be turning into tightness instead of soreness. It does seem like the inner edges of my collar bones rub together sometimes, so I still pop and lightly crackle when I move my arms all around. I'm hoping this will go away soon.

For all of you ECHO experts, I got my post-op baseline ECHO last week and have a few questions on the results. Of course, I can't find my last ECHO from before the surgery , so I can't provide accurate numbers to compare. I know what some of these mean, but some of this stuff I've never seen before. Any advice on what some of this might mean would be wonderful.


Measurements-

Ejection Fraction- 50% (This was 40% before the surgery)
Left Ventricular Dimensions End Diastole- 4.85cm (was 5.4cm before surgery)
Aorta- 3.78cm (was 3.90cm before)
Septal Wall- 1.6cm
Posterior Wall- 1.45cm
Left Atrium- 3.55cm

Hemodynamics-

Mean gradient across aortic valve- 3.9 mm Hg (are these good???)
Peak instant gradient across aortic valve- 6.8 mm Hg

Findings and Conclusions-

Moderate LV hypertrophy
Interventricular septum appears severely hypokinetic (huh??????)
Mitral Inflow E/A wave ratio is 1.65
Velocity across aortic valve- 1.30 m/s
Peak velocity across Pulmonic valve- 0.90 m/s
Peak velocity in Pulmonary Artery- 1.44 m/s
There is a greater than 50% collapse of IVC w/inspiration consistent with
normal RA pressures (huh?????)


My surgeon told me the walls of my left ventricle were enlarged, so I know those wall sizes are way above "normal". Does anything else look strange?

Thank you to anyone that can help me interpret these.

Lee

 

[StretchL]

Welcome back, Lee. Glad you're feeling better! That snap crackle and pop of the sternum may indicate that the surgeon left his bowl of Rice Krispies in there. Your surgery didn't happen to take place early in the morning, did it?

Idaknow much about echos, but, FWIW, here's what I do know, based on what I've read and the "Normal Values" indicated on a TTE of mine: I'll put my comments in CAPS for clarity's sake.
Measurements-

Ejection Fraction- 50% (This was 40% before the surgery)
( THIS IS THE AMOUNT OF BLOOK DISCHARGED FROM THE LEFT VENTRICLE WITH EACH HEART BEAT. I'VE READ NORMAL RANGE IS 55-75%.)

Left Ventricular Dimensions End Diastole- 4.85cm (was 5.4cm before surgery)
(MY ECHO REPORT SAYS NORMAL IS 3.5CM - 5.5CM)

Aorta- 3.78cm (was 3.90cm before)
(AGAIN, MY REPORT SAYS NORMAL IS 2.0CM - 3.7CM)

Septal Wall- 1.6cm
(THIS IS REFERRED TO AS THE IVSd, OR 'INTERVENTRICULAR SEPTAL WALL DIMENSION, AND .7CM - 1.2CM IS SAID TO BE NORMAL. I WONDER IF THIS ENLARGEMENT COULD BE DUE TO YOUR YEARS OF STENOSIS AND YOUR HEART THEREFOR WORKING TOO HARD?)

Posterior Wall- 1.45cm
(THIS IS REFERRED TO AS THE LVPWd, OR 'LEFT VENTRICLE POSTERIOR WALL DIMENSION.' MY ECHO SAYS NORMAL IS .7CM - 1.1CM. ALSO WONDER ABOUT THE YEARS OF STENOSIS BEING THE CAUSE.)

Left Atrium- 3.55cm
(MY REPORT SAYS NORMAL IS 1.9CM - 3.8CM)

Hemodynamics-

Mean gradient across aortic valve- 3.9 mm Hg (are these good???)
Peak instant gradient across aortic valve- 6.8 mm Hg
(AS YOU PROBABLY KNOW, THE PRESSURE GRADIENT ACROSS THE AORTIC VALVE IS CAUSED BY A STENOTIC VALVE. THE INABILITY OF THE VALVE TO OPEN COMPLETELY CAUSES THE PRESSURE IN THE VENTRICLE TO BE GREATER THAN THAT IN THE AORTA DURING SYSTOLE. THE WORSE THE STENOSIS, THE HIGHER THE GRADIENT. I HAVE MODERATE TO SEVERE AORTIC STENOSIS. MY PRESSURE GRADIENT IS 41MM HG. IT SOUNDS TO ME LIKE YOURS IS MINIMAL. MAYBE YOU'RE CURED!!??)

Findings and Conclusions-

Moderate LV hypertrophy
Interventricular septum appears severely hypokinetic (huh??????)
(HYOPKINETIC MEANS THAT IT MOVES SLOWLY... I HAVE NO IDEA WHAT THE REASON OR CONSEQUENCE OF THIS MIGHT BE...)

Velocity across aortic valve- 1.30 m/s
(THIS IS ALSO GOOD. THE SMALLER THE OPENING OF THE VALVE, THE HIGHER THE VELOCITY ACROSS THE VALVE. (THINK OF PUTTING YOUR THUMB OVER THE END OF A GARDEN HOSE, THUS REDUCING THE OPENING DIMENSION, AND INCREASING THE OUTPUT PRESSURE. MODERATE AORTIC STENOSIS CAUSES A CROSS VALVE VELOCITY OF 3.0-4.0 M/S.)

I HAVE NO IDEA OR COULD FIND NOTHING ABOUT THE REST OF WHAT YOU MENTIONED...

Hope this helped... I'd be curious to learn what your pre-op numbers were...

Congratulations on your good health!

 

[hensylee]

Hey, Lee. Glad to see you doing well. I think the way they push our arms back are going to definitely leave some stiffness and soreness in the shoulder area. It should work out by itself, but you know what to do if it doesn't.

Keep on getting better and better. Blessins.....