A bit worried

[Adrienne]

On November 30 I had an echo after not having had one for two years. Whereas the mitral regurgitation was 1/4 (mild) two years ago, it is now 2/4 (moderate) now. I have an appointment with my cardio on December 21 and plan to ask a lot of questions. I also plan to make an appointment at the Valve Clinic of the Montreal Heart Institute where I will be able to see my surgeon and question him too.

On the second page of the echo, it says that the posterior leaflet is immobile. I know there was calcification on P1 even when the surgery was done, and that is why he did not do a resection but instead pulled down the valve with Goretex neochordae (two of mine where ruptured).

I am now worried that someday I will need another operation. I realize I am not talking about the near future, but still, it worries me.

Is there anyone else out there who had a mitral valve repair where it eventually started to regurgitate more and more?

 

[ShezaGirlie]

Adrienne ~~ Before you get too much more worried, how about having a TEE since they show MUCH more than an ECHO..!

All the best to you with loads of good wishes too.

 

[Eva]

Adrienne ~~ Before you get too much more worried, how about having a TEE since they show MUCH more than an ECHO..!

All the best to you with loads of good wishes too.

Hi Adrienne,

I agree with Janie...do not get worried before you get the facts, as worrying is nerve wrecking and the tension it causes is damaging. It is difficult not to worry, but what if the technician was wrong?!! Do you have sysmptoms you did not have two years ago??

Lots of prayers and keeps us posted.

 

[Nupur]

I hope it's nothing significant Adrienne. Hope you never need a re-op.

 

[Superbob]

Adrienne,

I would just chip in that from very recent experience I can say that echo results can be inexact, and technicians and even cardios can misinterpret the results. It's good that you will be getting follow-ups, including with your surgeon. You can get the echo on a disk, if you haven't already, have ask your surgeon to look at it. Meanwhile, I would advise relaxing and enjoying the season and not worrying a lot about it, assuming you are symptom-free.

 

[Adrienne]

You can get the echo on a disk, if you haven't already, have ask your surgeon to look at it. Meanwhile, I would advise relaxing and enjoying the season and not worrying a lot about it, assuming you are symptom-free.

Since my cardio is also from the Montreal Heart Institute, my surgeon is able to see the actual results (if he chooses to) without my getting it put on a disk. The echo was done at the Heart Institute where both my cardio and surgeon work.

I am symptom free, and will try to enjoy the season.

For those of you who think I should get a TEE, first of all I am sure they would not do it since it is something they do only when one is very close to surgery (remember, this is public medicine). Number 2, the TEE is the worst test I have ever endured!!! It is not the scope that bothers me, it's the totally abominable, yucky, disgusting stuff they use to anesthesize the esophogous!!

I do think I am going to try to convince the cardio that I want another echo in a year, NOT two years. I hope he listens (again, remember, this is public medicine).

 

[Bina]

When I lived in Quebec there was absolutely no problem in getting echos as often as necessary.
It may be best to have one done every 12- 18 mths.
Such a simple test that puts our minds at ease.

 

[njean]

I don't really have any answers for you Adrienne but I do want to let you know that I will keep you in my prayers & hope that you do not need another OHS in the near future!

Like others have suggested, try to see if you can get an Echo done every 12 months if possible. In my case, they are doing Echos every six months & I haven't had any issues with my insurance company, YET!

Take care & enjoy the Christmas holidays!

 

[Pegasus]

Adrienne I too hope it is nothing to worry about, especially since you are asymptomatic.

My husband gets yearly echos at the Royal Vic with immediate results from cardio there. Surgeon's office books his appt. automatic each year. Hopefully you will be able to get yearly echos as well!

Bestwishes

 

[dsouter]

For those of you who think I should get a TEE, first of all I am sure they would not do it since it is something they do only when one is very close to surgery (remember, this is public medicine). Number 2, the TEE is the worst test I have ever endured!!! It is not the scope that bothers me, it's the totally abominable, yucky, disgusting stuff they use to anesthesize the esophogous!!

I do think I am going to try to convince the cardio that I want another echo in a year, NOT two years. I hope he listens (again, remember, this is public medicine).

The single worst thing I remember about my first AVR was the TEE. Unfortunately they are much better than a normal echo or I would refuse this time.

I was 17 months between echos and that was way too long as I am substantially worse now.
They used to do Yearly but the dates creep longer and longer. I won't let them do that again.

 

[netmiff]

Adrienne, I get annual echos, no problem . . Hoping that yours is just a bad reading or a bad tech or whatever.

 

[Adrienne]

I had annual echos before my surgery (different cardio and different hospital). However, since in 2007 things seemed stable, this cardio said I only needed them every 2 years. I am going to say to him that since things are NOT totally stable this time, I would really appreciate an echo in a year.

 

[Lily]

I had annual echos before my surgery (different cardio and different hospital). However, since in 2007 things seemed stable, this cardio said I only needed them every 2 years. I am going to say to him that since things are NOT totally stable this time, I would really appreciate an echo in a year.

I think this is a good idea. BTW, are you on any medications that could contribute to any kind of a change like this? (I ask because my last hypertensive medication eventually began causing me a couple of bad problems so it was changed but I think it might have been controlling my heart in a beneficial way also.) Hoping you'll be okay.

 

[MaryC]

Adrienne,
I had my 2 year echo in June. After the echo I was standing behind the technician and I saw her completing all of the information. At the end of her report I saw her type 'mild to moderate'. I felt my heart sink...literally!!!! I waited to get a call from my cardiologist and instead his nurse called. She was going over my results and said casually that I had 'a little more leakage'. I asked her if it said mild to moderate and she said it did. We talked some more and she suggested I set up an appointment with my cardiologist if I was concerned.

I set up the appointment and proceeded to resign myself to another surgery. I had some sleepless nights until I finally saw my surgeon. He told me my echo results were good. My EFT was good and my heart size normal. He said there are a lot of people walking around with moderate leakage. He told me I am due for another echo in a year but if I was really worried we could do one in 6 months. He said he fully expected it to come back the same. After that I calmed down and realized I was not surgery bound in the next few months. When I went to see my GP he said the same thing when he looked at my echo results. He said my heart is stronger than a lot of people who don't have heart issues.

So I guess the moral of the story is the game is the same even after surgery. We live echo to echo.....in between trying to live a full life. I am picking up light jogging again in an effort to lose a few pounds. I must not be in too bad of shape, right?!

Good luck and try not to worry too much. Easier said than done, I know!

Chris

 

[Adrienne]

Lily, the only heart medication I am on is 25 mg of Metoprolol per day (half tablet two times a day) which keeps my heartrate at a normal rate.

MaryC, it's not that I am envisaging surgery in the next year or two or anything like that, but I see it as a real possibility in 15 or 20 years (and I'll be old and decrepid then)!!

There are other things from the echo that I want to question the cardio about too (I'm too lazy to type it all right now).

Oh, there is another thing I should mention. The technician was a young man who had only been at the hospital for three months, and the way I understood it, had only been doing echocardiograms for the three months he was at the hospital, so he could be very inexperienced.

 

[MaryC]

Oh, there is another thing I should mention. The technician was a young man who had only been at the hospital for three months, and the way I understood it, had only been doing echocardiograms for the three months he was at the hospital, so he could be very inexperienced.

This is something I am always told by cardiologists...the echo can change from year to year just because each technician does the measurements differently. In addition, your technician is pretty inexperienced so who knows.

Chris

 

[Adrienne]

Well, I had my appointment with the cardiologist this morning. After asking him a million questions, he tried to convince me that because of the way echos are done, it really doesn’t mean that much and might be very close to what it was before. However, when I said that I was afraid of one day in 10 to 20 years having to have another operation, he said (as if we were talking about having a haircut) “you probably will”. He said that about 30% of mitral valve repairs have to be redone! I always thought the rate was much lower. It’s true that I had calcification even when it was repaired, and that’s why the surgeon had to do a more complicated type of surgery, but I’ve been hoping it would last. Anyhow, the cardiologist said they are working on all kinds of ways to fix the valve without surgery (by a catheter). I’ve already heard of the Evalve or Mitraclip, but he said there are other things in the works too. I know they can replace the aortic valve through a catheter, and in fact, my cardio has done that procedure along with one of the surgeons on a woman who could not have withstood surgery, but I have read nothing about mitral valve replacement by catherazation. In any case, I am going to make an appointment at the Valve Clinic at the hospital where I can see my surgeon. I would like his opinion. In any case, I know there is no imminent danger, but I am a worry wort!!

In the meantime, I will be able to get my next echo next year instead of waiting two years. When I asked him if maybe I should add an ACE Inhibitor which dilates the blood vessels and helps the heart move the blood in the right direction with less work, he said it was not necessary. Well, I guess I will just wait until next year and see what is happening at that time.

 

[Bina]

Adrienne, see what your surgeon says, he is the one who was "in there".
Maybe you can have another echo done in the spring with a more experienced tech?
My surgeon in Montreal has also done a successful percutaneous AVR on an 85 year old woman.
Times are changing, we are all very lucky.

 

[lb151]

I have just recently learned about how different echo reports can be. I was so depressed watching mine get worse and worse after surgery. I was referred to a heart failure specialist and the first thing he did was a MUGA scan. Its 100% more accurate than an echo and showed my EF at 38% instead of 25%,,,now,,I will never have faith in a regular echo again. The MUGA ia something they are doing more and more at the larger teaching hospitals and all you have to do is ask for it. Its non invasive and takes the same amount of time.

 

[Pegasus]

Adrienne, think of it that way, according to your cardio 70% of repairs last! My husband's surgeon said it should last, no guarantees though. Focus on the 70 %! And often repaired valves can be re-repaired but let's not even go there! Wishing you worry-free holidays! Good luck!