AS vs Regurgitation vs insuffiency?

[starkone]

Hi All,
As long as I have had the AS problem, I still do not understand
what is the difference between AS, regurg, and insuffieciency?
Do they all go hand in hand? Can you have one without the other? Which one is worse to have?
Also, say,valve opening has been designated at .8, with no regurg or insuff, also no symptoms. Some have stated that this size valve in indicative of surgery? Why, if no other probs?
Thanks for any techno help that you can provide.
Karen

 

[epstns]

Hi Karen,
I'm no expert at these things, being fairly new to it myself. I do know, though, that aortic stenosis is a thickening of the leaflets and/or narrowing of the aortic valve opening, while regurgitation (same as insufficiency, I think) is a leakage backward while the valve is supposed to be closed. They are sometimes found in the same valve if the thickening isn't allowing normal opening or normal closure. Sometimes in cases of aortic stenosis the pressure of the outflow of the narrowed valve also causes mitral regurgitation because it just overpowers the ability of the mitral valve to hold it back. This combination is what I have.

As for the valve opening, I can't give you a definitive answer. Maybe others can, but I have heard that different doctors have different decision points for asymptomatic patients like you and me. At last echo my valve area was said to be 1.0 cm squared, not yet into the decision zone. I'm seeing another cardio in a couple of weeks for another opinion, too.

Hope this helps. I'm sure others will chime in and complete the picture.

 

[ALCapshaw2]

Stenosis refers to "a narrowing or constriction" per my medical dictionary (very helpful in interpreting test results). This typically results from calcification of the Valve Leaflets which limits the *opening area* of the valve.

When the opening area is reduced to 0.8 square cm, that is typically considered to be a positive indicator for surgery. Depending on the rate of calcification, as the opening closes even more (after shutting down to 0.8 cm sq) you become at risk for SUDDEN DEATH on exertion.

Another indicator you should pay attention to is Chamber Size. If your chambers are becoming enlarged, they may or may not return to normal after valve replacement surgery. If they do NOT return, you will have PERMANENT Damage to your heart wall which may limit your exercise tolerance and stamina.

Note that Cardiologists often tend to want to postpone surgery as long as possible while Surgeons tend to prefer to operate sooner rather than later, to avoid *permanent damage* to the heart.

Regurgitation refers to "the backward flow of blood through a defective valve". Typically this means the valve is not *closing* completely.

'AL'

 

[starkone]

but.....is which is worse to have....reguritation or stenosis?
Is one more dangerous than the other??

 

[Nancy]

Here's a site that explains a lot of things.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/23659.html

 

[John Cochran]

Lots of good answers so far, so I'll just add a couple of points. The top-rated heart medical centers (places like Cleveland and Mayo) no longer recommend waiting for symptoms before surgery. That is because with modern diagnostic techniques, e.g., echocariography and angiograms, changes in the heart can be detected before symptoms set in. As Al said, once the aortic valve has diminished in surface area to less than 0.8 cm squared, surgery is usually indicated. In addition, the heart attempts to compensate for diminished valve function; over time this results in dilation of the ventricle (which is what does the actual pumping of blood). After surgery, this may correct itself; however, the changing size of the ventricle, and the extra strain, may cause rhythm problems and begin to involve other previously normal valves through distortion of the tissue.

Not everyone who has aortic stenosis has aortic insufficiency. But, sooner or later, a stenotic valve often causes regurgitation (leakage) because calcification of the valve impedes its ability to close properly.

Even without symptoms, there are risks to your health that you should be aware of. You should have prophylactic antibiotics prior to any invasive procedure, including having your teeth cleaned. This is because diseased/misshapen valves are more likely to become infected (endocarditis). Also, you should avoid any kind of isometric exercise, which is the kind where you strain against an unmoving force (example: using a lug wrench on a car wheel). The reason is that isometric exercise increases the pressure in the body's great vessles. On the other hand, aerobic exercises, like walking, biking, swimming, etc., actually reduce the pressure in the great vessels, and is a good thing as long as you have no symptoms like fainting or severe shortness of breath.

Over-exerting yourself at this time is not a good idea. As others have mentioned, sudden cardiac death is possible with this condition, although rare. Just use common sense and you should be fine.

I hope this helps a little.

Best,
--John

 

[bvdr]

Hi,
Another site that has some easy to understand explanations of insufficiency and stenosis is heartcenteronline.com (I'm not very good with a computer so I don't know how to insert it as a link for you.)

They are different problems and can either exist independently or can co-exist. Sometimes when they co-exist not all the usual symptoms may be present because one can mask the other. Don't let that throw you through.....that will be covered in the next class . Happy searching!..............................Betty(bvdr)

 

[rajeevg]

Surgeons prefer to do the surgery as early as possible even if there are no symptoms. With modern advances in heart surgery, risk is far less now than what it was some years back.

I had my AVR done seven weeks back. I had no symptoms, I was leading normal life ( No breathlessness). However My echo was showing that my heart(LV chamber) was getting enlarged day by day, though it had not reached alarming limits.

My surgeon adviced me to go for it now as the risks were far less and age was on my side ( I am 42). My cardio felt that I could have waited for couple of more years.

The reason I chose to do it now was that I could manage the risk better as there was no symptoms pressure. I was able to prepare well, choose the surgeon and time of operation at my convenience. I travel a lot ( over seas) and I never wanted some condition to develop when I am least prepared.

I am fine now after 7 weeks of surgery. I had quick recovery with no post operative complications. It went very smooth. I joined the work last week , though I am not fully recovered yet , I am almost there. I think it was worth having surgery now with stronger heart than later with a risk of damaged heart.

I hope this helps

Rajeev

 

[Georgia]

Rajeev, I think you were right on the mark. I didn't find out I had bad valves until the deterioration had been underway for years - and my heart (LV) was enlarged and I was in chf. I'd been diagnosed with mitral valve prolapse years before but no one followed up; I'd had some symptoms - occasional high bp readings, onset of "wheezing" a couple years ago; I'd had radiation treatment to my chest; complained about general tiredness for a couple of years (checked thyroid - which was ok - and advised to lose weight) but no one thought to do an echo.
As they say on this website, surgeons want to cut immediately, cardios want to wait forever. Sounds like you made a good decision.

 

[ccrawford]

Everybody is different

Everybody is different

Unbeknownst to me, I experienced symtoms as long as twelve years ago. After prolonged excercise, I would have a pain in the back on the right side. I was diagnosed with AS at that time, but I didn't associate the symptom with the heart valve. Six months ago, the symptoms started getting worse so I went thru a series of diagnostics including an echo which showed the valve to be at 1.2 cm The symptoms really got worse a month ago and I could barely walk to my mailbox without a couple of rest breaks (it's about 1/4 mile) another series of tests including a cath showed that the valve area had not changed, but the pressure gradient accross the valve was at a point where surgery was advised. I readily agreed to the surgery, and while still pretty weak, can now tromp to the mailbox with nary a break in stride. My cardio says that my right side (angina like) symptoms were very unusual. Its funny how the same problem can exhibit itself in such different ways. Chris

 

[Georgia]

Back pain & carmps

Back pain & carmps

Oh, yeah, I had back cramps for 3 years, too; just thought they were cramps. Surprise - they're gone. Chris you were going downhill for a REALLY long time!

Perusal of stories on this site certainly suggest there are a number of similarities of symptoms, PARTICULARLY where there's a known difficulty with a valve. It seems that this information should ring bells for pcps; and it wouldn't hurt to provide those with mitral valve prolapse and rheumatic history with information on long-term dangers. I would hope that this is occurring now; I doubt that in 1979 (when I was diagnosed with mvp) anyone envisioned the situation where medical care is so fragmented and people change pcp's like their underwear due to changing health plans and contracts with hmos and ppos.

We really expect a lot from our pcps - to know us, understand our neuroses, etc., just like our old family doctors did. I'm on my third pcp since 95 due to changes in our health plans; and never know when this guy might retire or lose his contract with the HMO: those who provide really good care (good = expensive) tend to be invited to leave the hmo. When they have a huge percentage of turnover of patients every year, I suspect they can't possibly be Marcus Welby.

But I still think we're (valve patients) underserved and probably diagnosed later than we ought to be, given the state of technology today.