Conflicting Echos

[strawberry]

Hi!

It's been a while since I posted...I only have mild valve issues. However, I recently had an echo after two years. My previous echos had both noted a myxomatous mitral valve and mild AI. My cardio wants to follow especially the mitral valve.

ANYWAY, the report says the AI is still mild which is reassuring. However it also says "mitral valve is structurally normal."?? Which do I believe? I've been told for two years my mitral valve is degenerating and now it's normal? Which would be great but...the past reports did not say thickened or mildly myxomatous or myxomatous changes, they said "the valve is myxomatous with redundant chordae." I called and of course the nurse called back and said she left a message with the doctor but the nurse is off for the next week and will get back to me then, and continue coming in yearly. Of course my appointment isn't until December.

I've heard of fluctuation in prolapse degree or regurg degrees but this seems very strange to me. Does anyone have any thoughts?

This report also says I have a bidirectional interatrial septal aneurysm. Does anyone know much about that?

Thanks

 

[Ross]

Hint:An echo is only as good as the tech performing it. One sees one thing, the other sees another. Which is the truth? What does the Cardiologist see?

 

[strawberry]

Hi Ross,

The echo reports say who they are read by and this was by one of the cardios in the practice..this is who she left the message for. My last echo was read by the doctor I usually see and who says we want to keep an eye on it cause it's myxomatous. If it weren't for the AI and this new aneurysm, would they be telling me that's it, never mind don't come back? I'm half tempted to just not go back anyway.

Which is right? That's the big question. I do they do another then a tie breaker?

The report said with the aneurysm: no obvious shunting so I don't know if they're going to look at that closer either.

 

[Ross]

I wish I had an easy answer for you. I'm betting "mitral valve is structurally normal" myself. You might inquire if a Catscan can clear this up once and for all.

 

[Nancy]

It's the techs that can vary greatly in their technique. The person reading them is just interpreting what the tech did. So garbage in-garbage out.

I had an echo many moons ago (don't have heart issues, but had one anyway). I had a trainee do the first round, and then the experienced tech do the second. The trainee was afraid to press too hard for fear of hurting me. The second guy had no problem pressing hard (unfortunately). Guess who got the better images??

That's the kind of thing that can throw off an echo.

 

[debster913]

Myxomatous mitral valve

Myxomatous mitral valve

Hi there--

All I can tell you is what is from my own experience. I also have (or had?) a myxomatous mitral valve and had mine repaired a year ago tomorrow. From what my cardiologists explained to me over the years, yes, myxomatous is the same as degenerative. Whereas there are those who have mitral valve prolapse and can go on their entire lives without surgery, those of us who have myxomatous MVP will find that surgery is inevitable. For some, the valve slowly degenerates, and for others the valve degenerates quickly. In my case, my valve lasted me a good 30 1/2 years before I needed it worked on.

Anyway, really to answer your question, valves can show more or less leakage on echoes. There are so many factors involved, but none of them are that the valve is getting better. They don't. When my valve failed last spring, I had three separate tests to determine the severity of my leak. My echo showed severe, my angiogram showed moderate, and my TEE showed moderate-severe. These tests were all done within three weeks of each other. In fact, my cardio was reluctant to send me to a surgeon because, despite my symptoms, my valve wasn't leaking badly enough (at least to warrant the symptoms I was having). He did refer to me a surgeon anyway, and the surgeon took a look at all three tests and was the one to say that my valve was severely leaking, and it was time for surgery.

I think it's best to sit down and discuss your echoes with your cardio, or at least take your tests to one who you trust. You two can then make the decisions that are best for your care.

Best,
Debi (debster913)

 

[strawberry]

Nancy, that's a good point about the quality of the imaging. I wonder which would be which though? Would a fuzzy picture make a normal valve seem not, and then a better picture make it seem OK? If so I'd think there'd be a lot of false positives around. I'd like to think Ross is right but how would a normal valve look myxomatous to two different techs at two different cardios? I wonder if the aneurysm has anything to do with all this. BTW, even though I've been silent, I have checked in occaionally and I'm so sorry to have discovered Joe's passing. You give so much support here and I'm so glad you remain...

Debi, the funny thing is they always said the valve wasn't leaking...yet. It's the only one that wasn't! Now it just shows a trace leak. But they were watching for development of a leak and then progression, or a snapped chord.

From what I read on the ASA, it can be associated with a PFO or an ASD and sometimes shunting isn't obvious without a TEE or contrast. Interstingly, one of the defects it's associated with is a PDA which I had. I do plan on talking it all over with with my cardio. It will be intersting to see if the cardio who read the echo calls me back or makes me wait til the nurse comes back. I have much more respect for Drs. who call back themselves. My Dermatologist who took off a squamous cell off for me calls himself and has my back. Well, the back of my hand.