Echo test results, advice welcome

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bb81

Member
Joined
Feb 28, 2023
Messages
16
Location
Houston
Just picked up test results and the Dr failed to mention I had several leaky values. He seemed very lost when going over the eccentric jet regurgitation like he's never seen it before. I am attaching my echo conclusions and also looking for a better Dr in the Houston area so any suggestions or advice from experienced heart valve patients would be much appreciated.
 

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Hi

I'm no specialist in numbers like that, but they look like something needs attention but not something which needs any panic :)

hopefully some of the other members better versed in those things will add in.

Either way, focus on the fact that you're on the right path because now someone knows and you're in the system.

Best Wishes
 
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I see lots of "normal" statements and not anything alarming, but I am not experienced in echocardiograms. Mine are read by two doctors, echo doctor and my cardio, so I trust the process. If you cannot understand something, assume the positive, it's better for your "head".
 

bb81

Level 1 (mild) regurgitation is of no real concern in any valve. Level 2 (moderate) varies quite broadly in volume and severety, generally the aortic valve surgery is indicated starting from moderate-severe and worse. Often the eccentric jet adds to the margin of error in quantifying the regurgitation with echo.
Today there is growing evidence that the main indication for surgery in aortic regurgitation is the global longitudinal strain (GLS), and not the ejection fraction drop or LV volume increase which show later in time. Not all echo doctors measure GLS so far.
 
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bb81

Level 1 (mild) regurgitation is of no real concern in any valve. Level 2 (moderate) varies quite broadly in volume and severety, generally the aortic valve surgery is indicated starting from moderate-severe and worse. Often the eccentric jet adds to the margin of error in quantifying the regurgitation with echo.
Today there is growing evidence that the main indication for surgery in aortic regurgitation is the global longitudinal strain (GLS), and not the ejection fraction drop or LV volume increase which show later in time. Not all echo doctors measure GLS so far.
My next to last echo showed Mitral valve calcification and explained why I have irregular heartbeat. It goes with those who have had bypass surgery and age. They told me they would keep an eye on the valve for progression. Surgery is usually the last resort.
 
bb81
Level 1 (mild) regurgitation is of no real concern in any valve. Level 2 (moderate) varies quite broadly in volume and severety, generally the aortic valve surgery is indicated starting from moderate-severe and worse. Often the eccentric jet adds to the margin of error in quantifying the regurgitation with echo.

Today there is growing evidence that the main indication for surgery in aortic regurgitation is the global longitudinal strain (GLS), and not the ejection fraction drop or LV volume increase which show later in time. Not all echo doctors measure GLS so far.

Thank you for the info
 
My next to last echo showed Mitral valve calcification and explained why I have irregular heartbeat. It goes with those who have had bypass surgery and age. They told me they would keep an eye on the valve for progression. Surgery is usually the last resort.
Thank you for the information
 
bb81



Level 1 (mild) regurgitation is of no real concern in any valve. Level 2 (moderate) varies quite broadly in volume and severety, generally the aortic valve surgery is indicated starting from moderate-severe and worse. Often the eccentric jet adds to the margin of error in quantifying the regurgitation with echo.







Today there is growing evidence that the main indication for surgery in aortic regurgitation is the global longitudinal strain (GLS), and not the ejection fraction drop or LV volume increase which show later in time. Not all echo doctors measure GLS so far.



Thank you for the information Much appreciated
 
I'm nowhere close to a doctor. I went 3 years at moderate regurgitation with my mitral valve. That's like a Level 3ish. When you reach mod to severe, Level 4 ish, then there will probably be talk about intervention. That's what happened to me. Your EF looks ok I think. I would guess that you may be getting echo's more frequently, but I'd keep on top of your cardio and ask questions like what is the plan and what would constitute a need for intervention?
 
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The main concern that I see in your echo is that you have left ventricular hypertrophy (LVH). With your moderate regurgitation, your heart is working extra hard to get the blood needed by your body. It is like when a weightlifter puts stress on their muscles by lifting weights, with the goal of muscle adaption and muscle enlargement. But, it is not a good thing when your heart enlarges and it can lead to long term problems if it does not reverse. If it becomes too enlarged, it may not fully reverse in size after surgery, and this can lead to serious problems.

Fortunately, your LVH is mild and, as such, it will likely fully reverse after surgery. Also, you are young and when our organs are young, they tend to be more resilient.

Some of the feedback that you have given about your current cardiologist is concerning. From what you describe, he seems unknowledgeable about some things and glossed over some things. In a previous thread you indicated that he seemed to not care about the tightness in your chest. It is always a good idea to get a second opinion on these matters, and I would say this is especially true in your case, given some of the red flags that you have shared with us. I would suggest seeking out one of the top 10 clinics in the country and getting a second opinion from one of their top surgeons.

Personally, I had the same diagnosis at one point of mild LVH. I had aortic stenosis, which was driving mine. Our conditions were different, yours is regurgitation, mine was stenosis, yet some of the factors driving surgery are the same- you want to get surgery done before you have irreversible damage done from your heart’s adaption. Another similarity is that my local cardiologist was not very concerned about my LVH, nor was he too concerned that my stenosis was moderate, and near the severe threshold. He felt that my surgery date was likely between 5 and 20 years away. I sought a second opinion from Cedar Sinai and was told by their top surgeon that due to my LVH, I should get surgery now, and he had an opening next week. Talk about a difference in opinions! So, I sought a third opinion from a highly respected cardiologist at Scripps in San Diego and was told that my LVH was not significant enough yet to drive getting surgery- going over in detail with me the different stages of LVH and at what point it usually becomes irreversible. He estimated I was 1-2 years away from needing surgery. In my view, he was spot on, and I did get my surgery about 18 months after that consult, which was guided by the team at UCLA, in terms of timing.

None of us are qualified to tell you that it is time for surgery or not. But there are two things that I want to stress.

1. Opinions vary widely, as demonstrated by my experience. Get at least one more opinion, possibly more than one more.

Some cardiologists will hold onto patients too long and cause their patients to suffer irreversible damage. And there are some surgeons who might be a little too eager to operate. Sometimes when you’re a hammer, perhaps everything looks like a nail. Over the course of 20 months, I ended up getting 6 opinions: 4 from cardiologists and two from surgeons. When my stenosis became severe, I still did not have symptoms, and ultimately, I was the one who made the decision to get surgery and not wait for symptoms, which leads me to my second point.

2. Don’t wait too long to get surgery.

Due to my relatively young age of 53, I went with a mechanical valve, as would be called for by most international guidelines for my age. I would always tell my consultants that I would rather get my procedure 6 months too early than 6 months too late. Since my mechanical valve will likely last me the rest of my life, it made no sense to kick the can down the road a few months as I waited for symptoms, at the risk of causing irreversible structural damage to my heart. So, I got the procedure done before symptoms. It turns out there is good data showing better long term outcomes if surgery is done before the onset of symptoms. After my surgery, my surgeon showed me photos of my calcified valve and told me that my valve was beyond severe and was actually critical. He said it was good that we operated when we did, because I was a ticking time bomb and could have dropped dead at any moment. He emphasized that the imagery estimates the severity of the condition, but once he has the chest opened with his eyes on the actual valve, he can accurately assess the true severity.

I’m glad that you plan to get a second opinion. Please keep us posted of how that goes.
 
The main concern that I see in your echo is that you have left ventricular hypertrophy (LVH). With your moderate regurgitation, your heart is working extra hard to get the blood needed by your body. It is like when a weightlifter puts stress on their muscles by lifting weights, with the goal of muscle adaption and muscle enlargement. But, it is not a good thing when your heart enlarges and it can lead to long term problems if it does not reverse. If it becomes too enlarged, it may not fully reverse in size after surgery, and this can lead to serious problems.































Fortunately, your LVH is mild and, as such, it will likely fully reverse after surgery. Also, you are young and when our organs are young, they tend to be more resilient.































Some of the feedback that you have given about your current cardiologist is concerning. From what you describe, he seems unknowledgeable about some things and glossed over some things. In a previous thread you indicated that he seemed to not care about the tightness in your chest. It is always a good idea to get a second opinion on these matters, and I would say this is especially true in your case, given some of the red flags that you have shared with us. I would suggest seeking out one of the top 10 clinics in the country and getting a second opinion from one of their top surgeons.































Personally, I had the same diagnosis at one point of mild LVH. I had aortic stenosis, which was driving mine. Our conditions were different, yours is regurgitation, mine was stenosis, yet some of the factors driving surgery are the same- you want to get surgery done before you have irreversible damage done from your heart’s adaption. Another similarity is that my local cardiologist was not very concerned about my LVH, nor was he too concerned that my stenosis was moderate, and near the severe threshold. He felt that my surgery date was likely between 5 and 20 years away. I sought a second opinion from Cedar Sinai and was told by their top surgeon that due to my LVH, I should get surgery now, and he had an opening next week. Talk about a difference in opinions! So, I sought a third opinion from a highly respected cardiologist at Scripps in San Diego and was told that my LVH was not significant enough yet to drive getting surgery- going over in detail with me the different stages of LVH and at what point it usually becomes irreversible. He estimated I was 1-2 years away from needing surgery. In my view, he was spot on, and I did get my surgery about 18 months after that consult, which was guided by the team at UCLA, in terms of timing.































None of us are qualified to tell you that it is time for surgery or not. But there are two things that I want to stress.































1. Opinions vary widely, as demonstrated by my experience. Get at least one more opinion, possibly more than one more.































Some cardiologists will hold onto patients too long and cause their patients to suffer irreversible damage. And there are some surgeons who might be a little too eager to operate. Sometimes when you’re a hammer, perhaps everything looks like a nail. Over the course of 20 months, I ended up getting 6 opinions: 4 from cardiologists and two from surgeons. When my stenosis became severe, I still did not have symptoms, and ultimately, I was the one who made the decision to get surgery and not wait for symptoms, which leads me to my second point.































2. Don’t wait too long to get surgery.































Due to my relatively young age of 53, I went with a mechanical valve, as would be called for by most international guidelines for my age. I would always tell my consultants that I would rather get my procedure 6 months too early than 6 months too late. Since my mechanical valve will likely last me the rest of my life, it made no sense to kick the can down the road a few months as I waited for symptoms, at the risk of causing irreversible structural damage to my heart. So, I got the procedure done before symptoms. It turns out there is good data showing better long term outcomes if surgery is done before the onset of symptoms. After my surgery, my surgeon showed me photos of my calcified valve and told me that my valve was beyond severe and was actually critical. He said it was good that we operated when we did, because I was a ticking time bomb and could have dropped dead at any moment. He emphasized that the imagery estimates the severity of the condition, but once he has the chest opened with his eyes on the actual valve, he can accurately assess the true severity.































I’m glad that you plan to get a second opinion. Please keep us posted of how that goes.











Man this is beyond helpful and I really appreciate you taking the time to write all this info with me. I just got a cardiac CT last week with of course the results of my heart not showing up on my portal reports. I have my TEE Monday and doctor should go over everything with me and from there I will collect my tests and get my second and third opinions after that. Did you send your info to these doctors in other states or did you have to show up in person for them to consult you?
 
"Did you send your info to these doctors in other states or did you have to show up in person for them to consult you?"

I showed up in person, but all my consults were in S. California, within about a 90 minute drive from my home. I am fortunate in that I live 90 minutes from LA and an hour from San Diego, so it is not too difficult to get in person consults.
 
Do you think they will look over my results through a virtual consult? I don't know many good cardiac surgeons in Houston.
 
Do you think they will look over my results through a virtual consult? I don't know many good cardiac surgeons in Houston.
I believe that many clinics offer this. At one point I contacted Cleveland Clinic and was told that they would be willing to give a second opinion about my echo and other results. I was quoted $500 for this service. Ultimately, I decided not to take them up on this, as we have so many top clinics availabe in my area, and I prefered to meet in person.
 
One of my major concerns is they have me on 3 bp meds and still my diastolic pressure hovers around 88-90. I try and monitor salt intake as well but I'm on valsartan 80mg, amlodapine 10mg and diltiazem 120mg. Some are to control the irregular beats which seem to be helping.
 
One of my major concerns is they have me on 3 bp meds and still my diastolic pressure hovers around 88-90. I try and monitor salt intake as well but I'm on valsartan 80mg, amlodapine 10mg and diltiazem 120mg
88 to 90 for diastolic is not terrible. It is generally considered borderline high. Have you tried weight loss and exercise to try to reduce blood pressure? This helps significantly for most people. My dad was able to go completely off of his blood pressure meds by losing about 20 pounds and increasing his exercise. Regular sauna use can also lower blood pressure, but don't use a sauna without getting clearance from your cardiologist. Perhaps when you get the second opinion you can ask about that.
 
88 to 90 for diastolic is not terrible. It is generally considered borderline high. Have you tried weight loss and exercise to try to reduce blood pressure? This helps significantly for most people. My dad was able to go completely off of his blood pressure meds by losing about 20 pounds and increasing his exercise. Regular sauna use can also lower blood pressure, but don't use a sauna without getting clearance from your cardiologist. Perhaps when you get the second
I lift weights 2-3 days a week but slack on cardio. I have cut about 10 pounds since my knowledge of my leaky valves and lvh. I need to get my diet straightened out as well. I was prescribed I low dose of testosterone for having such low numbers but just stopped taking that since the news because that can add to my bp.
 

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