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.