Gradients?

[Yvonne]

I've been reading many posts talking about what gradients people have and I'm just wondering...I know this will sound stupid...but, what gradients are these? I have my echo reports here and I see these numbers:

Aortic Valve
Max PG 28 mm/Hg
Mean PG 18 mm/Hg

Is this the peak gradients? If so, mine is much less than others I've been reading (although it's still higher than the normal range) Or are the gradients something else?

Bear with me as I'm still trying to understand why exactly I need this surgery. I've been told that my valve is now leaking severe, when only about 5 months ago it was moderate/severe.

 

[Bill B]

The "gradient" is the drop in pressure of the blood as it crosses through the valve. Normal AV has no pressure gradient, which means there is essentially no resistance to flow. As the AV shrinks from stenosis, resistance develops so you get higher pressures on the heart side of the valve, which drop once the blood crosses the valve to the aorta, creating the gradient across the valve.

Although your gradients (pressure drop across the valve) may be nowhere near others here (mine peaked at 70, average 44 right before surgery), you have another problem which is leakage which means you're not getting effective forward flow of blood and could develop serious problems from that. Please discuss this directly with your cardiologist and/or surgeon and they should explain very clearly why you need the surgery. It's not just the numbers.

Good luck. My recent operation saved my life and I am a very happy man now.

 

[Yvonne]

Thank you so much for the explanation, Bill.

My cardiologist and surgeon did explain the leakage and regurgitation problems I have, but I think I'm just looking for an "out". I've been reading so much online and maybe it's too much, I don't know. My cardiologist did say my leak was severe at 4+ and that's where the concern is. The surgeon does feel he'll get better results if he operates now instead of waiting until symptoms show up and I'm not feeling as good as I feel now.

It's kind of a Catch-22 for me - I feel great, so I don't see the need for surgery, but the surgeon explained that feeling great is the best results for him to operate under.

I'm very glad to hear about your surgery and success. That's wonderful and very uplifting!

 

[vhmoriarty]

My symptons just came back three months ago...and was just shortness of breath after walking up hills in which I blamed on being outta shape. Then I go in and my gradient is 102. He said just that showing of symptons is the best time to go ahead cause what happens if I go into Congestive heart failure, blah blah....it will be harder to operate.

So yes go ahead and go for it now.

 

[deano89]

i was similar situation although a different valve (mitral) i asked about numbers and was told its not all about numbers! i had no symptoms ,i was caught in this dilemma also but i must say its always there in the back of your mind and i found that really stressful i am now 2 weeks post op and the surgeon told me after the op that leaflet was actually torn, so i am glad its all behind me now touch wood! i to had severe regurgitation
looking back now i am glad i did this while i was fit and otherwise healthy the surgeon gave me a 1% risk factor because i was in good shape but i do understand the emotional rollercoaster you are on

 

[Bina]

Bill B gave a great explanation.
High gradients will more likely affect those of us with BAV or stenosed valves.
Regurge may not show a high number but warrants equally serious consideration.
Waiting does nothing.
I waited a long time, denial...denial...denial....Don't do that.

 

[Yvonne]

Thanks for all the advice, everyone! I'm starting to feel a bit better about this...although, I'm guessing I won't really feel good until this is all behind me and I'm home recovering

 

[Bill B]

Thank you so much for the explanation, Bill.

My cardiologist and surgeon did explain the leakage and regurgitation problems I have, but I think I'm just looking for an "out". I've been reading so much online and maybe it's too much, I don't know. My cardiologist did say my leak was severe at 4+ and that's where the concern is. The surgeon does feel he'll get better results if he operates now instead of waiting until symptoms show up and I'm not feeling as good as I feel now.

It's kind of a Catch-22 for me - I feel great, so I don't see the need for surgery, but the surgeon explained that feeling great is the best results for him to operate under.
I'm very glad to hear about your surgery and success. That's wonderful and very uplifting!

I was in the same position - ZERO symptoms. I did not believe the diagnosis, but my surgeon cautioned me that my first symptom could be my last and strongly encouraged me to get the operation while my heart was still relatively normal. If you wait until you heart begins to fail there may be permanent changes to its architecture that will make recovery much harder and possibly less complete. You seem to have a smart surgeon like mine. Git er done!

 

[ALCapshaw2]

I've been reading many posts talking about what gradients people have and I'm just wondering...I know this will sound stupid...but, what gradients are these? I have my echo reports here and I see these numbers:

Aortic Valve
Max PG 28 mm/Hg
Mean PG 18 mm/Hg

Is this the peak gradients? If so, mine is much less than others I've been reading (although it's still higher than the normal range) Or are the gradients something else?

Bear with me as I'm still trying to understand why exactly I need this surgery. I've been told that my valve is now leaking severe, when only about 5 months ago it was moderate/severe.

Those abbreviations are a bit confusing.
It's not clear to me what they mean by PG

Max = Peak
Mean = Average

Therefore:
Max PG = Peak Peak Gradient (that's redundant)
Mean PG = Average Peak Gradient (that's in conflict)

Could PG be your Pulmonic Gradient?
BUT, you state that your have a Leaky Aortic Valve.

Bottom Line: Ask your Cardiologist to Clarify your Echo Report.

'AL Capshaw'

 

[Bina]

I've been reading many posts talking about what gradients people have and I'm just wondering...I know this will sound stupid...but, what gradients are these? I have my echo reports here and I see these numbers:

Aortic Valve
Max PG 28 mm/Hg
Mean PG 18 mm/Hg

Is this the peak gradients? If so, mine is much less than others I've been reading (although it's still higher than the normal range) Or are the gradients something else?

Bear with me as I'm still trying to understand why exactly I need this surgery. I've been told that my valve is now leaking severe, when only about 5 months ago it was moderate/severe.

Yvonne, these are Aortic Valve echo stats that you are talking about.
Peak Systolic Gradient---PG
Mean Systolic Gradient--MG

My readings in 2002 were the same as yours are now. Mine were: PG 29 MG 18
At time of my surgery in 2005, I had PG 40 and MG 22 with dangerous symptoms and I was forbidden to drive a car.

Post op now, my readings are PG 13 and MG 7