Houston Results for Ken

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ken taylor

Well-known member
Joined
Aug 15, 2009
Messages
152
Location
Boquete Panama
Interpretation Summary
The left ventricle is mildly dilated.there is moderate septal hypertrophy. Inferolateral wall is thin and akinetic. remaining wall segments are normal. left ventricular systolic function is low normal. EF (BP) = 50%
The transmitral spectral Doppler flow pattern is suggestive of impaired LV relaxation.The pulmonary venus flow suggest normal LAP. Moderate to severe
valvular aortic stenosis. The aortic valve area=1.0cm2 Mean AV gradient= 36mmHg. Right ventricular systoloc pressure is 20-25 mmHg.
Mildly dilated ascending aorta. Ascending aorta diameter = 4.1 cm. Left Ventricle is mildly dilated. there is moderate septal hypertrophy. LVED vol.[bp]=151ml.LVES vol.[bp]=75ml.EF[bp]=50%LVOTTVI=21.1cm Mitral valve deceleration time 254msec. The transmitral spectral Doppler flow pattern is suggestive of impaired LV relaxation. Left ventrical systolic function is low normal. Remaining wall segments are normal.Inferolateral wall is thin and akinetic. Right Ventricle is normal in size and function. ATRIA The left atrial demension[4ch]4.2cm. the indexed left atrial volumeis 20ml/m2. the left atrial size is normal. The pulmonary venous flow suggest normal LAP. The right atrial pressure0-5mmHg right atrial size is normal. MITRAL VALVE the mitral valve leaflets mildly thickened. TRICUSPID VALVE is normal in structure and function. Right ventricular systolic pressure is 20-25mmHg AROTIC VALVE The arotic leaflets moderatly thickened. The arotic valve ismoderatly calcified. Arotic valve opening appears moderately reduced. A bucuspid arotic valve cannot be excluded. PeakAV gradient=61mmHg. mean AV gradient=36mmHg. LVOTTVI=20cm. The arotic valve area=1.0cm2.AV TVI=94cm. Moderate to severe valvular arotic stenosis. Mild arotic reguragitation. PULMONIC VALVE appears normal in limited views GREAT VESSELS Ascending arota diameyer=4.1cm. Mildly dialated assending arta. PERICARDIUM/PLERAUL no pericardial efusion visualized. MMODE/2D Measurements & Calculations IVSD:1.6cm. LVPWD:0.90cm. LVIDd:5.8cm. LVIDs4.4cm. FS:25% EF[Teich]:49% LA dimension:3.8 ?? Surgery Now are LATER Thats My Call Cardiology say come back in 6 months. Surgeon say do not waite long Your feed back Appreciated if you understand all this Ken
 
That was a Very Thorough Echocardiogram Report!

My (non-professional) interpretation is that you are 'on the edge' for recommending surgery.

What are your Symptoms?

Without symptoms, my guess is that the Cardiologist will suggest waiting and recommend another echo in 6 months (unless your symptoms become more pronounced, then call you in for another echo immediately).

With symptoms (and maybe even without), a Surgeon may agree to go ahead so as to avoid further damage to your heart. It will be interesting to hear what the THI Surgeon has to say.

'AL Capshaw'
 
I just sent my test results to THI today. Im waiting to hear from the surgeon for a second opinion. I hope they are as good as people say.
 
Danny they are that good in Houston. Dr. Ott and Dr. Gregoric are amoung the worlds best. Al the delima I face is the cardiology folks want to waite until I show symptions, And the surgeon Dr. Gregoric seems to think If not now very soon . Is it possible that I could have no change for several years are will the change come quick ? and what about my mitral valve they say its ok but I read that it is not perfict from the report . does that mean that I will face the same thing down the road ? I should have ask theses things yesterday . So I need for them to reply to these questions. I do not know what to do . If im in Panama and have symptions can I get to Houston ? are will I be trapted there ? what happens with symptons ? Tell me your thoughts Folks Ken
 
You can call you physicians back!! It sounds like you really have more questions. Do they know about your trek across Spain? What is their opinion of the timing of your surgery and your life long dream? If the cardio says you cannot make the trek then why is he asking you to postpone surgery? These are definitely questions I would ask those doctors. Every year you get older and isn't there a teeny bit more chance that as you get older, the surgery could be a bit more difficult for you?

If you were to have the surgery now, could you recover and be recovered and retrained for your walk in time for a good season to start that walk?

Please mix these two things together with them (your doctors). And don't be afraid to call them back more than once. They usually have assistants who may field the question (take the question to the actual doctor) and then bring you the answer by return phone call. Ask them about the mitral valve. Keep asking questions!!! That is what they are there for. YOU need to perfectly understand all the pieces of this puzzle. And they need to be there for you with good advice. Ask them what they would do. Many of us do that.... what if this were your brother, or your son? What would you tell them?

Good luck. Keep us posted. Call NOW!! :)

Marguerite
 
MORE I just finished talking to the cardiology dr. He says keep doing what im doing and that the mitral valve is no proublem now are in the future. And that he thinks surgery in one are two years is probable and possible longer he will see me about every 4 to six months to look for some changes to try to stay ahead of the game . As far as Spain the proublem is some days ill be in the middle of no where. Besides I love a challenge . I will walk with my ON _X in the future. Thats ok because I live in western Panama it is so beautiful . We say God was born there. KEN
 
You have fallen into the Age Old Battle between Cardiologists vs. Surgeons.

OLD School Cardiologists like to wait for symptoms
(which are a sign of DAMAGE to the Heart).

Surgeons like to FIX the Problem before further damage occurs to the heart. At some point, the Heart *Muscle* Damage can become PERMANENT and NOT totally fixable by Valve Replacement.

Patients ponder "What is the Benefit of Waiting for things to get Worse".

In the Days of Olde, Surgery probably was more risky. Today, First Time Surgery has a Very Low Risk of Morbidity (1% nationally) and Mortality (1% nationally). Risks are even Lower at the Top Heart Hospitals with Top Rated Surgeons. Many of our members have opted for 'early' Surgery to FIX their problem and ensure the Best Possible Outcome (by avoiding further damage).

By the Way, Cardiologists are NOT the "Gate-Keeper" to surgery. YOU and any Surgeon you select can decide whether to proceed or not REGARDLESS of what your Cardiologist thinks. If you don't like what your Cardiologist thinks, you can find a new cardiologist.

Valve Problems can sometimes be 'slowed' by medication but eventually they will result in Death if not replaced.

Bottom Line: When you have a Plumbing Problem, hire a Plumber (Surgeon).

You may want to see if you can arrange for another discussion with the Surgeon you saw at TMI before going back to Panama.

Good Luck !

'AL Capshaw'
 
I totally agree with AL Capshaw, if I listened to my cardiologist I'd be dead, she wanted to watch and wait and I elected to do the surgery, did not give a rat's butt about what she said, and guess what? they moved my surgery up, it was starting to disssect. PS....I've changed cardiologist.....I'm alive....

Lot of luck and Godspeed!
 
OK im convused- If I get a Eco or Sono or what ever you call it. Every 4 months .I was thinking that- that would good enough to see any change before any damage is done. YES OR NO? give me your thoughts as why this is dangerous. Ive been told that the rate of change is very slow. Ken
 
I was told that MITRAL Valve Stenosis tends to proceed Slowly.

We have a saying about AORTIC Stenosis that goes:
"The Worse it Gets, the FASTER it gets Worse".

My Cardio was hoping to get 3 years with medication.
ONE year later, it 'was time'. It took 1 month to get in to see the Surgeon he referred me to and another month to find an open date. I got there 'just in time'.

Hopefully Echo's every 4 to 6 months would catch your progression. The Big Question is "What is the Benefit in waiting?"

When it comes to timing, I think Surgeons have a better 'feel' for that issue. What did the THI Surgeon say about When to proceed?
 
Ken,

I lived in Texas, 550 miles from THI at Houston when I had AVR. As you can see in my signature, I was diagnosed 10 years before. I had NO symptoms other than a noisy aorta valve and was in excellent health. I was taking no medication. My cardiologist of which I respect very much did an echo each year. I had been jogging 3 miles a day since 1976. One month after a yearly echo and (also had stress test) that showed no change I blacked out while speed walking. The day before I had felt strange but slowed up and the feeling went away. I suspected the valve, so the next day, (not being too smart) I increased my speed but this time I didn't have time to slow before I bit the ground.

The next day after another echo I started making surgery arrangements at THI. This was back when there had been problems with AIDS contamination to the blood banks. I was concerned I might need blood so I donated 4 pints to take with me to Houston.

I flew to Houston the day before surgery and met my surgeon, Dr. J. Michael Duncan. He had been recommended by my cardiologist.

Maybe my story will be of some help. Wishing you the very best.

BTW, we visited Panama last year.
 
I was told that MITRAL Valve Stenosis tends to proceed Slowly.

We have a saying about AORTIC Stenosis that goes:
"The Worse it Gets, the FASTER it gets Worse".

My Cardio was hoping to get 3 years with medication.
ONE year later, it 'was time'. It took 1 month to get in to see the Surgeon he referred me to and another month to find an open date. I got there 'just in time'.

Hopefully Echo's every 4 to 6 months would catch your progression. The Big Question is "What is the Benefit in waiting?"

When it comes to timing, I think Surgeons have a better 'feel' for that issue. What did the TMI Surgeon say about When to proceed?

Ken, this is all very confusing to all of us all of the time! You are not alone in the confusion.

Al's quote above (and his other one to you) is only his opinion garnered from his experience. You must seek your doctor's counsel. If our questions and statements breed new questions for your doctors (cardio or surgeon) then you should have further discussions with your doctors. That is what we are good at here. Teaching others from our experiences and gathered information.....how to talk to your docotrs; what kinds of questions to continually ask; what points to have made completely clear.

Some people will, of course, have bad luck. It is the stuff of life in our fragile existence. You may have good luck! You may wait this out for several years. Or, having now hit the 1.0 cm sq measure of your aortic valve, that stenosis may close things down significantly by your next echo. Two cardios (I only switched because my first was not at the hospital I would want to use for surgery) both said, once that valve hits 1.0 a patient generally needs surgery within 3 years. Do you know when your valve hit 1.0? When was your last echo? So sometime between then and now. My cardio "called in the surgeon" at .7 cm sq. Please ask your cardio when he/she "calls in" the surgeon -- at what measure of the stenotic valve. It does seem, as Al mentions, that many of us here have a rather rapid decline toward the end of the stenosis; it seems like it does close up faster; builds up the deposits more quickly or something. When you come back in 4 months (I wouldn't wait 6, personally) see if you can have the same echo technician do your echo. There are, of course, inconsistencies in how they are read, so I think it would be helpful for the same person to be reading them (anyone can correct me if I'm wrong there).

Please ask some more questions. Keep learning. And keep walking and enjoying your beautiful Panama.

Best wishes

Marguerite
 
Marguerite,

Ken's Last Echo was Last Week (after flying to Houston from Panama where he lives, without his Panamanian Wife who was NOT allowed to accompany him by our state department).

His unanswered Question (actually written in one of his posts) was:

If he returns to Panama and then his Stenosis (or dilation) becomes Severe, will he have enough time (or even be able) to FLY back to Houston and secure a Surgery Slot in time to save himself.

I suggested he raise that question with the Surgeon he consulted at THI (Texas Heart Institute).
 
Truth be known I had mild stenoses 5 years ago this month.The funny thing is they were considering replacement back then ,but decided not to , I never knew the proublem was my arotic valve . I have always had mitral valve prolapse and thought that was the valve they were wanting to replace. I just found out it was in fact my arotic valve. So It went from mild back then to where it is now. My delima is that I had bypass just 5 years ago. So part of me says just do it get it over, The other part say the farther down the road I can go the less chance I will have of having by pass later . That would be three times, What risk does three times add. So thats where im at stuck in the middle . So chim in friends ! your thoughts do help. Ken
 
Marguerite,

Ken's Last Echo was Last Week (after flying to Houston from Panama where he lives, without his Panamanian Wife who was NOT allowed to accompany him by our state department).

His unanswered Question (actually written in one of his posts) was:

If he returns to Panama and then his Stenosis (or dilation) becomes Severe, will he have enough time (or even be able) to FLY back to Houston and secure a Surgery Slot in time to save himself.

I suggested he raise that question with the Surgeon he consulted at THI (Texas Heart Institute).

And an excellent point you make, Al. As are all your points!! You are a valuable and dedicated contributor. I sense that there might be a slight language barrier between Ken and you and I and I was simply trying to temper the emphaticism so that he would, as we both suggest, talk to his physicians. One thing I try to do with these responses is to "give the patient voice" -- to remind them that they are able to advocate for themselves and that they should -- they must!

I did read that his wife was not able to accompany him. The world is a crazy place -- what a ridiculous and unfortunate situation. However, Ken seems very capable and determined to secure his personal well-being. I hope that you and I and others here can encourage him to keep pushing for an understanding and game plan that he can live with.

Ken. Your cardiiologist should be able to discuss future by-pass problems with you. I hope you can continue probing your doctors until you get a good plan for yourself.

Best wishes

Marguerite
 
Truth be known I had mild stenoses 5 years ago this month.The funny thing is they were considering replacement back then ,but decided not to , I never knew the proublem was my arotic valve . I have always had mitral valve prolapse and thought that was the valve they were wanting to replace. I just found out it was in fact my arotic valve. So It went from mild back then to where it is now. My delima is that I had bypass just 5 years ago. So part of me says just do it get it over, The other part say the farther down the road I can go the less chance I will have of having by pass later . That would be three times, What risk does three times add. So thats where im at stuck in the middle . So chim in friends ! your thoughts do help. Ken

Ken,

I understand your concerns better than you might know.

Surgical Risks do rise with each one. I have been told anything from 10% to 25% for a 3rd surgery. Most surgeons would NOT replace your MV until it "meets surgical criteria" which sets you up for a possible 3rd OHS.

TOUGH CHOICES !

If you decide to wait and watch, I second the recommendation to have another echo in No More than 6 months and maybe even 4 months if your Cardio will agree to that time span. Keep a Watchful Eye for ANY changes. I made a Spread Sheet that lists Every Parameter from my EchoCardiograms so that my Cardio and I can review the history following each new echo. In retrospect, the first signs of further deterioration of my AV showed up 6 months after my diagnosis of AV Stenosis. As I mentioned before, I got to surgery 'just in time'. That is why I have become an advocate of the "Sooner is Better" philosophy for Aortic Valve Replacement.

From MY perspective, there is little benefit to postponing AVR once it is clear that the valve WILL need to be replaced at some time. The other side of the coin is that Muscle Damage WILL progress as you wait and eventually you can reach a 'point of no return' where the Muscle Damage cannot be repaired 'even if' you get the valve replaced. Talk this over with your SURGEON and ask him for his recommendation on WHEN to proceed.
 
Thank you, I must say I think that the thing is that I really just want to get it done. If my wife were here it would be on a fast track. I guess I will just have to suck it up a be a man . I know the risk are small but if there was a serious thing happen my wife will not be permitted to come here. Now this is just one of many reasons I choose to live in another country. Things just do not make sence here any more .I think next week I want to have cath done to see how the plumbing really is. Thanks you folks are really needed!!!!!
 
The option of going ahead and 'getting it done' has a lot of merit. It minimizes the Biggest Complaint about OHS, the WAITING, along with the progressive damage to your heart muscles.

Several of our members have taken that proactive approach. Some have reported that their hearts / valves turned out to be in Worse Shape than the tests seemed indicate. Some valves even "disintegrated in the Surgeon's hands".

One More Question you may want to ask your Surgeon is:

What are his thoughts about replacing Both the Aortic and Mitral Valves in ONE operation to avoid the risks involved in a Third Operation. Admittedly this is somewhat of a gamble on whether your MV will continue to deteriorate or 'stabilize' (possibly for years). Unfortunately there is NO good way to KNOW the answer to that question.

It doesn't hurt to ASK. Some surgeons are beginning to agree to replacing Both Valves in patients with a progressive disease in the second valve.

Hopefully you will find that 'sense of Peace' that comes when you arrive at a decision that you are comfortable with.

Best Wishes!

'AL C'
 

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