Im a Walking Miracle apparently & Ready to Knock it outta the Ball Park!

[vhmoriarty]

Had my labs done today before my surgery. The anesthesiologist and I got into a bit of a arguement.

He asked what my gradient was...I told him 100. He looked at me puzzled and preceded to tell me I had to be wrong...he had never seen a patient with it over 60. So I went through my whole kit n koobdle. He still preceded to tell me I had to be wrong. So I said...If Im so wrong take a look at my echo. (There the hook in the eye).

He almost started crying when he saw it. There it was plain as day 100. He looked up at me and we both were quiet for a moment. And he said ma'am you have had someone looking over you for the last little while, cause people with their gradients in the 60's are severe...yours is critical and your still here. I said yes, I have so many reasons I am still here and I have gone too far to go back now.

So everything is going as scheduled. I will have my Ross Procedure done on 11/13/09. My husband to be will try to keep everyone updated.

 

[Superbob]

Swing for the fences!

 

[Duffey]

What gradient are they talking about? Could you write down what it says on your report, because I'm uncertain what number they're referring to. . . . and I'm curious! Did you have a heart catheterization yet? You might have mentioned it, and I've missed it. Sorry if I'm asking a redundant question.

 

[TXGal]

Wow, thank God you are here! I'll be praying that all goes well. Keep us updated!

 

[Jkm7]

Why don't they move the surgery date up if the doc is so concerned? Why are they having you wait? Did he mention perhaps you should proceed faster?


Take good care of yourself in the interim.
Best Wishes.

 

[tobagotwo]

The anesthesiologist is mixing up his numbers. One of the reasons I had to push to have the surgery done this time was because my pressure gradient was only 60, which barely qualifies as severe AS. He is thinking the threshold is the average, which it isn't.

Don't worry, though. He's probably great as an anesthesiologist, and having a big pressure gradient isn't a great way to be special anyway...

Best wishes,

 

[Duffey]

The anesthesiologist is mixing up his numbers. One of the reasons I had to push to have the surgery done this time was because my pressure gradient was only 60, which barely qualifies as severe AS. He is thinking the threshold is the average, which it isn't.

Don't worry, though. He's probably great as an anesthesiologist, and having a big pressure gradient isn't a great way to be special anyway...

Best wishes,

You think 100 is the peak, Bob?

 

[tobagotwo]

Nope. Bet somebody posts with a higher one.

It's nothing to sneeze at, though.

Best wishes,

 

[Lily]

I've never understood all of the gradient stuff exactly but this thread question reminded me that my dad, who had a serious heart problem and had also developed CHF but who did not have serious valve issues, also had gradient troubles of some such kind, caused by his type of worsening heart health.

So, I think from his experience that there can be some kind of significant gradient issues that aren't directly related to defective valve action.

I don't suppose that's helpful and it's halfway a question I guess. Is there a thread here somewhere that anyone can recall that is kind of a gradient tutorial?

 

[vhmoriarty]

Duggey....Answer

Duggey....Answer

What gradient are they talking about? Could you write down what it says on your report, because I'm uncertain what number they're referring to. . . . and I'm curious! Did you have a heart catheterization yet? You might have mentioned it, and I've missed it. Sorry if I'm asking a redundant question.

Okay here is the basic answer I can find:

The aortic valve controls the direction of blood flow from the left ventricle to the aorta. When in good working order, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as AS.

When the aortic valve becomes stenotic, it causes a pressure gradient between the left ventricle (LV) and the aorta. The more constricted the valve, the higher the gradient between the LV and the aorta. For instance, with a mild AS, the gradient may be 20 mmHg. (Hence mine being around 50 from the age of 15)

In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. ( My Case it is now 100 )

Due to the increased pressures generated by the left ventricle, the myocardium (muscle) of the LV undergoes hypertrophy (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened.


Basically my gradient the space or whatever you wanna call it was 50 when I was younger. When I had my daughter it had went up to 72...they feared at that time they would have to replace my valve RIGHT THEN. After pregnancy my blood gradually became slower through the valves retaining back to a 68. Now has became a 100.

According to the doctor I spoke with today, people with a gradient of 60 are known as severe aortic stenosis and in need of repair, he is puzzled why they didnt replace it at pregnancy....Well they didnt want to rip me open basically from top to bottom...c-section, tubes tied, then heart surgery to top it off. So they avoided it at the time.

I have never had a heart cath. They did a MRI which is basically just as good in all the cardiologists terms while I was preggo. They will be doing a transespohgual echo while I am out though.

Hope this answers your question Duffey

 

[vhmoriarty]

The anesthesiologist is mixing up his numbers. One of the reasons I had to push to have the surgery done this time was because my pressure gradient was only 60, which barely qualifies as severe AS. He is thinking the threshold is the average, which it isn't.

Don't worry, though. He's probably great as an anesthesiologist, and having a big pressure gradient isn't a great way to be special anyway...

Best wishes,

But I love being special, lol! According to him however, a 60 is severe and mine being 100 is critical

 

[vhmoriarty]

One reason they dont do surgery is cause if your not having symptons...while fix the car right? Well I didnt start having the symptons until about three months ago...which is only stair flight exhaustion. The other nights episode of the chest pain was new to me however. And actually it isnt that far away....almost two weeks.

 

[vhmoriarty]

Thanks to Wikipedia....here is another answer:

A normal aortic valve has no gradient.
If the mean gradient is <25 mm Hg, the stenosis is mild;
if the mean gradient is between 25 mm Hg and 50 mm Hg, the stenosis is moderate;
if the mean gradient is >50 mm Hg the stenosis is severe;
and when the gradient is greater than 70 mm Hg, the stenosis is critical.

 

[Duffey]

Thanks to Wikipedia....here is another answer:

A normal aortic valve has no gradient.
If the mean gradient is <25 mm Hg, the stenosis is mild;
if the mean gradient is between 25 mm Hg and 50 mm Hg, the stenosis is moderate;
if the mean gradient is >50 mm Hg the stenosis is severe;
and when the gradient is greater than 70 mm Hg, the stenosis is critical.

Yep, understand all that, but there is a mean and a peak gradient. I didn't think the peak could be 100; at least I've never seen it in the literature.
If you look at your echo report, there should be some identifying information that precedes the gradient #. Can you share that?

 

[Bina]

There are 2 gradient measurements; peak and mean.
Before surgery when I was in very sad condition my peak gradient was 40
and my mean gradient was 22.
Now my readings are 13 and 7.

 

[vhmoriarty]

Apparently it is my peak (cause i remember him using that word today) for the 100. I will get a copy of it when I go back to my doctor. I could be wrong, but I dont remember him saying mean....I just remember peak....cause he got all quiet. Then explained he had never seen anyone with one that high and not well I guess basically dead and having tons of symptons.

I am also going next week to get a copy of ALL my cardiologist reports, since Im getting shifted around alot without any insurance. Im tired of them to wait on paperwork.

Ill let you guys know.

 

[Danny]

Are they not wanting to move your surgery up if your in that bad of shape? I know its only 2 weeks away, but if they think your in danger, it seems they would put it as a priority. Just curious.

 

[vhmoriarty]

Are they not wanting to move your surgery up if your in that bad of shape? I know its only 2 weeks away, but if they think your in danger, it seems they would put it as a priority. Just curious.

Well I literally live within 5 mins doing the speed limit and 2 ya know being a Nascar Driver.

When I went in the other night they started to keep me all the way until surgery. Then one of my primary cardiologists said as long as I rest, my symptons dont worsen, and I dont run up and down stairs, take my meds, call my drs if anything changes. (which have also became my BFF now, lol) then I should be able to wait till the 13th.

Im wondering if it might be my whole insurance thing too. But they did all the labs today so I am sure if something shows up they will change or something. My chest xray from the other day was normal...NO CHF. By the way I have never suffered from either.

 

[Kathy McCain]

Hi Valarie,

Just want to say, I'm happy to hear that you have a surgery date and the prognosis looks good!

Keep us posted and hang in there! You can do it!

 

[ctyguy]

I knew I was in trouble when I went for my initial tests at C.C. My peak gradient was 115. The tech doing the test was sounds like "hmmmm" and "whoa". Not the thing you want to hear. When I questioned her of course she was hesitant to say anything, thats for the docs. What I did get out of her though is "you need surgery, and soon". For what its worth my valve opening was also measuring .9 I think anything below 1.0 is deemed critical.

Post surgery the pressure gradient was at 15.

So based on whats been posted in this thread I think I was even luckier than I thought I was already

BTW....ran 4 miles today, heart rate at about 165. Pre-surgery I couldn't run 200 yards without chest pains and SOB. OHS is daunting but the results rock !