Is it normal for echo's to be THIS abnormal post-op?

[deek]

I just had my second echo since my mitral valve repair March 27 and it's terrible (or at least I think so)!

Any thoughts? Should I be concerned???????

FINAL IMPRESSIONS:

1. Mild to moderately dilated atria.
2. Moderately depressed left and right ventricular systolic function. There is mid to apical septal, inferoseptal, and apical anterior hypokinesis with overall moderately depressed systolic function calculated at 38% by biplane Simpson's method.
3. Diastolic dysfunction.
4. Moderately-severe Tricuspid Regurgitation.
5. Mild to moderate pulmonary hypertension: 69mmHg.
6. The mitral valve is post-repair, with no residual regurgitation and only minimal elevation in antegrade gradient, consistent with the early postoperative phase.

My surgeon wants to view the echo film but said not to worry, that these things should improve with time. WTH? My echo's prior to surgery were not THIS bad. In fact, the TEE I had prior to surgery indicated only mild mitral regurgitation and he still proceeded with the repair. Good thing, as it was three times the size and severely leaking. But still, I'm confused? TR was "trace" in ALL my previous echos...I wouldn't think it would increase by 3 grades following MVR. Theoretically, isn't repair to the left suppose to improve the right? I understand the heart needs time to heal and remodel...blahblahblah...but is it normal to be this abnormal? Anyone else have echo's like this after OHS? I'm just really concerned about the TR and PH...I've done some research and apparently it's quite common for TR and PH to progress post MVR and in fact, many centers are fixing the TR at the same time, even IF it's mild. I don't know? I'm just confused and frustrated. And to top it all off I feel like I'm regressing in my recovery...I feel heavily congested in my chest/lungs and it worsens when I lay down...forcing me to cough. Is this normal two months post-op?

I sincerely thank you for any insight here. I don't know what I'd do w/out this forum. I guess I just expected to be feeling better than this at two months and I certainly wasn't counting on two crappy echos...(I know, I know...they aren't that reliable...but they're all I have to go on here.)

Thanks, Dee

 

[laurad37]

did u have regurtiation with your tricuspid valve before you had your Mitral replaced?

 

[deek]

Laura,
Only "trace"....at least that's what all my 100 echo's said...which I don't have a lot of faith in. You had your TV repaired, right? Can I ask what for? Regurg or stenosis? What were your numbers? Hope all is well with you? Have you figured rehab out yet? I'm suppose to start tomorrow at 8:00am ...I'm already thinking of not going.

 

[Ross]

Do NOT get upset with these first post op echos. Your body is readjusting and realigning things constantly. Some can look absolutely horrible shortly after surgery. They should test again in 6 months and then again at 1 year. That's when the changes will be apparent.

 

[Bina]

Dee, try not to freak out.
When I was 2 months post op I couldn't do much of anything....hubby was still helping me day and night.
I had an echo done at 3 1/2 months post op, and even though I felt crappy, my cardio said the numbers were improving.
Chat with your surgeon. Best wishes to you.

 

[bvdr]

I had my mitral valve replaced nearly 6 years ago. This year I had the best post-op echo to date. I would say that by your echo report that your pulmonary hypertension is significant and that is definitely something to be concerned about. It may not seem like you are still early post-op but you still are. There should still be considerable change coming your way. Keep informed, ask your PM and your surgeon questions(LOTS of them), but remember your heart is still adjusting to major changes and it may take a whole.

 

[Nancy]

Your PH may be contributing to your breathing problems. You should ask about what they intend to do about it.

Here is a site for PH:

http://www.phassociation.org/Message_Boards/main.asp?board=1

 

[ALCapshaw2]

I'm just confused and frustrated. And to top it all off I feel like I'm regressing in my recovery...I feel heavily congested in my chest/lungs and it worsens when I lay down...forcing me to cough. Is this normal two months post-op?

Thanks, Dee

Dee -

Has your Surgeon discharged you now?

I'm thinking the Surgeon needs to know about these symptoms, or you could consult your Cardiologist and see if he wants to involve the Surgeon. You may have fluid building in your lungs / chest cavity. If so, someone will need to decide how to get rid of it. Diuretics and increased use of an Incentive Spirometer may be enough. If not, they may need to drain it.

Bottom Line: Tell your Cardiologist about these symptoms ASAP and take it from there.

You may need further testing to fully assess your other issues. The Gold Standard for Pulmonary Hypertension is a Right Heart Catheterization. The Gold Standard for Aortic "Dilation" is either a Chest CT or MRI.

'AL Capshaw'

 

[tobagotwo]

Two months is not a lot of time. Your heart is still adjusting to its very new circumstances. Recovery of the circulatory system usually starts to look more normal by six months, and may be glitchy for the first year.

You may want to look at whatever prescriptions you are taking. Most people are at least getting beta blockers to depress the heart activity. Maybe yours is too depressed. Some meds can have a side effect of coughing. Cardiologists often want to depress the heart activity as much as the patient will bear for recovery, sometimes ignoring that the result of that can be an unsatisfactory day-to-day life for the patient. There are many different options for prescriptions to try, if your current meds are not agreeing with you.

It's not uncommon for the atria to take a long time to remodel, and sometimes to not completely revert to their former size, even over time. Of course, over time means a year, rather than two months. Usually, that's not too much of a problem anyway, but it can create seating issues for the tricuspid and mitral valves, because the size and shape of the seal is different from the original. Usually, the heart's pressures help cause the valves to reseat to some extent over time, but it takes a while.

Your heart is changing size and shape, so there are apt to be temporary adjustment issues, which would be very difficult at this time to separate from long-term issues that may coexist with them.

The change to the tricuspid ("trace" is the practical equivalent to "none") most likely has to do with the redistribution of pressure within the heart, particularly because of the apparent pressure backflow from the PH. Your elevated backpressure may be temporary, as things adjust, and that number is somewhat questionable, as echoes are not so reliable on PH measurements. The likelihood is that the PH pressure will reduce some over time, as the body adjusts. For many, PH is a secondary to their valve issues, and it may dissipate after surgical correction. For others, it is or becomes primary, and must be dealt with as a separate health issue.

If you question the accuracy of echoes you are getting, insist on having it done at a different facility next time.

It's reasonable to retain a pulmonologist, to determine if treatment is required for the assumed PH.

Best wishes,

 

[laurad37]

Laura,
Only "trace"....at least that's what all my 100 echo's said...which I don't have a lot of faith in. You had your TV repaired, right? Can I ask what for? Regurg or stenosis? What were your numbers? Hope all is well with you? Have you figured rehab out yet? I'm suppose to start tomorrow at 8:00am ...I'm already thinking of not going.

I had my pulmonary replaced for severe regur and the tricuspid repaired for mild regur.I don't remember what my numbers where and I don't have a copy of the echo. I'm doing ok. I have decided to do rehab at home until I can drive. I went to rehab about 4 times but it's so hard to get a ride there. I did like it when I went but the stress of finding someone to take me isn't worth it. And besides i was the youngest person in there and nobody really even would talk to me. I tried talking to some people to make it more interesting but the age difference was a big deal to them.

when was that echo done that said there was on trace regur on the tricuspid valve? how much time has there been between that echo and this one?

 

[deek]

I had my pulmonary replaced for severe regur and the tricuspid repaired for mild regur.I don't remember what my numbers where and I don't have a copy of the echo. I'm doing ok. I have decided to do rehab at home until I can drive. I went to rehab about 4 times but it's so hard to get a ride there. I did like it when I went but the stress of finding someone to take me isn't worth it. And besides i was the youngest person in there and nobody really even would talk to me. I tried talking to some people to make it more interesting but the age difference was a big deal to them.

when was that echo done that said there was on trace regur on the tricuspid valve? how much time has there been between that echo and this one?

Laura,

What was their reasoning for repairing the TV?

I know what you mean about the rehab...as I type I'm reminded of the fact that I was suppose to be there this morning...opted not to...kind of for the same reasons: 1.) It's hard for me to find someone to watch my 3 year old and 2.) I, too, am the youngest one there by 20 some years or MORE. Felt uncomfortable...like everyone was looking at me and wondering, "WTH is she doing here!"

As for the echos, my last two were TEE's, one which was done the end of January. All the others ranged from July 08 thru January 09.

Good luck with the rehab at home. THIS is going to be a struggle for me as my 3 year won't let me do nothing. This is probably one reason why I feel as if I'm regressing in my recovery....haven't walked in over 3 weeks!

 

[Eric]

I had an echo done after my surgery 4 yrs ago. See below for details. My cardio and surgeon were both surprised that I had moderate/sever aortic regurg. I thought I was headed for a reop but three months later the echo showed moderate to moderate/severe. 6 months later it showed the same and as of my last echo 6 months ago it has not changed. I have the echos only once per year now and I'm holding steady. I hope you do as well.

 

[marilyn]

I hope you don't mind me asking you questions. I have read many things you have written, and you seem to be well informed. I have been reading the information about the valves. I have moderate regurg. in both the mitral valve and the tricuspid. I have had the aortic valve replaced. I have not been told to have surgery on the others. I get symptoms of shortness of breath, but I also get squeezing/aching in the chest and jaw pain. I have blockages in arteries that have started to fill up 50% as of last cath 2007 and the LAD was 60% at that time. So I do not know if I am worse or not. It would be hard for me to know if a valve is involved. I also sometimes get very fatigued when I get short of breath. The short of breath that I am getting is like it is hard to breath and when I walk sometimes I have a hard time. This does not go on all the time. I thought a valve would have to get severe to be operated on.

 

[zipper2]

Dee have they mentioned any other tests cus of your echo?
they may want to do,i had 2 echos since my 2nd surgery for
valve and of course i don't understand all the shamazzle #'s
either i know what severe means i have few them,but now i go
back for holter and pulmanary and another test on 18th,19
I'm gonna see what else he has to tell me regarding the echos and
whats concerning me is the severe atria dialation,but only found on
my echo,so i'm not worrying less he tells me i need to.
Just wondering if they requested any other tests for you.

Take care and in my prayers God Bless

zipper2 (DEB)

 

[deek]

I hope you don't mind me asking you questions. I have read many things you have written, and you seem to be well informed. I have been reading the information about the valves. I have moderate regurg. in both the mitral valve and the tricuspid. I have had the aortic valve replaced. I have not been told to have surgery on the others. I get symptoms of shortness of breath, but I also get squeezing/aching in the chest and jaw pain. I have blockages in arteries that have started to fill up 50% as of last cath 2007 and the LAD was 60% at that time. So I do not know if I am worse or not. It would be hard for me to know if a valve is involved. I also sometimes get very fatigued when I get short of breath. The short of breath that I am getting is like it is hard to breath and when I walk sometimes I have a hard time. This does not go on all the time. I thought a valve would have to get severe to be operated on.

Not at all. Although I don't think I'm the best person to answer them as I have many questions myself right now. I do have a brother who is a physican at Johns Hopkins and he has been very helpful in helping me obtain some pretty good literature/lectures on the subject. In fact, I just listened to a presentation by my surgeon, Steven Bolling, MD, on the subject of progressive TR post MVR and AVR surgeries. Apparently, it happens in 50% of patients who don't have cocommitant TR at the time of left-sided heart surgeries. In fact, he advocates for repairing the TV at the same time IF the TV annulous is = to or greater than 3.5cm even IF the TR is mild as it is proven that if the TVA is dialated to 3.5 or greater TR will very likely persist and late TR following left-sided heart surgery has a very poor prognosis. Mortality & morbitity is highest of any heart surgeries due to the fact that many patients are older and already have right-sided heart failure. Of course, I'm being told that most likely my TR and PH will improve, if not resolve itself completely within in time, but I find the information on this starteling as my TR was trace prior to surgery and now it's moderately-severe and my PH is moderate to severe as well. I'm going to give my heart the time it so obviously needs to heal and remodel itself before I get too freaked out here but it's definately something to keep and eye on. My biggest concern right now is the moderate to severe PH as I don't think this is being looked at or even considered. I've learned the hard way that one has to be proactive and agressive with their health care as I have been told so many things, many of which that were just plain WRONG. Everyone on here probably has at some point. For example, I went to Cleveland Clinic 3-4 months prior to surgery and was told that I had "functional" MR and that there was absolutely nothing anatomically wrong with my valve. They also told me that I would NEVER have to have surgery for my MV. Turn's out my surgeon was quite suprised when he opened me up to find my valve dialted to 3 times the size and severely leaking. I was also told from specialists at CC and U of M that MVR would not help my blood pressure...welll it did. Prior to surgery, I was on 10 medications and my BP was 220/125 at times....since my surgery it has stayed at normal levels. So....long story short is, Dr's don't know everything and I've learned to question them. I hope they are right this time and I will give it some time, but it's something to keep an eye on. As for your symptoms, it could be from your MR and TR, usually TR is well tolerated, meaning you don't become symptomatic until it's too late, BUT the MR certainly could be the cause. Keep an eye on it and question your DR's if these symptoms are not going away. Hope you feel better!

 

[deek]

Dee have they mentioned any other tests cus of your echo?
they may want to do,i had 2 echos since my 2nd surgery for
valve and of course i don't understand all the shamazzle #'s
either i know what severe means i have few them,but now i go
back for holter and pulmanary and another test on 18th,19
I'm gonna see what else he has to tell me regarding the echos and
whats concerning me is the severe atria dialation,but only found on
my echo,so i'm not worrying less he tells me i need to.
Just wondering if they requested any other tests for you.

Take care and in my prayers God Bless

zipper2 (DEB)

Thanks, Deb! No they haven't. Are there any tests that I should specifically ask for? I know Nancy mentioned a right-heart cath but I'm only 9 weeks post-op and I heard you have to wait longer than this following OHS. And I have a PM so and MRI/A is out. I saw my cardiologist on Friday and she dx me with CHF but believes I will get out of it and that my TR and PH will go away within time. My echo films were sent to my surgeon, as he requested them, so I'm still waiting on his impressions. I "think" he's going to say the same thing, at this point. If things still look this way at 6 months THEN and only then should I be concerned. Good luck to you and you will be in my prayers as well. You certainly have been through a lot and it's people like you who I find so inspiring. Take care! Dee

 

[ALCapshaw2]

I hope you don't mind me asking you questions. I have read many things you have written, and you seem to be well informed. I have been reading the information about the valves. I have moderate regurg. in both the mitral valve and the tricuspid. I have had the aortic valve replaced. I have not been told to have surgery on the others. I get symptoms of shortness of breath, but I also get squeezing/aching in the chest and jaw pain. I have blockages in arteries that have started to fill up 50% as of last cath 2007 and the LAD was 60% at that time. So I do not know if I am worse or not. It would be hard for me to know if a valve is involved. I also sometimes get very fatigued when I get short of breath. The short of breath that I am getting is like it is hard to breath and when I walk sometimes I have a hard time. This does not go on all the time. I thought a valve would have to get severe to be operated on.

Marilyn -

Jaw Pain is a Classis Symptom of Coronary Artery Disease, especially in women. I'm surprised your Cardiologist has not suggested having another Cath since it has been around 2 years since your last one. I think it's time to have a talk with your Cardio about getting another Cath (and echo if it's been more than 6 months since your last echo).

'AL Capshaw'

 

[ALCapshaw2]

Not at all. Although I don't think I'm the best person to answer them as I have many questions myself right now. I do have a brother who is a physican at Johns Hopkins and he has been very helpful in helping me obtain some pretty good literature/lectures on the subject. In fact, I just listened to a presentation by my surgeon, Steven Bolling, MD, on the subject of progressive TR post MVR and AVR surgeries. Apparently, it happens in 50% of patients who don't have cocommitant TR at the time of left-sided heart surgeries. In fact, he advocates for repairing the TV at the same time IF the TV annulous is = to or greater than 3.5cm even IF the TR is mild as it is proven that if the TVA is dialated to 3.5 or greater TR will very likely persist and late TR following left-sided heart surgery has a very poor prognosis. Mortality & morbitity is highest of any heart surgeries due to the fact that many patients are older and already have right-sided heart failure. Of course, I'm being told that most likely my TR and PH will improve, if not resolve itself completely within in time, but I find the information on this starteling as my TR was trace prior to surgery and now it's moderately-severe and my PH is moderate to severe as well. I'm going to give my heart the time it so obviously needs to heal and remodel itself before I get too freaked out here but it's definately something to keep and eye on. My biggest concern right now is the moderate to severe PH as I don't think this is being looked at or even considered. I've learned the hard way that one has to be proactive and agressive with their health care as I have been told so many things, many of which that were just plain WRONG. Everyone on here probably has at some point. For example, I went to Cleveland Clinic 3-4 months prior to surgery and was told that I had "functional" MR and that there was absolutely nothing anatomically wrong with my valve. They also told me that I would NEVER have to have surgery for my MV. Turn's out my surgeon was quite suprised when he opened me up to find my valve dialted to 3 times the size and severely leaking. I was also told from specialists at CC and U of M that MVR would not help my blood pressure...welll it did. Prior to surgery, I was on 10 medications and my BP was 220/125 at times....since my surgery it has stayed at normal levels. So....long story short is, Dr's don't know everything and I've learned to question them. I hope they are right this time and I will give it some time, but it's something to keep an eye on. As for your symptoms, it could be from your MR and TR, usually TR is well tolerated, meaning you don't become symptomatic until it's too late, BUT the MR certainly could be the cause. Keep an eye on it and question your DR's if these symptoms are not going away. Hope you feel better!

Dee - Have you updated the Surgeons who gave your WRONG information? If not, I would urge you to do so, not to be confrontational, but to educate them. How else will they learn that their impressions turned out to be erroneous?

'AL Capshaw'

 

[deek]

Dee - Have you updated the Surgeons who gave your WRONG information? If not, I would urge you to do so, not to be confrontational, but to educate them. How else will they learn that their impressions turned out to be erroneous?

'AL Capshaw'

I haven't, but it certainly IS my intension. The cardiologist was Dr. Shiota and the surgeon was Dr. Tomislav Mikalovic (sp?) both at CC.

 

[Hot Rod Harry]

I did have leaking right after MVR, which never got better, but progressively got worse. I wish you the best of luck Dee.