Need help with reading Echo

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.

ken taylor

Well-known member
Joined
Aug 15, 2009
Messages
152
Location
Boquete Panama
OK For those that understand My Echo please tell me what you think. Should I still be in the waiting room as Im still walking 1 to 2 hours a day or should I go to cleveland for a second openion, How long will it be ? your best guess before they will do the surgery. The left Ventrical is dialated by systolic diameter. Left venticular systolic is low to normal. LEVD vol(bp)=140 mi. LVES vol. (bp)=69ml. EF(bp)=51% LVOT TVI=17.2cm Mitral valve deceleration time is 201msec the transmitral spectral flow is suggestive of impaired LV relaxation Ec suggest increased LV filling pressure Doppler suggest left ventrical dysfuction Inferolateral wall akineses Remaining wall segments are normal. Arotic ValveAV max 3.7 m/sec Peak AV gradiente 55mmHG mean av gradiente is 29 mmHG Arotic valve area 0.97 m2 Mild arotic reguration QUESTION is for you yhat really understand this stuff. Should I still be in the waiting room and if so give me your best guess as to how much longer. Thanks Ken in TEXAS
 
Ken, the way that most cardiologists decide to refer people to a surgeon is looking at the echo cardiogram and checking off the symptoms a patient is experiencing. The things that jump out at me include impaired LV relaxation, a reduced ejection fraction, a distinct pressure gradient and aortic valve area of less than 1 cm2. The stiffness in the left ventricle is caused by the heart's long term struggle to push blood through the narrow valve. If the valve is not replaced soon enough, it is possible the left ventricle will never recover its ability to relax leaving you with "diastolic dysfunction". You may then have to live with reduced exercise tolerance and symptoms of congestive heart failure after your recovery is substantially complete. The reduced ejection fraction is not too bad yet but it is unlikely to improve until the valve is replaced. Likewise, the pressure gradient will continue to rise. Some surgeons want to replace valves when the valve area drops below 1.0 cm2 many cardiologists want to wait until the valve area drops to something more like 0.7 cm2. One of the things that is important is how fast your pressure gradient is rising and the valve area is being reduced. Do you have your previous report? It should give you a feel for the difference in pressure gradient and valve area over time. Only this kind of comparison will tell you how rapidly the valve is degrading. You must also keep in mind that the values produced via an echocardiogram are generally considered less accurate than a heart cath so your actual values may be different. In my own case, my valve went from 1.25 cm2 to 0.69 cm2 in seven months. I don't think anyone can tell you how fast your valve is changing. I think one can only be certain of the rate of change by following the reports over time.

You didn't mention experiencing any symptoms. There, again, you will find that many cardiologists want to wait until symptoms are beginning to seriously alter your life. My cardiologist only referred me to a surgeon when I began experiencing chest pains. My surgeon said that he would have prefered to replace the valve before any symptoms appeared since the valve is never going to improve and he would prefer surgery while the patient is still reasonably healthy. As patients, we have to navigate between these somewhat different viewpoints. For this reason, a second opinion from a surgeon can be very helpful.

Larry
 
Thanks ; I mfeel the same as you. Thats why I think to go to Cleveland. My DR. in Houston seems to want to hold off surgery until I show symptoms. Here is the ECHO from 1 year ago. The left ventricle is mildly dialated there is moderate dilated. there is moderate septal hypertrophy. LVED vol.(bp)= 151ml. LVES vol. =75 ml. EF (bp)= 75ml.EF (bp) =50% LVOT TVI =21.1 cm. mitral deceleration time is 254ml. the transmitral spectral spectral doppler flow pattern is suggestive oe impaired LV relaxation. Left ventricular systolic function is low normal. Remaining wall segments are normal. Inferolateral wall is thin and akinetic. The arotic valve leaflets are moderately thickened . The aortic valve is moderately calcified . Arotic valve appears moderately reduced. A bicuspid aortic valve cannot be excluded. Peak Av gradient=61mmHG. Mean AV gradient = 36 mmHG. LVOTTVI=20 cm. the aortic valve area =1.0cm2. AV TVI=94cm. Moderate to severe arotic stenoses. Mild arotic regurtation. Another thing at the time this ECHO. was done I insisted on a Cath. After the cath ,they told me it was not much diffrent than this ECHO. Now my queston that I just ask them- And I am waiteing for there answer is - Why do they say that a bicusped valve can not be ruller out? Would the cath answer that Question? are is that only determained at the time they cut the old valve out. THANKS ALL FOR YOUR COMMENTS. Im thinking of going to cleveland to see if they will do the surgery now. Are will they keep me on hold . Im 61 years old and in good health . IN saying that I want my recovery to be with a good heart. not comprimised.
 
As a CCF patient, I do not understand why you would talk to a surgeon before the Cardio says it is time. I would get opinions form other Cardios, however I believe there are some pretty good Cardios in Houston. Cosgrove did my 1st and I only met him after surgery in the ICU. I am not saying that is a good thing, but I strongly believe the Cardio is the one to make the call. You may be able to get your cardio to get the 2nd opinion from a Cleveland cardio without a trip there.

With no symptoms, I would be happy and continue walking 1-2 hours a day.
 
Why should I want to hold off on surgery? how can waiteing for the heart to be compromised before proceding be benificial. It will not get better in time, and my heart will not be as strong as it is now. The only way to get better is surgery. Plus im tired of living with this over my head all the time. Lets fix it and move on!! Ken
 
As a CCF patient, I do not understand why you would talk to a surgeon before the Cardio says it is time. .

Becasue, as has often been said here on VR.org, cardios tend to want to wait until symptoms occur before pulling the trigger, whereas surgeons prefer to operate before permanent damage is done to the heart. Symptoms can be a sign that the heart is already damaged. There is no harm in talking to a surgeon and getting a surgical second opinion.

Jim
 
Well, as one who has "pulled the plug" on my (former) cardio and gone to the surgeon, tests and files in hand, I can empathize with your quandary. Cardiologists do not always provide the go-ahead when you feel the time is right. They have a tendency to want to keep you from the surgery as long as possible. This is because there is a fatality rate (about 1%) for patients in otherwise normal health, and because the surgery is life-altering. A loose rule of thumb (similar to what Jim has pointed out) is that Cardiologists tend to want to help us avoid the immediate danger of the surgery, and surgeons want avoid waiting, so they are operating on the strongest heart they can, and so the heart is least likely to remain compromised after the surgery heals.

However, some of us know what we're expecting, and feel competent to push that decision, assuming that the surgery and our disease state fall into the normal bounds of ethical medical professional practice.

The defacto standard for surgery for aortic stenosis is when the valve opening is less than 1.0 cm². Some doctors like to wait longer, even as low as .6 cm² (mostly the cardiologists, rather than the cardio-thoracic surgeons). I personally feel that is way too long for most patients. Additionally, most cardiologists and surgeons would like to know that you are experiencing symptoms that show that your heart is under severe stress.

You are on the cusp, but not quite there yet. Your gradients are high, and your stenosis is at the point where the calcification is classically also causing regurgitation (insufficiency) by blocking the valve from closing properly as well as opening fully. Likely, it won't be long for your valve opening to get defensibly under 1.0 cm². (May show as aortic opening, effective valve opening, valve area, aortic aperture, or similar wording on echo report.) The speed of calcification accelerates with time: the worse it gets, the faster it gets worse. Tally your symptoms, and make sure your cardiologist is aware of them. Ask for an echo in six months, if they're not already suggesting that.

That being said, your heart is not typical for this situation. Your left ventricle is dilated, not specifically muscularly enlarged: it's contracting with less vigor than normal, and you are experiencing akinesis (lack of muscle contraction) in the interior wall of that ventricle. Your ejection fraction (EF) is normal, but at the very low end of normal. Most hearts in this situation are muscularly enlarged and pumping like athelete's hearts, with EFs in the mid to high sixties. This should also play into the decision, especially in terms of performing the surgery while your heart is in its best possible condition. It may raise your operative risk to some slight extent, although I couldn't guess how much. Ask the surgeon about that.

I don't think that most surgeons would go for it quite yet, but I don't think it far on the horizon. Likely, your next echo (in six months) will put you undeniably into the ethically operable category.

Without question, waiting is the hardest part .

Best wishes,
 
Last edited:
Thank you very much!! I love this family. Tobagotwo , skeptic and scott. QUESTION I like pushing my self, Do you think the 2 hour walks are good or bad. My heart rate stays mostly in the 90 range and goes up for a few minutes on the hill to 125. most of the walk it stays at 100. and also my last blood pressure test 117/74 but most of the time 120/80-- as I near the point of surgery will that change and be a signal to watch. Thanks Ken
 
HI, Ken-

Welcome to the waiting room. It is excruciating at times. I waited with an aortic diameter sitting at 1 cm2 for 12 years! My pressures were lower than yours though. Then suddenly last year there was a drop to .8 cm2 and now at .7-.8cm2. My mean pressure is 42mmHG and peak is 75mmHG. My left ventrical is just barely starting to enlarge. Up until about 1 year ago I was asymptomatic. I am scheduled for surgery in 6 weeks.

I agree with others here to tell you not to panic, but definitely keep a more frequent check on your measurements and perhaps consult a surgeon for input. My surgeon was able to "listen" to my heart last week and told me it doesn't really sound "tight" yet, but because I'm symptomatic he thinks it is time.

Some athletic folks never have symptoms. But do keep a close eye on yourself for any changes. It is tough because the symptoms tend to creep up slowly so you don't really notice if you're not paying attention until suddenly one day you're like "Hey--am I getting old or what?". My symptoms started with me feeling sort of light headed like I had low blood sugar. Got that tested while feeling light headed and the blood sugar was fine. The main thing I have noticed is a reduced exercise tolerance--exercise used to make me feel stronger. Now it just makes me tired. And my walking pace has slowed unconciously to keep from getting out of breath and heart palpitations. Also, sometimes I have a hard time catching my breath when I lay down on my side. Hopefully, you never have any of those sypmtoms. They are minor enough to ignore or blame on something else, but I now realize that's probably a bad idea.

Good luck!
 

Latest posts

Back
Top