Question about pressure gradients

[Simon Booker]

Hi there

My Dad is getting on very well after an AVR last summer in Oxford, UK. We had a twelve month check up recently and got some confused information back from the Consultant that I just don't recognise. I recall being told that the pressure gradient was absolutely fine but that the gradient was 7? Does that make any sense?

Kind regards

Simon

 

[ARGreenMN]

Here's my understanding, but I'm no expert. The gradient is the difference in pressure on one side of the valve vs. the other. Ideally there would be little difference, so the gradient would be small. When a valve is bad (like mine was before surgery) the gradient can get pretty high, which is not good. They measure both the mean (avg) gradient and the peak gradient. That number you stated (7) sounds like a mean gradient to me, and it's fabulous to be in single digits. That's what the valve manufacturers shoot for. The peak gradient is higher than the mean and I'm not sure what "good" numbers are for peak, but I think my numbers before surgery were 85 for the mean and my peak was 128 (both very, very high - thus the need for surgery).

 

[ALCapshaw2]

Pressure Gradients are measured in *millimeters of Mercury*, abbreviated mmHg (Hg is the chemical abbreviation for Mercury). Anything less than 10 mmHg is pretty Low.

'AL Capshaw'

 

[Lily]

I "think" as a valve opening gets smaller the gradients get higher. But there are several gradients to measure within the heart and there are other things that can go wrong with the heart (besides bad valves) that can also cause gradient problems. As my bioprosthetic valve opening has gotten smaller, my pressure gradients have gotten higher -- and it's not a good thing.

 

[dick0236]

Here's my understanding, but I'm no expert. The gradient is the difference in pressure on one side of the valve vs. the other. Ideally there would be little difference, so the gradient would be small. When a valve is bad (like mine was before surgery) the gradient can get pretty high, which is not good. They measure both the mean (avg) gradient and the peak gradient. That number you stated (7) sounds like a mean gradient to me, and it's fabulous to be in single digits. That's what the valve manufacturers shoot for. The peak gradient is higher than the mean and I'm not sure what "good" numbers are for peak, but I think my numbers before surgery were 85 for the mean and my peak was 128 (both very, very high - thus the need for surgery).

Thanks for this post Andy. I know very little about the specifics of "why" I needed surgery.....back then I just trusted that the doctors knew what was in my best interest. One of the few medical records I've seen, concerning my situation in 1967, was " Cardiac catheterization was performed and showed that he had a gradienet of 117mm over the aortic valve". Assuming that we are talking "apples too apples", your post makes me more comfortable in my decision to have the surgery "back then".

 

[Simon Booker]

thanks very much - it is good to know that the gradient seems good!

Kind regards

Simon

 

[skrob49]

Hi there

My Dad is getting on very well after an AVR last summer in Oxford, UK. We had a twelve month check up recently and got some confused information back from the Consultant that I just don't recognise. I recall being told that the pressure gradient was absolutely fine but that the gradient was 7? Does that make any sense?

Kind regards

Simon

10 days post OP (StJudeRegent 19mm), my wife's TTE reads 17mmHg/39mmHg for mean and peak gradient. Our surgeon said it is okie but seems high to me. Hope the gradients will improve as the valve stablises. I plan to ask the cardiologist next week and keep you posted. Meanwhile, congratulations, absolutely fantastic to have such low gradients. By the way, what type of valve replacement was it ??

 

[Simon Booker]

Thanks - the valve was an Edwards Perimount Bovine tissue 23mm - implanted in May 2009. I'm not sure what the immediate post-op gradients were, but it seems logical that things might settle down over time. Since posting my original question, I've got more information from the cardiologist - apparently the peak pressure gradient is 14mmhg - so I'm guessing the mean is 7mmhg.

He does have a minor leak across the seat of the valve - but it seems the cardio is relaxed about this - they suggest two yr monitoring.

Simon