Regurgitation Level and Symptoms Question

[erin]

There have been a few questions on my mind since my last cardio appt. and I thought y?all might know.

I have read in a few threads that some people have symptoms before severe regurgitation? Is this a result of their regurgitation or the result of a secondary, complicating factor? Does anyone know of any references that discuss this?

Can a person?s size impact the reading of results? I have a smaller frame and wonder how that translates to traditional breaks of regurgitation, aneurysms, etc.

Also, my cardio said that an artificial valve could do no better than my current valve (which is moderate), however, I have read individuals post-replacement where they say their valves are back to ?normal?. Is normal post-replacement ?moderate?? or is normal back to ?trace??

As always thank you tons for all the help!

 

[erin]

I thought of another question I forgot...

and I think I know the answer, but just to be sure I understand:

Does your blood pressure level alter your regurgitation level?

Thanks so much!!!!!

 

[RandyL]

All I can tell you is it is different for everybody however Normal should be no leakage or maybe a slight trace and this is where you should be after surgery whether it is a tissue valve or mechanical valve. Thats of course why you are having the surgery so that you don't have any regurgitation.

 

[Kate]

Hi Erin,
I don't know the answer to most of your questions - someone else will likely be along soon who does. However, as a relatively small person myself (5'3"), I did discover that size matters with some measurements. For example, I had a 4.8cm aortic aneurysm - below the size normally operated on - but my surgeon decided to operate because, for someone as small as I am, this actually is a pretty big aneurysm. I believe similar issues can come up when considering ventricle size. Of course, there are many critical measurements - like pressure gradient - that aren't about size and would not be impacted by this. Hope this helps, Kate

 

[pipersmith]

Thanks for asking

Thanks for asking

I have wondered this myself. My aortic insufficiency is severe based on flow measurements - according to the ECHO and TEE. My ejection fraction is within the normal range, so I too have been wondering why I am so symptomatic. I have a nagging feeling that another issue is involved - I will be glad to read the responses to your questions.

I know from reading and from the surgeon that many people require surgery that have no apparent symptoms, and that symptoms are an indication for a need for surgery, even if the measurements do not indicate the need.

Good luck....

 

[davidfortune]

People are different. This shouldn't be a revelation to any of us. Some thin people have coronary artery disease, some fat smokers live without CAD or lung cancer. Some non-smokers get lung cancer.

People are different. Our bodies respond, adapt, and quit at different levels. The heart deals with diminished efficiency (which is what regurgitation is all about) differently in different people. Too many factors (some of which are unknown and will always remain so) to be able to definitively determine causality.

Why do some valves degenerate faster than others? Genetics? God's Providence? Exercise (or lack of) History? Smoking? Cholesterol? Bad Juju? There is often no way to determine. It just is. Sometimes we think we know the reason but really we just have a theory since proof requires repeatability.

Interesting comment from the Doc re: artificial valve always having moderate regurg. I would ask for clarification on that one. What does he mean by artificial? I don't believe that is true for some bioprosthetic valves or for an autograft in the case of AVR.

Trace, Mild, Moderate, Severe.... These are opinions and in most cases educated guesses. Unless you have a MUGA the interpretation of regurgitation is based on skill of the technician (Huge factor), quality of the echo (Huge factor), and experience of the doc interpreting (Huge factor). There is reasonable variability among all three of these to cause the classification to be a reasonable estimate.

I concentrate more about symptoms or heart measurements.

As others have said sometimes size matters sometimes it doesn't. Relative size always matters if you are lucky enough to have enough history. If your aorta is 1.5 times its normal size that is bad. If you know what normal is for you. If not they can guestimate based on body surface area but it is an estimate.

There are many indicators for surgery and each of us reach that threshold differently. Symptoms and size don't always match.

Best of luck.

 

[Marge]

<< Unless you have a MUGGA the interpretation of regurgitation is based on skill of the technician (Huge factor), quality of the echo (Huge factor), and experience of the doc interpreting (Huge factor). >>

I've not seen much on this board about MUGA. I had a MUGA about a year and a half ago. I didn't know it was much good for measuring regurgitation. But it is, according to my cardio, the gold standard for an accurate measurement of EF, much more accurate for that than an echo. My MUGA showed an EF in the low 50s, whereas my echo had shown an EF of 35!

One thing about MUGA, though -- they can't do it with patients who have certain arrhythmias (A-fib or A-flutter). So now, acc. to my latest echo, I still have a 35 EF, but I can't do another MUGA, because now I have chronic A-flutter. Darn! I sure would like to be able to check what my EF really is.

My cardio sez: Just think of your EF as being somewhere between 35 and 55. Great help, huh? Either it's normal (low normal, but normal) or it's severely impaired! Take yer choice!!!!

 

[tobagotwo]

David said it. Everyone's different. And no, from the postings I've seen, you really couldn't correlate secondary factors to the advent of symptoms.

There are certain fitness factors that can make a difference. Ultrafit cyclists tend to be so fit that they don't know they need surgery until they're at risk of sudden death. Heavyset folks, particularly inactive ones, are apt to feel symptoms sooner. However, neither speaks to other issues in the heart besides the valve problem.

However, there are cyclists who are symptomatic at moderate stenosis or regurgitation, and those with largesse who never do seem to get symptoms.

The hardest part is judging your own symptoms. We tend to toss them off as having been from too much lunch, or getting older, or some other convenient excuse. We don't want to think we're in trouble enough to have symptoms.

To an extent, blood pressure and the natural size of your arteries has to affect the gradients for stenosis, but the variance is not all that large.

Get all of your echoes, back to the first, and concentrate on the size of your left ventricle's chambers, and wall thicknesses. Being small, it could take you a lot of heart expansion before your left ventricle actually reaches the "official" hypertrophy size. What should be more important to you is how much it's grown since the beginning, and if that growth is accelerating.

Best wishes,