Second Echocardiogram

[Nocturne]

Going to get my second echo done to check for AS progression (last one was about 18 months ago). Hoping for a miracle but considering that I can still hear the damn murmur I'm prepping for yet another test where the doc looks at the results and has to spend a few minutes finding his eyeballs on the floor and putting them back into his skull. "At YOUR age?!?"

We'll see. As I understand it this is a big one because it a second data point allows a rough graph of progression rate to be made. Scant progression won't reveal much but there's always the chance to leaping from very mild stenosis to moderate or even severe in a year. Never happens? We'll see.

 

[Nocturne]

Well... Tech told me "mild" stenosis, and definitely a regular old tricuspid aortic valve with calcification. None of which is a huge surprise -- but I want to see the numbers. I was "very mild" before, and some of the numbers weren't QUITE above the threshold.

 

[dornole]

Good news Nocturne. I hope this helps you worry a little less. You could be in for a long stretch before you need to do anything at all, except for diligently going to your appts.

 

[Paleowoman]

Once you see the cardiologist Nocturne you should get a copy of the echo results and then you'll be be able to check the pressure gradient which will give an indication of the stenosis. Did you get the results of those blood tests your new cardiologist was going to do ? I may have missed something but I seem to remember you wrote that she had ordered some tests.

 

[Nocturne]

I need to get my hands on the old test numbers and compare them to the new when they are available.

ISTR the peak velocity was 2.3 M/sec and mean pressure gradient was about 13 mmHg last time.

Old test was done by another doc, and not in the same system. I have a copy on my phone somewhere, I think, if nothing else -- would like to get it to the new doc, actually.

 

[epstns]

That really doesn't sound bad, nocturne. Mild stenosis shouldn't get in the way of your life much, if at all. Just need to keep a fairly close watch on it. Also, be aware of the timing of your murmur. Some murmurs "peak" (their sound on the echo gets higher-pitched) early in the cycle, some closer to the middle, and others late in the cycle. The later in the cycle your murmur peaks, the stiffer your valve leaflets likely are. As my stenosis became more and more severe, the peak audibly moved later in the cycle. Late-peaking murmurs are one of the informal/subjective measures used in assessing readiness for surgery.

All that being said, you may be in The Waiting Room for quite a long time. There is no real way to draw statistical inferences or make projections as to when your valve will become small enough to warrant surgery. We all progress at different rates, and the progression is not linear, nor is it predictable. That's why they put us on regular follow-up schedules rather than calculating how many years to wait before checking it again.

 

[Nocturne]

Thanks, all.

So I got the data back and compared it with my old echo from 15 months ago.

Doc's notes said I have a bicuspid valve, which surprised me as three different techs had said it looked normal (although two of those seemed unsure). Further notes say that "there is focal aortic leaflet calcification" and "the non/left commissure is calcified resulting in bileaflet morphology", which to me says I was born with a normal aortic valve that calcified into a bicuspid one. I've never read about this happening before, so... curious.

Doc also notes "mild aortic stenosis" with V1/V2 of 0.39. There is "trace" aortic regurgitation, where there was none 15 months ago.

15 months ago, my peak velocity was 2.36 m/s. It is now 2.40 m/s -- this is fairly slow progression, right?

15 months ago, my peak gradient was 22.3 mmHg. It now appears to be 28 mmHg. That seems like more rapid progression.

The only other real concern I have here is PV Vmax (which I take to mean maximum velocity across the Pulmonary Valve) of 1.25 m/s, where the norm is 0.6-0.9 m/s. This makes me worry about pulmonary stenosis, but doc's note says that "the pulmonic valve appears normal in structure and function".

Pretty much everything else looked normal, except for "physiologic" regurgitation in the mitral and tricuspid valves.

Aortic diameter is 29 mm. This looks to be about average -- I seem to remember some talk here about artificial valves smaller than a certain diameter being problematic. I'm safely larger than that? I cannot remember the magic number.

Anyway, thanks. I was worried immediately after reading my results until after I compared them to last year's and figured they weren't so bad. Not as good as miraculous remission, but not terrible either.

 

[Nocturne]

(Post deleted due to duplication)

 

[Nocturne]

On further investigation, my V1/V2 ratio looks really low compared to my other numbers -- by itself just suggestive of moderate aortic stenosis while my other numbers suggest mild or not even mild stenosis. What gives? Something else to ask the doc I guess. Just weird that by most measures I'm barely mild, if that, but V1/V2 is into moderate territory.