TEE results indicate valve has improved

[TakeStock]

I fell asleep during my TEE yesterday and the doctor left before I woke up, so I never got to ask whether the regurgitation had improved as the angiogram results showed. The nurse only heard him say the vegetation was all gone, but nothing else. Finally today I was able to get a hold of my cardio?s nurse and she looked up the results online: my mitral valve regurgitation has now been classified as ?moderate-severe? instead of severe (4+), so apparently the vegetation from the endocarditis was affecting my valve?s ability to close all the way.

This is what my first surgeon was expecting after the angio?s results (it showed ?moderate? regurg) and he had said if the valve showed improvement we should hold off surgery. At first I was bothered by a sudden change in plans so close to my surgery date of March 18. But after thinking it over this weekend, I think I?ve decided that putting this off a few years or more, if the cardio and surgeons agree, would be my preference. I had built up a mindset that welcomed the OHS, so once the possibility of avoiding surgery crept into my thoughts, it ate away my courage like a strep infection. So now that I?ve entertained thoughts of a surgery-free future, I just hope the surgeons/cardio agree when I finally get their phone calls (could be a few more days with these guys ).

For now, assume my March 18 MVR is at least postponed. If everyone feels surgery is still needed, I?ll need at least an extra week after the 18th to get ready since I?ve had to put everything on hold pending these results. Since my heart measurements, my pulmonary pressure and my EF are all normal, I don?t think my surgeon will have a problem with that.

Out of curiosity, who out there has ?moderate-severe? MV regurgitation and has been told to wait for surgery, and who has been told to go ahead with surgery?

 

[pnwcoast]

I had severe mitral regurg and my cardio encouraged me to get it fixed. Sooner the better he said.
I had some heart enlargement at the time, slight but still, any damage is not a good thing. I waited several more years. My heart is still a bit large "mild left atrial enlargement" they call it.
Everybody is different but the waiting I did (for two years) was not in my best interest. I shoulda had it done when my cardio said I needed it fixed.

 

[TakeStock]

pnwcoast, if I don't get the surgery now I'll definitely be getting echo's every 6 months or so to see if the LV begins to get enlarged. Since this all came from endocarditis, not chronic MVP, I have no idea if and when my heart may become enlarged.

BTW, I was somewhat surprised that my original TTE echo results on Feb 11 were proven invalid after the angio and TEE showed less regurg. I found this article which does a good job of explaining the different tests for mitral valve regurg, and the pros/cons of each.

http://emedicine.medscape.com/article/349648-imaging

I would say that if your cardio makes your MV surgery decision solely on a TTE, you should probably get a new cardiologist. The TTE is better for aorta valve diagnosis though.

 

[mrsnuffles]

I have moderate-severe mitral regurgitation and am due for repair surgery in the coming weeks. I have seen two surgeons and both have advised repair as soon as the waiting list allows. I have also read lots of literature which is of the general opinion that early intervention in moderate-severe regurgitation cases is preferred. The risk of operative problems is so low these days, they feel the avoidance of enlargement of the heart is preferable over waiting to see what happens. I guess it also depends on why the valve is leaking. In my case it is due to ruptured chordae and the concern for the surgeons is that at any time one or more further chordae may rupture which may make the problem a whole lot worse in a short space of time.

My opinion, and this is only my opinion based on my own experiences, is that as you are already expecting to have the surgery, maybe you are putting off the inevitable and perhaps if now is the right time in your life to get the surgery done, you should do it.

I hope whatever you decide, you have a successful surgery (whenever that may be).

Andrew

 

[Mary]

Bill,
For what it's worth, I don't know a thing about mitral valve regurgitation, but if you can postpone surgery without damaging the heart, I'd delay it as long as possible.

 

[Nupur]

Bill, very happy at the resolution. What are the numbers that the TEE showed, of EF and LV size? Btw, I am realizing, from my own experience, that reading an ECHO is kind of hard and the degree of regurgitation is hard to quantify in some cases. For me, the leak is like a big squirt from the corner and so they can't measure the regurgitation orifice which typically tells you the grade I think. The first echo classified me as severe, the TEE as mod-severe, and when the surgeon looked at it, he said he would call it moderate.

 

[pnwcoast]

pnwcoast, if I don't get the surgery now I'll definitely be getting echo's every 6 months or so to see if the LV begins to get enlarged. Since this all came from endocarditis, not chronic MVP, I have no idea if and when my heart may become enlarged.

BTW, I was somewhat surprised that my original TTE echo results on Feb 11 were proven invalid after the angio and TEE showed less regurg. I found this article which does a good job of explaining the different tests for mitral valve regurg, and the pros/cons of each.

http://emedicine.medscape.com/article/349648-imaging

I would say that if your cardio makes your MV surgery decision solely on a TTE, you should probably get a new cardiologist. The TTE is better for aorta valve diagnosis though.

I think 6 months is a good standard. That's where my cardio put me for several years prior to my surgery. Even though your situation is different than mine I think it's a good idea to keep a close eye on it. If nothing changes you my go to a 1 year echo.

 

[TakeStock]

Nupur, I think we are in the same boat as my TTE said severe, my angio said moderate and my TEE said mod-severe. I'll let you know what my surgeons and cardio think, but I'd be suprised if they don't all say we should wait, seeing as my heart is actually getting better, not worse. I definitely had severe regurg 2 months ago but with the strep vegetation gone, the valve is working better. I've been told that this could happen by a few nurses and by my infectious disease doctor, but it's not something that's well documented on the internet. When my cardio saw my first TTE in December he said I should plan for surgery within a month, not knowing I had endocarditis at the time. And little did I know that having endo might turn out to be a good thing -- because it meant with treatment my regurg might get better and surgery might be avoidable.

I didn't get the full report but my EF was 60% and my LV sizes were "normal" according to the nurse.

 

[Curtsmum]

My son had moderate/severe mitral regurgitation he also had stenosis. We waited and waited for surgery, then we was told he was plumonary hypertensive and had to be put on medication, so i see it as they left him to long before surgery.
If you can wait for surgery with no problems that will be a good thing.
Hope everything works out for you, all the best with which ever way it turns out.