Which is more accurate?

[Jim C.]

Does anyone know if a 64 slice CT scan measurement is more accurate than an echo measurement? I recently (May 09) had my annual echo done (same echo tech for 10 years) and it showed a 4.0cm "mild ascending aortic dilation". I just had a Coronary Calcium score done at "Heartsavers" for the very first time, and they mention, on the side, that they observed a "diffuse ectatic ascending aorta measuring 4.3cm".
The good news is that they gave me a calcium score of only 31 for the coronary arteries. This implies that they are very low in calcified plaque but that 4.3cm aorta startled me.

My latest Echo results (My cardiologist seemed happy with the numbers)
Aortic Root = 3.8
Ascending Aorta= 4.0
Aortic valve area= 1.5
Aortic Regurg.= Mild
Peak gradient= 34
Mean gradient = 19
EF = 65
Any opinions are greatly appreciated. Thanks, Jim C.

 

[Ross]

A 64 slice CT beats an echo any day!

 

[ALCapshaw2]

MY (Non-Professional) assessment of your Echo Numbers would be that you are in the "Watch and Wait" Mode and are showing early signs of Aortic Stenosis and an Ascending Aortic Aneurism.

How often does your Cardiologist recommend checking your status with an Echocardiogram? Personally, I would want to be checked every 6 months with those numbers and would NOT accept anything over 1 year.

Echocardiograms are a good Low Cost Non-Invasive "First Assessment" for Valve and Root issues. The numbers are highly dependent on the skill and knowledge of the Technicial performing the Echo.

You may also want to start interviewing Surgeons so that you will have someone Lined Up WHEN the time comes. One of our VR.com sayings is:
"The Worse Things Get, the FASTER they get Worse".

Be sure to tell your Cardiologist of any sign of Symptoms
such as Shortness of Breath, Lack of Stamina, Fatigue, difficulty sleeping, or irregular Heart Rhythms.

Has anyone advised you that you have a BiCuspid Aortic Valve (BAV)?
BAV is often associated with Connective Tissue Disorder (CTD) which is often associated with an Ascending Aortic Aneurism. See the BAV and CTD Forum for considerable information on these often linked conditions and their treatment.

IF you have BAV and CTD, you will want to find a Surgeon with LOTS of Experience dealing with those issues. Surgery of the Aorta is a Big Step Beyond "mere" Valve Replacement Surgery. You will most likely find such surgeons at Major Heart Hospitals and Not at Local / Regional Hospitals.

Feel free to ask any Questions that come to mind as you progress on your journey.

'AL Capshaw'

 

[Reddog]

CTs vs. Echoes

CTs vs. Echoes

One cardiac surgeon that I spoke with says that he trusts CT scans for spatial measurements (particularly since it gives a more complete view), and that echoes are more useful for measuring valve flow/leakage.

 

[skeptic49]

Welocme to VR, Jim! Some of your numbers are similar to mine...when last measured I was 4.3 cm on the ascending aorta and my valve area was 1.3 cm2. My gradients are somewhat higher than yours. As Al mentioned, you should know if your aortic valve is bicuspid. Mine is. My current status is waiting with a yearly echo and CT scan. I have met with a surgeon so I have someone lined up for when the time comes. I want it done now while I'm relatively healthy and strong, but my cardio and surgeon say wait.

Best wishes,

Jim

 

[Jim C.]

Thanks to all of you for the support. I am so glad I found this forum. This was my first post.
I am 54 years old and found out I had a BAV around 10 years ago. I was told that I would eventually need a valve replacement... but I am just now realizing I may need something done with the Aorta as well. Do they ever replace the valve and expect the Aorta to stabilize? I will need to talk to my cardiologist about this and also ask why he never mentioned it to me. He only does an echo once a year and says there isn't much that we can do except wait. Maybe he's right... but my General Practitioner is more concerned and started treating my blood pressure (was 150's/90's) with Benicar and Metoprolol. I'm wondering if I need to find a cardiologist that is more attentive.
It's difficult to find out which cardiologists have special interests in valve problems. Even though I live in Maryland I was considering making the trip to the Cleveland Clinic once or twice a year to get top quality care. Johns Hopkins and Univ. of Maryland don't seem to rate very well on "Healthgrades".

 

[ALCapshaw2]

IF you have a Connective Tissue Disorder it will NOT get better. It will need to be REPLACED.

My belief is that once you are diagnosed with BAV and an Aneurism, the only thing that your Cardiologist can do is monitor your condition (echo's, maybe a cath) and prescribe Blood Pressure Meds.

IMO, it is the SURGEONS who are most knowledgable about Valves and Aneurisms. You need to be interviewing Surgeons for their more focused assessment and to have someone 'in the ready' for when the time comes. I also believe that Surgeons have a better feel for timing.

I was surprised by your finding on Johns Hopkins and Univ of Md. You can't go wrong with Cleveland Clinic. Maybe it's time to give them a call.

'AL Capshaw'

 

[COLLEEN S]

Hopkins is third in the country for heart surgery, I had mine there under Duke Cameron. Very knowledgeable, also a professor at the medical school. Mine was aortic ascending, 8.0 , held in place by prior Ross surgery scar tissue, plus aortic St. Jude valve implanted for wide open shredded valve from BVD. Guess I prob have connective tissue disease too, nobody ever told me that though.
Come back and let us know how it is going.

 

[Lynlw]

Thanks to all of you for the support. I am so glad I found this forum. This was my first post.
I am 54 years old and found out I had a BAV around 10 years ago. I was told that I would eventually need a valve replacement... but I am just now realizing I may need something done with the Aorta as well. Do they ever replace the valve and expect the Aorta to stabilize? I will need to talk to my cardiologist about this and also ask why he never mentioned it to me. He only does an echo once a year and says there isn't much that we can do except wait. Maybe he's right... but my General Practitioner is more concerned and started treating my blood pressure (was 150's/90's) with Benicar and Metoprolol. I'm wondering if I need to find a cardiologist that is more attentive.
It's difficult to find out which cardiologists have special interests in valve problems. Even though I live in Maryland I was considering making the trip to the Cleveland Clinic once or twice a year to get top quality care. Johns Hopkins and Univ. of Maryland don't seem to rate very well on "Healthgrades".

I don't know how Hopkins ranks as a whole hospital but they are usually in the top 5 for hearts at the US News best hospitals. OF course most of the data for "hearts" is for bypasses, but I seem to recall one of the best aorta guys, Cameron is at Hopkins

edited I just looked and the 2008 rankings has Hopkins #1 for over all best Hospital http://health.usnews.com/articles/health/best-hospitals/2008/07/10/best-hospitals-honor-roll.html

 

[cbdheartman]

Jim,

The CT is must certainly more accurate. I was told at Cleveland Clinic that they often use the echo to determine whether to send you for the CT. Also, I learned from Dr. Cameron at Hopkins that the CT is more accurate than the cardiac MRI, but if you are younger they like to do the MRI because doesn't involve radiation.

I am living in Silver Spring and I am debating between CC and Hopkins. From my research and sense of things, I think you will find surgeons who are just as good at Hopkins as at CC. The downside at Hopkins consists in the aesthetics. The place is kind of dumpy whereas Cleveland is pristine, new and beautiful.

I will say having interviewed and met with surgeons at both places, Dr. Duke Cameron is really a remarkable man. He isn't your typical surgeon. He has a great humanity and takes a real interest in you.

 

[Maryka]

Well, I would say that Hopkins is historical and exam rooms are tiny, but clean. My hospital room there was huge, clean and good hygiene was always practiced. My view from my room was of the beautiful and historic Johns Hopkins Dome. It was late December, but I loved to watch the sun reflect off the dome.

I found a post card with a picture of the hospital with the dome centered--an anchor for all the new and old hospital around it. My hospital room window is a tiny speck in the back, but it is there. I keep the card at my desk at work and think about those hard but hopeful times in my life!

As I have mentioned before, Duke Cameron was made the head of the cardiac surgery department the day after he did my surgery. I like to think I am responsible for his long-awaited chance to take his rightful position!