Cardio appt. echo

[Mb]

Hello guys:

Here is my husbands most recent echo report. All input welcome.

Mitral Valve:
St. Jude valve in mitral positiion. Normally seated. Peak transmitral gradient is 12mmhg. Mean is 3mmHg. Mitral regurgitation by color and spectral Doppler. Degree is difficult to assess due to prosthesis shadowing. However, proximal flow convegence on the aneromedial side of the valve suggests a mild paravalular leak. There is focal thickening of the mitral chordae.

Left Atrium:
The LA is dilated.

Aortic Valve:
St. Jude v, in aortic position. Well seated. Peak AV gradient is 41mmHg, mean is 21mmHg. Evident of trace aortic insufficiency by color Dopplar. Also evidence of a miold posterior paravalvular leak unlike the normal jets by Doppler. Ascending aorta diameter above the sinotubular junction is 33mm.

The left ventriular cavity size is normal The left vent. systoclic function is within normal limits. Mild symmetric left vent. hypertrophy. EF of 73%

Tricuspid Valve:

There is color and spectral Doppler evident of severe tricuspid insufficiency with systolic flow reversal in the hepatic veins. There is incomplete TV closure. There is prominent right atrial dilitation. The superior/inferior RA dimension is 62mm. The medial-lateral right atrial dimension is 65mm.

Pulmonary valve:
Trace PV insufficnency. The RV systolic pressure estimated from the regurgitatnt tricuspid velocity (assuming a RA pressure of 10mmHg. The estimated RVS pressure is at least 44mmHg. This is likely to be an underestimate given the early truncation of TR velocities consistent with elevated RA v wave.

Right Ventricle
Moderately dilated. Mildly and diffusely hypokinetic consistent with increased afterload.

Interatrial Septum etc.
There is dialostolic flattening consisten with RA volume overload. There is paradoxical IVS motion consistent with a right ventricular volume overload. There is abnormal IVS motion consistent with prior surgery.


I don't think it is great, but not all that bad....right?

Marybeth

[Ross]

Marybeth, honestly I don't even think the link I sent you is going to be much help. This thing reads badly to me, but you should really grill a Cardiologist about it. I don't know that anyone here can interpret that all that well. :o

[Nancy]

Certainly agree with Ross about grilling the cardiologist about this echo and see if there needs to be additional testing done.

Several things bother me about the report.

The paravalvular leaks in the aortic and mitral valves, even though they appear to be mild. Joe had a mild paravalvular leak in his mitral that caused significant symptoms and had to be repaired.

The fact that the mitral regurgitation was not able to be assessed is bothersome. Also the thickening of the chordae.

The EF seems excessive.

The severe tricuspid insufficiency with reversal of flow into the hepatic veins is definitely something that I don't like. With Joe's problems that might indicate portal hypertension, and compromise of the liver function. In Joe's case it spills over into his spleen as well.

The right "prominent" atrial dliation and moderate right ventricle dilation would indcate, for me, right sided heart failure.

The RVS pressure of 44mmHg and the fact that this appears to be an underestimation is a red flag for me.

The afterload in the right ventricle, bothersome.

The abnormal IVS motion "consistent with prior surgery" needs to be discussed thoroughly to find out if it is consistent with restrictive/constrictive heart disease.

Sometimes at the bottom of an echo report, there appears a diagnosis of conditions. Did this appear on Wayne's report?

[Mb]

Thanks, both of you.

When I got home yesterday, the written report was at the house, as our cardio is under instructions to copy me on everything.

He had called last Friday morning, and really only said that from the echo, it was very evident that Wayne was very suseptible to fluid overload, and to watch very carefully for any weight gain. He should err on the side of overdoing the lasix, not underdoing.

When I read the report, my heart sunk, as I thought there was some obvious problems that we didn;t know about. But, often when reading something, it sounds worse than it is.

Nancy, the conclusion at the bottom of the report reads:

Compared to review of the study of 8/2/04, the comparison is limited by differences in machine and color acquisition. The paravalvular AI is suggested on the prior exam, but not the MR, either by proximal flow convergence or continuous wave Doppler. TR velocities were similarly truncated before, but not comparably recorded to compare RVSP. LV and RV size and function appear comparable.

Maybe this will help someone..........help me.

Marybeth

PS - Ross, you are right. The link doesn't really mentioned many of the things, mentioned above. Except, by the gradients, it appears the St. Jude valves may be stenotic????

[Mb]

Nancy:

Perhaps you can clarify something.

I thought almost all mechianical valves leaked to some degree. Is a "paravalvular leak" different?

Marybeth