What is Aortic Regurgitation (Aortic Insufficiency)?
Aortic regurgitation is the medical term for a leaky aortic valve. It is also known as aortic insufficiency or aortic valve incompetence and is a form of structural heart disease. In this article I will uses the terms aortic regurgitation and aortic insufficiency interchangeably. In severe aortic insufficiency the severe leak can lead to enlargement of the heart and symptoms of heart failure requiring aortic valve replacement. Mild and moderate degrees of regurgitation are usually tolerated well and don’t require treatment or cause symptoms. A tight aortic valve is known as aortic stenosis. Another commonly leaky heart valve is the mitral valve which is known as mitral regurgitation.
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What is the Aortic Valve?
The aortic valve is the valve that blood has to go through to leave the main pumping chamber of the heart and get to the body via a large blood vessel called the aorta. Since it is a valve, it stops blood from flowing backward into the heart once it is pumped out. If the aortic valve is leaky, blood can flow backwards into the heart.
What Happens to the Heart in Aortic Regurgitation?
In aortic regurgitation, the leaky aortic valve leads to extra blood flow into the heart. If there are small amounts of leak, the heart hardly notices this. If the leak is larger however, the heart has to grow larger to accommodate the extra blood. Initially this is a good thing as over time it means the aortic insufficiency is tolerated well. Over time however the enlargement can be harmful and lead to failure of the heart muscles and congestion, basically heart failure.
How is Aortic Regurgitation Diagnosed?
Often patients with aortic regurgitation don’t know they have it. The aortic insufficiency is picked up on an ultrasound scan of the heart known as an echocardiogram. Some patients may have a classic murmur of aortic regurgitation that can be heart with a stethoscope. The most common way of diagnosing and following aortic insufficiency is the echocardiogram, an ultrasound scan of the heart.
Acute vs. Chronic Aortic Regurgitation
Acute aortic regurgitation is where there is a sudden event that causes the leak to happen. This is much less common than chronic aortic regurgitation that occurs and progresses over a long time typically. Acute aortic regurgitation, if it is severe, is not handled well. It can lead to congestive heart failure and shock since there is not enough blood going forward to the body. In chronic aortic regurgitation the leak progresses slowly over time and the heart has time to adapt, and so symptoms don’t typically develop for a long time.
Causes of Aortic Regurgitation
Acute aortic regurgitation occurs due to something that can rapidly affect the valve. This includes damage from heart procedures, infection on the heart valve, aortic aneurysm, or conditions that affect the aorta such as aortic dissection where there is a tear in the aorta, the main blood vessel that leaves the heart. Acute aortic insufficiency is not common.
Chronic aortic regurgitation is much more common. This is typically due to disorders of the valve itself, most commonly bicuspid aortic valve or calcified degenerated aortic valve. Sometimes regurgitation can occur as a result of a leak around the prosthetic valve known as paravalvular leak.
An example of moderate aortic regurgitation on an echocardiogram. The colorful jet going from right to left represents the blood leaking backwards into the heart.
Stages of Aortic Regurgitation
Stage A – This is for people who are at risk of developing aortic regurgitation but do not have it yet. This includes patients with bicuspid aortic valve, history of infection on the valve, rheumatic heart disease, and people born with abnormalities of the valve.
Stage B – These patients have mild or moderate aortic regurgitation. The heart function is normal and there are no symptoms. The heart is not significantly enlarged.
Stage C – These patients still have no symptoms, but the aortic valve is severely leaky. The heart pumps relatively normally, however there is clear evidence of enlargement.
Stage D – These patients have both a severely leaky aortic valve and symptoms. The heart is typically significantly enlarged. Symptoms include shortness of breath, particularly on exercise, swelling and fatigue.
An example of severe aortic regurgitation on an echocardiogram.
Severity of Aortic Regurgitation
Mild regurgitation – This is generally a benign condition, does not cause symptoms and can be found in many people simply by chance. In mild aortic regurgitation less than 30 cc of blood leaks backwards per heart beat. The heart does not generally enlarge in this case.
Moderate regurgitation – This is generally handled well and not associated with symptoms. Typically between 30-60cc of blood leaks backwards per heart beat. The heart may enlarge a little but not a concerning amount. This should be followed over time to ensure severe disease doesn’t develop.
Severe regurgitation – This is often handled well, although after some time heart enlargement and symptoms typically develop. Over 60cc of blood leaks backwards per heart beat. In patients with symptoms or evidence of heart failure, aortic valve replacement is generally recommended. In patients with no symptoms, regular surveillance is required to ensure no development of heart dysfunction.
Another example of severe aortic regurgitation on an echocardiogram. Again the colorful Doppler jet moving from left to right represents the blood leaking backwards from the aorta into the heart. Of note, this patient also has a leaky mitral valve, which is known as mitral regurgitation.
Medical Treatment of Aortic Regurgitation
In general patients with aortic regurgitation should have attention paid to blood pressure. High blood pressure should be treated with a goal of < 140mmHg with medicines known as calcium channel blockers or ACE inhibitors being preferred. An example of a calcium channel blocker would be amlodipine. An example of an ACE inhibitor would be Lisinopril. In patients with severe aortic insufficiency, beta-blockers are generally not used as they lead to lower heart rate, which means more time for the heart to fill with leaking blood with each beat.
Indications for Surgery in Patients with Aortic Regurgitation
Although some patients with severe aortic insufficiency may be able to have their valves fixed, the majority will require aortic valve replacement. In the future the TAVR procedure may become an option for aortic regurgitation.
Symptoms – In general, the development of symptoms is an indication for surgery for aortic regurgitation. Patients with severe aortic insufficiency and symptoms of heart failure have a significantly increased risk of death. These symptoms include fatigue and shortness of breath.
Heart Dysfunction – Patients that have severe aortic insufficiency and are found to have reduced heart pumping function, even in the absence of symptoms. This strategy is associated with better outcomes than waiting for worse heart dysfunction or the development of symptoms in these patients.
During Surgery for Other Heart Conditions – Patients with severely leaky aortic valve should have the aortic valve replaced if they are undergoing cardiac surgery for any other conditions including bypass surgery for heart blockages or other valve surgery.
Heart Enlargement – Even if there are no symptoms and the heart function is normal, if the heart is noted to enlarge significantly surgery can be considered. Particularly if there is a low risk of undergoing surgery.
Aortic Regurgitation Summary
Aortic regurgitation is a leaky aortic valve. When mild or moderate it is not typically of concern. Severe insufficiency can lead to heart enlargement and symptoms of heart failure so it needs to be watched closely. Severe aortic regurgitation with symptoms typically requires aortic valve replacement.
Hi
I am a 47 year old female and was told I have moderate regurgitation with 60 to 65% ejection fraction, which I was told was in the normal range. I was told to have follow up echo in one year. The diagnosis scares me. Do you agree with the idea of a one year follow up, the wait and see approach? I would like to be aggressive and get repair/replacement sooner rather than later, if needed.
I have palpitations, but I also have SVT, so I suppose they could come from that, too. Sometimes they’re quite strong and scary. I would not say I get out of breath per se, but my heart will pound hard after a flight of stairs.
Thank you.
In the case of moderate aortic regurgitation alone, surgery is not warranted and 1 year follow up sounds a good plan.
Thank you. When you say aortic regurgitation alone, what do you mean? What would make it not alone?
Thanks for being so helpful.
By lone, i mean there is no other associated heart disease such as another leaking valve, or coronary artery disease. Happy to help.
aortic valve regurgitation & tricuspid valve regurgitation both mild..What is treatment ?
None needed.
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Since my teens I have been monitored by a doctor to oversee my mild leak and mitro valve prolapse. It was always mild so nothing was of concern.
I am 42 yeas old now and just diagnosed with
aortic valve regurgitation, as well as an aortic root anuerysm. The doctor explained that my heart had enlarged from the leak and I also have a bi-cuspid valve that needs to be fixed.
Since my mid 30’s I have been on testosterone treatment after being diagnosed with low t levels. Light weight training and full contact kickboxing is my therapy on a regular basis. Based on your experience, will I be able to continue this sport after my surgical procedure is conducted? Thank you for your assistance,
It depends on the type of repair and surgery performed, while you would almost certainly be ok to go to the gym, competitive sports may be prohibited in certain circumstances, please be sure to discuss this as part of the treatment plan.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I am told I haveAorya Stenosis, and it went from Moderate to Severe in one year. I hv no symptoms & was shocked. I am a very active 77 year old female who takes care of her ill husband & 2 grandchildren every day or the past 14 years. I donot want to have Surgery. How long can I live without it?
Do you have details of your echo report?
No, I do not. I became very upset & left the office. I had only seen this Cardiologist once before & he then explained I had “moderate aorta Stenosis & not to worry, it will take 5 years to go to Severe. Went back in a year& was told severe with mild refutation. Need Surgery. I am frantic
I think you should discuss things more with your cardiologist and see if you can understand their thought process on why things may have progressed.
i have a mild aortal regurgitation . need advise
You don’t have anything to worry about.
I have mild aortic regurgitation and have palpitations almost every day if not every other day need advice
With regards to the mild aortic regurgitation, that alone doesn’t require any specific treatment. As for the palpitations, the next step is to obtain a physical exam an EKG, and maybe a monitor to characterize what they are. I assuming your echocardiogram was normal otherwise.
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New dx of aortic regurgitation today. Moderate to severe. 55% ejection. Slightly less in a mitral valve also.
This was surprising bc I have had symptoms, and have had a number of procedures that reportedly revealed nothing, though I couldn’t get any return call or visit from my ling-time cardiologist. Receptionists said I needed to talk with him. Never returned calls or would answer in the clinic when I came in. That was about a years ago.
Lots of palpitations skyrocketing bp at one point, and feeling like my heart is pounding out of my chest, at times, especially after activity.
I am dumbfounded that I had not been told. This year was incredibly stressful and I had several.events that put me in the hospital/dr office. If they or I had known, maybe we could have mitigated some damage.
I was diagnosed with moderate to servere aortic valve regurgitation, as well as an aortic root anuerysm of 4.4 – 4.5 cm (although based on my height and weight is considered in normal range). I am 51. I was actually on the operating table last January, fully sedated, heart cath in, etc, to have my aortic valve replaced and aortic root repaired. Surgeon and his team changed their mind while I was on the table and decided to continue watching me. I have since had a second opinion. The new cradiologist and surgeon now are recommending surgery. Leak is still in moderate to severe range (2+ – 3+). I do have symptoms (shortness of breath and fatigue with exertion). EF 62. I have flip flop heart feeling regularly and have PAC’s and hard heart beats on a regular bases. As you might expect, I am confused and since this is the second go around, I’m just looking for some additional input.
I would need to see the images and a CT scan to comment responsibly. In general severe aortic insufficiency, if determined severe by an expert, if symptomatic is operated on. As a valve specialist a lot of care goes in to the determination of severe. The decision to replace the root then depends on how large the aorta is and the patient themselves and their risk profile.
Is mild aortic regurgitation patient are prone to heart failure in future ? My husband is 35 year old and he is diagnosed with this disease… this make me very worried about him and our future…sometime i don’t sleep whole night and continuesly thinking about it..plzzzz dr. help me what should i do to make things good . Is it possible to make him 100 % cure from this disease..?
Mild aortic regurgitation in isolation with an otherwise structurally normal heart and aorta is not generally a cause for concern.
I’m 35 years old and for the last 3 years I’ve suffered from Shortness of Breath and EXTREME fatigue. Last year I did blood work, a sleep study test, and complete PFT which were all normal. I live a very healthy lifestyle and workout about 5-6 days a week with 45 minutes intense exercise. I had an echo done which should a trace of mitral regurgitation and mild tricuspid regurgitation. My doctor says it’s not concerning but why would I be experiencing these symptoms almost on a daily basis?
I am 63 years okd and have been told my aortic valve is reakt loud. It sometimes beats real fast, I have chest pains severe at times it knocks me to my knees and even wakes me up at night. What should be done about this?
Would recommend starting with an echocardiogram.
Hello, my echo revealed I have bicuspid aortic valve with moderate regurgitation and ascending aortic aneurysm 5.7 cm. I dont have any symptoms but cardiologist insists on surgery. He also put me on atenolol 25 mg+ramipril 10 mg. After starting on atenolol, I now have chest tightness. What do you recommend I should do?
In general with a bicuspid aortic valve and an aneurysm of that size surgery would be recommended if it was felt you are a suitable candidate. The surgery would be aortic valve replacement and aortic root replacement, there are a number of different techniques used.
Hello,
My recent echocardiogram indicatec
1) Moderate Aortic Valve regurgitation (with mild mitral valve regurgitation) My ECG showed 1st degree AV block.
I requested the echo because I have some shortness of breath when carrying groceries or making my my bed etc,( small household chores) I also feel somewhat weak upon mild exertion. I feel totally normal at rest. I will see a cariologist in two weeks. Any feedback would be greatly appreciated. I am a bit confused about the significance of these results.
Moderate aortic regurgitation in isolation is typically not a cause for concern and typically needs surveillance. Its important to clarify the severity of the disease and the effect inherit size and function and you can discuss those findings with your cardiologist.
Also the echo indicated that my heart size is normal. I do feel something is “off” but im worried my concerns will be dismissed. Oh also i have stage 2 kidney disease.
( it was stage 3 but kidney function improved since hoing vegan one yr ago)
Sir I have mild to moderate ar with bicuspid aortic valve I am 19 years old so sir after how many years do I need aortic valve replacement can I live till 50 without surgery
Depends on degree of leak, the mechanism of the leak, the change over time and the way the heart handles the leak.
Some people need nothing doing for years, others need it doing faster.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I had paroximal AFib with RVR and went to ER . had adenosine and then cardizem to get NSR . Echo was done and showed left Ventricle Diastolic Dysfunction with three leaking valves: Aortic/moderate, Mitral/mild, and triscupid/mild. Being treated with metroprol 50mg tid, enapapril 20 mg qd, rhymol 150mg tid, ASA 325mg qd, HCTZ 12.5mg qd.
Stress test negative. Now having PAC’s now off and on. No surgery only being treated with medications.
Mitral E to E prime ratio = 9.7
Mitral E to A ratio = 2.3
LVPW diastolic thickness = 1.1 cm
IVS = 1.0 cm
EF = 65
LV stroke volume TE = 47.1 cm
MV deceleration time= 190 ms
I just turned 61, female, Hashimotto hypothyroid, new onset HTN x 7 months, anxiety, depression, hyperlipidemia, 5′ 5 , 148 lbs.
What is your thought on the treatment ordered for this kind of heart failure? Thank you.
I don’t agree with “here are some scripts see you in three months”.
The valve disease itself has no specific treatment at this stage. In terms of diastolic dysfunction there is no specific medical regimen preferred, control of hypertension and treatment of standard risk factors is usually prescribed and in your case treatment of the atrial fibrillation. Your need for blood thinning medication can be determined by your risk profile (CHADS2 CHADS2VASC etc). In your case close attention to the thyroid treatment would be advised also.
Hi, Can I do Zumba with mild aortic regurgitation
If the only issue is mild aortic regurgitation then there are generally no restrictions.
Yes.
I have both mitral and aortic valve leaks. The valves have actually grown together.
Shortness of breath is an everyday thing. For the last 1 1/2 months, I have had an extremely bad cough. Been to the Doctor’s office 3 times. Been on Prednisone and 3 rounds of antibiotics, had lung x-rays that I am told are clear. I never thought to ask them to check the xray for fluid around the heart. We have recently moved and I do not have a Cardiologist now. My question is; Can this coughing and fatigue be related to the heart valves? The coughing can get so bad that I pass out. Got to admit that will be hard on the heart. Please help. It’s bad when you start trying to find remedies on your own because nothing else is working.
Do you have specifics of the echo report, how bad it the leak?
I am 27 years old, and was told I have Bicuspid aortic Valve. I was told by my cardiologist after an echocardiogram that I have pretty bad regurgitation. I have a lot of chest pain and tightness along with palpitations and dizziness. I was prescribed Losartan to help so with my blood pressure. The cardiologist told me that the leaking alone shouldn’t be causing my chest pains to be so bad and every day like I have them. My heart is not inlarged and I don’t have stenosis or an aneurysm. He wants me back in 6 months. I get scared because of the chest pain. I also get a lot of left arm and shoulder pain and my ribs hurt all the time. It hurts to just touch my ribs sometimes. Should I get a second opinion as to why my chest pain is so bad? It terrifies me because I have two small children.
Did you have any form of stress testing? Do you have the details of the read of the echocardiogram?
Hi, I have aortic regurgitation since diagnosed in 2004 Bp at that time 180/55. Placed on Norvasc
10mg. My Bp is now 136/55. My new cardiologist says after looking at my echo that I am a 2-3 mild to mod. condition and he would like my Bp down to 110/50 or even better 100/50 to help the valve work better and avoid surgery. He is placing me on Nifedipine er 90mg once a day. I have my concerns about all the side effects. I my just be over reacting or should I get a second
opinion?
Thanks for reading
If you only have mild-moderate aortic regurgitation no specific treatment is advised, blood pressure control and cardiac risk factor control is reasonable.
Hi, I’m 29 with mild to moderate aortic regurgitation and about 60% ejection fraction.
I cycle a lot and get to my max heart rate for about 30-40 minutes per ride. Is this OK?
Also was I likely to be born with this as never had any illness if so is there a possibility it will just say the same?
Also I like a drink well this effect the condition?
They say eco in another 2 year is this too long?
Sorry for the question, I was surprised there was something wrong with heart and didn’t do a very good job of asking questions.
I would suggest you seek consultation with a cardiologist that can take a full history and physical but in general mild to moderate regurgitation is of no clinical significance. Interestingly, the faster the heart rate the less time for the aortic regurgitation so technically it is even less significant while the heart rate is faster! I agree with another echocardiogram in 2 years.
I am a 44 y/o female and have been recently diagnosed with ascending aortic aneurysm 4.2cm, leaky valve, and lung pressure. I also have lupus. My echo results are:
I don’t know what you need but I’ll give you general:
Left ventricle ejection fraction 60-69%
Mitral valve mild regurgitation
Aortic valve mild to moderate regurgitation
Tricuspid valve mild regurgitation
Right ventricle systolic pressure 30mmgg ra pressure 5 mmhg
I am curious if you would recommend surgery. I don’t know what all this means. I am also very scared Dr says nothing to worry about at this time but this is my heart and lungs. Please advise me in what you recommend. Thank you for your time.
You don’t need surgery for the moderately leaky aortic valve or the mild aortic aneurysm. I would recommend a yearly echocardiogram for that.
Hello, my husband is diagnosed with mild aortic regurgitation and mild pulmunary regurgitation but his ECG is normal. I’m so worried about this because my husband is only 32 years old. Doc pls help me..Is this a dangerous condition? What should my husband do to cure this condition? How many days or months should I go for a follow up check up? Doc I badly need your answers. It would be a big help. Thank u and God bless!
This in isolation is not dangerous.
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Are there any treatment for this doc? How many months or years doc should my husband go for a follow up check up? thank u so much doc..
Are there any treatment for this doc? How many months or years doc should my husband go for a follow up check up? My husband doesn’t have any symptoms doc. He doesn’t feel any discomfort in terms of breathing. So can my husband still do some physical activities like basketball after being diagnosed with aortic and pulmunic regurgitation both MILD? thank u so much doc.. I would love to read your responce. It’s really a big help and I am so thankful that you are giving us time. Godbless you even more.
I am a 44 y/o female and have been recently diagnosed with ascending aortic aneurysm 4.2cm, leaky valve, and lung pressure. I also have lupus. My echo results are:
I don’t know what you need but I’ll give you general:
Left ventricle ejection fraction 60-69%
Mitral valve mild regurgitation
Aortic valve mild to moderate regurgitation
Tricuspid valve mild regurgitation
Right ventricle systolic pressure 30mmgg ra pressure 5 mmhg
I am curious if you would recommend surgery. I don’t know what all this means
Hello Dr. Ahmed! You were so very kind to respond to one of my questions I posted on your article regarding right ventricle systolic pressure. I was concerned about pulmonary hypertension, as I had readings of 36 to 41 mmHg on prior echos done back in 2005 through 2009.
I just had another echo done and was very happy to see that my pressure reading was down to 22 mmHg!
In my echo report, all of the chambers were also of normal size. Ejection fraction 63% It also showed trace-mild tricuspid regurgitation and mild tricuspid regurgitation, which had shown on prior echos.
The new things mentioned, however, were: Mild aortic valve sclerosis, mild aortic regurgitation, and borderline LV hypertrophy.
I am a 49 year old female, in good shape, mild hypertension (currently on furosemide), and I walk three miles per day.
Are those new findings anything to be concerned about?
Thank you so very much for your help!
My husband (age 31) was just diagnosed with Severe Aortic Valve Regurgitation. He went in for a routine checkup and his PCP noticed a heart murmur. They did an EKG and Ultrasound gave the diagnosis of aortic valve regurgitation and tried to get him in with a cardiac surgeon immediately. The cardiac surgeon is backed up, but we went to see a cardiologist who confirmed it is severe – he has had shortness of breath issues over the past 7 years, but nothing too noticeable. The aorta is normal size and healthy other than the one valve, but the heart is very enlarged. They told him there are no restrictions other than major exercise right now. Is there anything we should be doing? Do you have any information on what the recovery would be for this surgery?
He has severe aortic regurgitation with symptoms and enlarged heart to what is thought to be a severe degree so it seems reasonable the valve is replaced. In general this is an urgency but not an emergency. The recovery depends on a number of things. The condition of the patient, the health of the heart, and the technique used. In our center we generally use minimally invasive surgery to minimize recovery time and avoid “cracking” the chest. I would agree with activity as tolerated and also avoiding major exercise.
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Hello,
I have been diagnosed with a thoracic aortic anuerysm 4.4cm and a moderate leaking heart valve. Doctors have said that over the last two years the anuerysm has grown at approx 1mm per year and they believe I will require surgery within 5-10 years, however they also said that in their experience the valve usually goes before the anuerysm and therefore surgery could be sooner. Over the last few years my mother uncle and aunt have passed away with these conditions, I also have a sister who has undergone a successful surgery for the condition at age 38 and two younger sisters have recently been diagnosed with the condition. I am 55yrs old.
Should doctors be planning surgery sooner or should they wait until the valve deteriorates further in your opinion?
Should I fly with this condition?
What level of exercise should I be doing? At the moment I’m doing moderate walking and I have stopped using the gym altogether.
Thank you for taking the time to reply.
Surgical indications for aneurysm are generally in the 55mm range, and 44 mm would generally warrant ongoing surveillance. The rate of growth per year depends on many factors and stability can be ascertained by serial scans, some grow faster than others and some are slow growing, yours has been slow thus far which is good. The most important thing is control of blood pressure and avoidance of large fluctuation in blood pressure. In the case of a bicuspid valve, in some cases earlier surgery at 50mm may be discussed. The aortic regurgitation will only really hasten the situation if it is truly severe, or if symptoms develop or if the heart shows evidence of significant strain, otherwise that too is watched over time. If the disease is seen to be stable and symptoms aren’t an issue then flying shouldn’t be an issue.
Maintaining some form of physical activity is important, fast walking etc would likely be encouraged but strenuous exercise such as heavy lifting would be discouraged.
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I had a recent stress echo which indicated I have moderately severe aortic regurgitation. There is some uncertainty as to whether I have a bicuspid aortic valve although there is some mild dilation (41mm) of the Ascending aorta. The cardiologist report was very positive and reassuring i.e there was no enlargement of the left ventricle nor any adverse modelling. My heart function (ejection fraction) was normal (67). Based on my performance with the stress test, the cardiologist recommended there was no need for any exercise restrictions and to have another echo in a year. My question is whether it is inevitable I will require a new aortic valve, or alternatively how long does it normally take for the regurgitation to transition from moderately severe to severe and requring a new valve. I am currently asymptomatic, other than having a few PVCs – a life long occurrence
I had a recent stress echo which indicated I have moderately severe aortic regurgitation. There is some uncertainty as to whether I have a bicuspid aortic valve although there is some mild dilation (41mm) of the Ascending aorta. The cardiologist report was very positive and reassuring i.e there was no enlargement of the left ventricle nor any adverse modelling. My heart function (ejection fraction) was normal (67). Based on my performance with the stress test, the cardiologist recommended there was no need for any exercise restrictions and to have another echo in a year. My question is whether it is inevitable I will require a new aortic valve, or alternatively how long does it normally take for the regurgitation to transition from moderately severe to severe and requiring a new valve. I am currently asymptomatic, other than having a few PVCs – a life long occurrence.
Lionel: Dr Ahmed. I recently had s stress echo which indicated I had moderately severe aortic regurgitation. It is uncertain whether I have a bicuspid aortic valve but at any rate I have a mildly dilated ascending aorta (41mm). I am asymptomatic and my stress echo results were very good in terms of heart function ie ejection fraction of 67; normally sized left ventricle, no adverse remodelling and normal blood pressure response. My cardiologist said my response to exercise was excellent and that my heart was compensating well with the regurgitation. What is not clear is how long it will be before I will need a new heart valve -2-5 years. Based on your classification system I would appear to be between Stages B and C of your classification system. Would you agree?
Yes, stage B seems about right. The staging was more for education purposes, the approach used by contemporary valve experts would be integrated using all information. I’m your case it all looks reassuring. It’s important to know the size of the ventricle with dimensions and volumes, accurately drawn, and these must be tracked closely over time.
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Hi Dr Ahmed. 54 yo male, very active with severe aortic regurge. EF 68%, regurge vol 58 cc. Have had Cardiac MRI, yearly echo. Mild LV hypertrophy. asymptomatic. Having cardiac cath tomorrow as get prepared for surgery. 3 cardiologist say no need for surgery yet, Two cardiologists recommend talking to surgeon. Two surgeons we have are very good, but don’t do surgical minimally invasive aortic valve replacement. Would like to look at hospitals that do surgical minimally invasive, but am concerned about who to go to if have complications after surgery. I live in the Dakota’s. How does the transition of care work if I were to come to your hospital for surgical valve replacement, but live so far away.
Thanks in advance for your response
Hi Chris,
The decision to proceed with aortic valve surgery in aortic regurgitation depends on multiple factors.
I typically ask the following –
Are there symptoms, if not in general than on stress testing?
How fast is the disease progressing, is it stable on serial scanning?
How sure am I that the disease is severe?
Is there involvement of the aortic root?
What is the risk of surgery and what are the surgical options?
Is there co-existent coronary artery disease?
In general, wherever possible we perform the mini-AVR procedure, we feel it is preferred by patient, enhances recovery and is associated with excellent outcomes. The risk of aortic valve surgery in good hands and post-operative care in an otherwise healthy person should be minimal although a heart operation is a heart operation! and should be treated as such.
We have many patients that travel from out of state, hospital stay in uncomplicated disease will be around 3-4 days. Thereafter we recommend patients stay in town, typically in the adjacent hospital guest rooms for a few days till 1 week follow up prior to traveling home. If considering this option, imaging studies and clinical data will need to be reviewed before hand.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Dr Mustafa’s service to humanity is really great . We appreciate, congratulate , thank and adore this pioneer of medical science.
Hi Dr Ahmad, I am writing from India. My mother aged 77 has been recently diagnosed with Aortic valve regurgitation. She was feeling out of breath and fatigued from last one week and her ankles and feet started swelling. She recently got under surgery for replacement of both knees. We have been told to go for Valve replacement but as my mother is getting old we don’t want to take any risk. Her latest Echo cardiogram report findings are
Cusp opening : 2.40 cm
Thickened/Calcified : Normal
Closure Line : Central
Gradient Peak : 16.93 Mean : 8.43 mm hg
AV area
Aortic Regurgitation (Gr 1-4) : Moderate AR
LVPWT 12.0
IVS 12.0
EPSS 17.0 mm
LVEF 58.0
AOD 36.0
LAD 37.0
LWPTF 60.0 %
IVSTF 56.0 %
We are very much confused, So kindly advise the treatment. Is it possible to control this situation by medication or she will have to undergo surgery.
Do you have details on the size of the ventricle, LVEDD or LVESD?
From the report provided the degree of aortic leak is only moderate and so surgery would typically not be recommended. I suggest that first you seek opinion to clarify the degree of leak.
Hi Dr. Ahmad,
I was diagnosed with BAV aged 4, I am now 35. My diagnosis is as below.
* BAV
* Dilated ascending aorta 4.5 cm (change from 4.3cm within 6 months)
* Mild aortic stenosis
* Mild to moderate aortic regurgitation
At my last cardiology appointment the doctor advised 4.5 cm is a trigger point for thinking about intervention i.e. surgery. I have now been put on beta blockers and have a further echo in 6 months. My question is how long off might surgery be?
thanks
Emma
Emma, read these two articles i think you will find them useful,
https://myheart.net/articles/bicuspid-aortic-valve/
https://myheart.net/articles/aortic-aneurysm-what-you-need-to-know/
Basically, in those with BAV, the indication is not 45, rather 50 – 55. Close follow up is important.
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Hi doctor i have shortness of breath in 2013 and BP 150/96, Pulse- 105 and doctor recommended Echo and results shows Mild AR and Dialeted LV. After 10 months I undergone another Echo Which show Normal structure of heart and No regurgitation in any valve. my question is that why there is a difference between two Echo. Is I have a AR.
Initially you had mild AR and now you have no AR. Regardless the aortic valve isn’t a significant problem.
2 years ago, I was having frequent episodes of heart pounding, palpitations and feeling faint. I was seen several times after the episodes in the ED and my ekg showed prolonged QT intervals on each episode. I was told to follow up with a cardiologist, which I did, and had an echo done. The results of that were mild to moderate aortic valve regurgitation. The doctor said I was young (I was 40 at the time) and not to worry, because it would be many years before surgery needed to be done. My question to you is, should I have been told to schedule follow up visits to monitor the condition? I haven’t been contacted by their office in 2 years, but I also haven’t reached out to them until just the other day. Within the last 6 months my breathing has gotten worse. I am SOB most days and I do have wheezing. I thought that maybe my asthma is getting worse as I get older. I’m being followed by a pulminologist who has prescribed me 2 new daily inhalers. I have some relief, but not great like I hoped. He wants me to do some breathing test in a small room now where oxygen is decreased and increased at different times to check my lung functions. I’m tired all the time, but I just thought it’s because I have a hectic lifestyle. I still get episodes of heart palpitations and dizziness too. Should I be worried? Does aortic regurgitation progress in 2 years? I’m 42 yo now. Thank you for your help.
It would be unlikely for aortic regurgitation to progress from moderate to very severe in 2 years. I suggest you have an echocardiogram since your symptoms are progressing and worsening of your valve disease ruled out.
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Hello Dr.
My husband has been diagnosed with severe aortic regurgitation..my question is do they now do TAVR for this or is TAVR strictly for aortic stenosis?
Thank you
Donna
As things stand the valve is only approved and designed for cases where stenosis predominates, the exception is where there is severe aortic regurgitation of an already placed bioprosthetic valve.
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Dr Ahmed I was diagnosed with mild aortic regurgitation and mild pulmonary hypertension my symptoms are palpitations and left chest pain need advice Ian 27 years old a mother of two the palpitations is scaring really bad
The mild aortic regurgitation is not really a concern. The mild pulmonary hypertension is best treated by adressing risk factors such as blood pressure, lifestyle, exercise, etc. In terms of the palpitations, a baseline EKG and maybe a monitor to characterize them would be suggested. For the chest pain, it depends on the character of the pain, but that needs to be addressed by a medical professional who can conduct a full evaluation.
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I had a EkG monitor and I had an event monitor they both showed sinus rhythm and occasional sinus tachycardia
Hi Dr. Ahmed,
I have been diagnosed with severe aortic regurgitation. I have been monitoring it for a while but it just got worse this past year. I’m 23 years old and my favorite hobbies are working out/lifting, so I was kind of bummed when the cardiologist said I had to stop all that. He is making me do a stress test next week but he told me that if I did needed surgery, it would most likely have to be the full procedure as opposed to non invasive. He seems to be a bit old school to me as he kept saying that non invasive is not as good as “opening you up and seeing it”. I just started working and can not afford to take 6 months off this early on. Do you have any recommendations for a surgeon in the boston area that specialize in non invasive surgeries? I would greatly appreciate your help on this.
Best,
Daniel
If you have severe aortic regurgitation and an indication for surgery as described in the article there are several options for approach to repair. In young patients a surgical approach is generally preferred over a percutaneous approach. Im not sure of what is available in the Boston area. In our center we use a mini AVR approach with a small incision that avoids the need for a sternotomy and has a faster recovery time.
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Is it unlikely for me to get the non invasive then? Is it true that they only reserve these operations for elderly and people who need it as opposed to me who is younger and “can handle” a percutaneous procedure? My main concern is being placed on pain medications especially for the length of time that I would need to recover. What would you recommend I do if surgery was required, which currently it is looking like that is the case? How can I push my cardiologist to send me to a non invasive procedure?
Thank you for your quick response and I look forward to reading your next one.
Dan
Hi, I have mild aortic regurgitation with an enlarged heart. I was told by my cardiologist that I need to see him every second year, however my new generalal practitioner insists that she can handle the situation. I am concerned as she says she can’t hear the regurgitation and believes it could have resolved its self.
Mild aortic regurgitation itself is not particularly concerning and doesn’t necessarily need specialist follow up. One would not expect to have a murmur from mild aortic regurgitation. The enlarged heart however is more concerning, what enlargement was referred to and what was the cause?
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56 year old female. About 10 years ago i had a couple of episodes of intense chest flutters, etc. My PCP ordered echo and Holter testing which showed leaky mitral valve. I have had issues off and on since then. I began having more severe and frequent issues and presented myself at the ER recently during an episode. An echo showed mild aortic regurgitation, mild mitral regurgitation, mild LV concentric hypertrophy; stage 1 diastolic dysfunction; impaired relaxation.
(My blood pressure has been 90-95/ 58-65 for the last 3-4 years). My ankles and legs have been swelling for about 3- 4 months, I have dizzy spells, get lightheaded, nauseated, and my arms go numb. I have a cough that gets worse when I eat or lie down. I have left sided kidney pain now. I have been fatigued for about the last 2-3 years to the point I feel I can harfly put one foot in front of the other! Are these symptoms related to the heart issues? Should I see a cardiologist?
The echo you had is actually fairly normal. The mild mitral and aortic regurgitation are not really anything to worry about and are almost certainly not related to the symptoms. It seems your symptoms are fairly disabling however and alternative causes should be investigated for sure.
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Hello, Dr. Ahmed, I had June 30 Echocardiography ( TTE) and I will see cardiologist only in September. Please, explain me, this report .
There is nonspecific thickening of the mitral valve leaflets with adequate excursion.
There is non significant mitral regurgitation and spectral Doppler interrogation.
There is nonspecific thickening of the aortic valve leaflets with adequate leaflet exursion.
There is mild aortic regurgitation by color and spectral Doppler interrogation.
No evidence of aortic stenosis.
Normal tricuspid valve structure and function.
Mild tricuspid regurgitation by color and spectral Doppler interrogation.
The pulmonic valve leaflets are not clearly visualized.
There no significant pulmolic regurgitation.
No evidence of pulmolic stenosis.
Normal left atrium
Normal left ventricular size and systolic function.
Left ventricular ejection fraction is estimated to be 65%.
No apparent wall motion abnormalites.
Diastolic physiology appears normal for age.
Normal right atrium.
Normal right venticular size and function.
Upper normal pulmonary hypertension with an RVSP/PASP estimated at 35mmHg assuming a right atrial pressure at 5 mmHg.
The pericardium appears unremarkable.
No abnormal pericardial fluid accumulation appreciated.
No apparent pleural effusion.
The aortic root is normal in size.
The artial septum appears intact by 2D imaging.
The interior vena cava is normal in size with normal collapse with inspiration.
I am female 64 years old.
Thank you so much and sorry for so long message.
The echo looks relatively normal to me with no real cause for concern.
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Hello, couple days ago I sent message to Dr. Ahmed, where i can find answer?
Thank you so much, Dr. Ahmed!
I just had Aortic valve replacement surgery. I had shortness of breath, fatigue, loss of weight, but had no swelling lower legs, no dizziness or fainting episodes. Quickly I started to have panic breathing, could not sleep. Would wake gasping for air and panting frequently like a dog. I thought I had walking pneumonia, needed a “Z” pack. I’m a workaholic, electrical contracting. Finally went, found bad valve, was diabetic, and immediately given lasix and other drugs to help my heart beat slower, stronger. Surgery was tough, but I was out of ICU in 2 days, reg room for 5 days more. Went home. Immediately felt relief, No shortness of breath, and generally a sense of getting stronger is what I am experiencing each day now. Main point is I went through a slow degradation that never caused me to even consider a heart issue. I’m 61 and never missed a day of work kind of guy. I was so devastated with the news. I have great doctors, surgery team, hospital care. I made it. I am off lasix, have an appetite. My surgery was on July 24, 2017. The result was my aortic valve was severely diseased, misshaped, and was replaced. I had left ventricle enlargement, no scaring, no blockages, all else in very good condition. I was told that I could expect 3-6 months time to reach a 50-55% level from the 65% standard. I was at 16%. I have the bovine type aortic valve. Thank you cardiac doctors, surgeons ,and support people. What a world we live in. God bless…
Hello Dr Ahmed,
I am 39 years old. I had just got my ECO report which says that there is a mild aortic sclerosis but no stenosis. There is no aortic insufficiency. Also mildly thickened mitral valve leaflets and trivial mitral regurgation. Have been referred to a cardiogist but got an appointment early next month.
Can you please explain me my report?
You have nothing to worry about with regards to the echo report there are currently no significant abnormalities that need attention. Your cardiologist will likely reassure you.
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Thankyou so much. You are doing a great job!
I am 39 years old. Due to shortness of breath and skipped a heart beat my doctor advised holter and Eco. The Eco report says that there is a mild aortic sclerosis but no stenosis. No aortic insufficiency. Mildly thickened mitral valve leaflets and trivial mitral regurgitation. I have been referred to a cardiologist and the appointment is early next month.
Can you please explain what the report means? and is the condition serious?
I am a 66 year old male who was recently told that I have moderate aortic regurgitation. This was discovered when it was found that I was in AFib. The AFib has been corrected and my cardiologist is monitoring the regurgitation. I have also had a pulmonary embolism which is now being treated with medication. My question is that in your experience, how long does it take for moderate regurgitation to become severe. I have been told that when this occurs, I will need surgery. Thank you for your anticipated response.
If can be many years and in some cases can always stay moderate. It depends on the mechanism of the regurgitation. For example if it is related to aortic root dilation then the regurgitation progression would be related to the aortic dilatation. If it is another mechanism such as calcification then the progression may be variable. I have found assessing between two time points i.e 1 year to the next can give a good idea as to stability of the leak.
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hi i was diagnosed with RHD in 2015. severe mitral stenosis with moderate Aortic regurgitation and mild aortic Stenosis. BMV was done in 2015. in august 2017 i am diagnosed with Severe Aortic stenosis with moderate Aortic Regurgitation. Ejection fraction is 60% and normal LV functions. please tell me how long i can wait for valve replacement surgery.
Usually the development of symptoms / heart failure / heart muscle dysfunction / heart enlargement means its time to have the valve replaced.
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Dear Dr Ahmed,
I was diagnosed with a bicuspid aortic valve for years ago. It has been monitored every year. I had mild regurgitation with no symptoms. Like a fool I carried on drinking and smoking as it was the same every year.
I quit smoking and drinking 2 months ago. My recent echo shows that I now have severe aortic regurgitation.
Details are as follows…
Left Ventriuclar Cavity size normal. LVEDV increased at 90ml/m2. Normal LV wall thickness. EF normal at 55-60%. Good LV longitudinal systolic function.
Normal right ventricular size and function.
Normal biatrial size.
Bicuspid aortic valve. Mild sclerosis with preserved motility of the cusps. Severe eccentric aortic regurgitation secondary to poor coaptation. Estimated PHT 392ms.
Mild billowing of anterior mitral valve secondary to severe aortic regurgitation. Trivial mitral regurgitation.
All else is normal and healthy.
I am 39 years old. Very active. Have lifted weights and ran marathons all my life.
I have zero symptoms and now follow the Esselstyn Diet so basically plant based with zero fat in my diet.
I have continued to exercise but have stopped lifting heavy weights and do more controlled weights and cardio.
Just recently, since the diagnosis, I have noticed heart fluttering and like a whooshing of blood in my heart and sometimes a thumping heart beat. This last for only a second or so. Maybe once or twice every other day. I am aware my awareness is far more focussed on my heart now though since my diagnosis.
How soon and how certain will I have to have surgery to replace the valve?
Thanks in advance for your help.
Surgery for the valve at this point would depend on the development of symptoms, the function of the heart (currently good), the size of the heart (do you have dimension measurements)? Also how big is your aorta?
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Thank you for replying. To answer your question this size of my heart is 5.7cm and the aorta is 4.3cm.
Dr.Ahmed,
What is your recommendation for weight training and running exercises for moderate aortic regurgitation due to Bicuspid valve?
It differs on a case by case basis and its difficult for me to tailor personal recommendations online as i don’t have the benefit of a history, physical and access to scans etc..
It also depends on the extent of any associated aortic disease, heart function and any stenosis of the valve.
If there is isolated aortic regurgitation that is moderate in nature and other matters are felt to be low risk, then physical activity particularly in moderation should be well tolerated. In most cases of diagnosed cardiovascular disease, competitive sports should generally be avoided.
………………………………………………………………………………………………………….
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I am 36 yrs old female. According to my cardiologist, i have mild AR and my average blood pressure is 140/90 so i am very worry about my heart. What would be the treatment or precaution to recover the AR.
For mild AR in isolation i wouldn’t worry about it at all. Controlling blood pressure and normal treatment of heart risk factors is appropriate.
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Dr Ahmed. My husband is 57, asymptomatic, and reasonably healthy for his age other than been medicated for hypertension since 2006. He was recently found to have an incidentally detected heart murmur. Echo report discovered an Aortic root and associated aorta aneurysym present. 5.3cm effaced aortic root, asc aorta 4.9cm. Arch 3.5cm. Aortic valve mobile, trileaflet appearance and moderate-severe aortic regurgitation. Lt ventricle normal size and function. Mildly increased septal thickness. Borderline Lt atrial size, mild Rt atrial dilatation. Trivial mitral regurgitation. Dilated IVC with respiratory variation. All other NAD. We are awaiting a cardiac MRI and would appreciate your thoughts at this point as to next line management? I’m not sure if his lifestyle would be considered with management however he is a tradesman who works isolated, most times physically demanding, and we reside 250kms from a tertiary centre.
He certainly needs evaluation. In our aortic clinic patients are seen together by a surgeon and a cardiologist specializing in aortic disease. In this case factors tat are important include severity of regurgitation, symptoms, rate of growth, and anatomic features of the aneurysm. Lifestyle counseling and activity restrictions need discussion. There amy be a case for operating at this point, or there may be a case for very close observation.
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My husband was diagnosed with a heart murmur 2 years ago and has been called back to clinic yearly to check how things are going. His symptoms are breathlessness on exertion and walking up slight inclines will cause him to stop due to his loss of breath. He has had ECGs and echos. Following an echo in December 2016 it showed left ventricular non-dilated with normal overall systolic function. Left atrium is severely dialated, the right ventricle is non- dilated with normal functions.The aortic valve is tri- leaflet, mildly thickened, opens well, aortic regurgitation not well defined.Dilatedleft atrium.In April while cutting the grass he was really struggling with his breathing, far worst than it had ever been. We made an appointment to go back to clinic and he was examined and told his condition was the same but his blood pressure was slightly raised and he was put on Ramipril 5mg twice a day. In July we flew to Spain and on our return my husband had what appeared to be a heart attack when collecting our luggage. He turned a very pale shade of grey, couldn’t get his breath, heart racing and pain in his chest. He was admitted to accident and emergency where blood tests indicated that he had had a heart attack. The blood markers were only just above the cut off but 6 hours later they increased to 96. He was given an angiogram which showed very mild atheroma within the LAD and right cononary artery of around 10% luminal loss. More obvious stenosis at the right ostium of the diagonal at around 30-40% luminal loss but nothing that could really explain what happened. He was prescribed aspirin and Clopidogrel and told that a MRI would be arranged. He was discharged with the following medication: statin 80mg, beta blocker, water tablet, Ramipril, Clopidogrel and aspirin. Last week we received the outcome of the MRI. Preserved left ventricular function with an ejection fraction of 63%. LV ever so mildly dilated but with preserved function. No late gadolinium enhancement and the aortic regurgitation is minimal.No evidence of mitral regurgitation- flow studies would suggest this is not significant.No evidence of myocardial infarction or myocarditis.In his letter the consultant said this was reassuring and has arranged for my husband to have another echo in 2 years. None of this really explains what caused the “heat attack” at the airport and my husbands symptoms do not seem to fit the diagnosis in that his breathlessness is quite severe when walking up a small incline or setting off quickly when again he can become quite breathless and feels light headed.He does not suffer with swelling in the ankles or difficulty breathing when lying on his back.I would appreciate your comments
It seems like most of the testing that has been done is somewhat reassuring. Has he ever worn a heart monitor to rule out arrhythmic episodes that could be related to the symptoms?
Yes he wore one for 24 hours which revealed basic rhythm was sinus rhythm with first degree heart block throughout. Heart rate varied between 50- 92 bpm, non-frequent multi focal ventricular ectopics seen isolated 2 couplets, 1 salvo, maximum 9 beats, an episode of bigeminy, maximum 43 cycles and trigeminy, maximum 12 cycles, non- frequent supraventricular ectopics noticed. In your opinion how often do you think my husband should be seen and what do you think may have caused the episode at the airport? Having read all the test results do you think his breathlessness is consistent with his diagnosis? Thank you
Age 64 hiker. After endocarditis,moderate to severe regurgitation enlarged heart shortness breath. 4 months after aortic valve repair surgery echocardiogram shows heart normal size but moderate to severe regurgitation. I have no symptoms and walk 4 miles day. On lopressor for heart health since surgery. BP 120/75. Heart rate 65 What are my options?
Need a little more detail. Was a prosthetic valve placed? Did the leak change at all after the surgery?
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Hello Dr Ahmed,
I was diagnosed with a leaky aortic valve about 6 years ago and have been followed by a cardiologist since that time. I am 68 years old, female and generally fairly healthy, although I have a history of long-term Crohn”s disease, largely asymptomatic for the past 20 years. I take norvasc 5mg and losartan for hypertension, and my BP is generally 120/80 or below.
I had a recent echo and my ejection fraction was 48%. I am now scheduled for a MUGA test next week and my cardiologist has told me if it also shows my EF is below 50% we will need to consider surgery. I have no symptoms, no shortness of breath, etc, although I understand my heart is slightly enlarged. Would you consider these indications for surgery?
Thank you so much!
The ejection fraction may be a little low and that may be an indication for surgery however its important to know the following.
Is the aortic valve severely leaky? This can be determined by several methods, i prefer an integrated method that includes a quantitative and qualitative component with volume assessment. This may include a TEE test to see the mechanism and echo with 3d or MRI to determine the severity of the leak and increased heart chamber sizes. If the valve is severely leaky and the function of the heart felt to be decreased as a result then surgery may be indicated even in the absence of symptoms.
Valve disease is complex and should be managed by someone with expertise in such.
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Dear Dr. Ahmed, I was diagnosed with a Bicuspid aortic valve. There is moderate (2+) aortic valve regurgitation. – Dilated aortic sinuses at 4.1 cm. Does this just need to be monitored over time? Or do I need to have any type of surgery. The doctor said the valve is open and not closing. Any input on this? Thanks
It needs to be monitored closely over time with physical exam and serial imaging.
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I just had an annual echocardiogram.
Key findings were stable moderate aortic regurgitation and other echo parameters- with the left ventricle continuing to well compensate for the aortic incompetence.
The specific results are as followed:
1) Left Ventricle: Normal left ventricular size. No evidence of left ventricle hypertrophy and no resting regional wall motion abnormalities. Doppler shows impaired relaxation pattern of LV diastolic filling. Indeterminate LV filling pressure.
LV vol – 130 mls; IVS d 1.8cm. LVPW d 1.0cm, LVID d 5.2cm. LVID s 3.8cm. LVFS 27 percent.
(2) Atrial Areas/volumes: LAA Area – 23 cm2. RA – 19cm2
(3) LV Systolic Function – LV Vol 130 mls, LV Vol (BSA/Sex) ULN 150, Overall LV systolic function was low normal with a LV EF of 54 percent.
4) LV Diastolic Function
MV Peak E- 0.4m/s, MV Peak A – 0.7m/s, E’MV Ann- 5cm/s, E/e’ratio – 8, E/A Ratio – 0.6, e’LV lateral -7cm/s, Lateral E/e’ratio – 6. RUPV A Vmax- 0.2m/s, RUPV S Vmax- 0.5m/s, RUPV D Vmax – 0.3 m/s
(5) Aortic valve: tricuspid aortic valve with localised prolapse prolapse of the anterior half of the right coronary cusp, resulting in eccentric posterolaterally directed regurgitation- 2-3/4 aortic regurgitation, no evidence of aortic stenosis, PPG 12mmHG, resting LVOFT SV equals 125 ml. Indexed equals 62 ml/m2,
AOV max vel – 1.7m/s, AoV peak PG – 12mmHG, LVOT Vmax- 1.2m/s,LVOT VTI-0.255m, LVOT Diam- 2.5cm, AovArea V max 3.3cm2, DPI-0.68
(6) Right ventricular-: normal size, wall thickness and systolic function -RV S’: 15cm/s
7) Left atrium – mildly dilated
(8) Right atrium – normal in size
(9) 1 /4 mitral and tricuspid regurgitation;
(10) normal pulmonary artery systolic pressure- RSVP equals 3mHg
(11) Pericardium normal
(12) Aorta – mild dilitation of the aortic root and ascending aorta of 41mm.
Can you please explain to me what this all means. My cardiologist suspects I won’t need surgery in the short- medium term. Would you agree?
The leak is moderate, the heart is not significantly enlarged, there are no overly concerning findings. The aorta, aortic valve and the ventricle need to be followed closely with at least yearly echocardiograms. It would take severe leak with symptoms or evidence of heart failure to warrant surgical intervention.
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Dr Ahmed
I am a 57 year old who has moderate aortic regurgitation (2-3/4) as well as a mildly dilated aortic root and ascending aorta (41mm). My most recent echo indicated stable echo parameters:
Normal Left ventricular size. LV volume – 130mls
Low normal overall left ventricular systolic function . EF – 54 (up from 53 six months ago)
No evidence of left ventricular hyper trophy.
Spectral Doppler shows impaired relaxation pattern of LV diastolic filling. Indeterminate LV filling pressure
Normal right ventricular size, wall thickness and systolic function RVS’- 15cm/s
No resting regional wall abnormalities
Mildly dilated left atrium – 23cm2
Right atrium – normal in size -19cm2
Mild aortic valve sclerosis without stenosis. PPG 12mm/Hg. Resting LVOFT SV – 125 ml. Indexed – 62 ml/m2
Tricuspid Aortic valve with localised prolapse of the anterior half of the right coronary cusp resulting in eccentric posterolaterally directed aortic regurgitation – 2-3/4 aortic regurgitation
1/4 mitral valve regurgitation
1/4 tricuspid regurgitation
Normal pulmonary artery systolic pressure , RVSP – 31mmHg
Normal pericardium
Questions
1) is an ejection fraction of 54 normal? I keep reading that 55 – 70 is the normal range. While six months ago it was 53 a year ago it was 62. What would account for this?
(2) given the echo dimensions remain stable my cardiologist wants to see me in a year for a further echo to monitor the valve and aortic dimensions. Does this seem reasonable?
(3) after experienced atypical chest earlier this year (April) I had an additional stress echo which I passed with flying colours – I still experience almost constant mild chest pain which is not exercise related and cardiologist is very confident it is not cardiac related. Does this seem reasonable?
(4) based on my latest echo results ( stable) is it likely I won’t need a new
Valve in the short- medium term?
Mark
1) The EF is literally impossible to pin down to a %, in my valve clinic i follow patients with 3D derived volumes from 3d echo or MRI, it is more accurate. The 54 is likely near the normal range, difficult to comment without seeing.
2) Yearly surveillance and monitoring for symptoms appears appropriate.
3) Difficult to say without knowing the full story, however the normal stress is clearly reassuring.
4) Its likely that is correct, although follow up is key.
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Dr Ahmed
I am a 57 year old male and my cardiologist recently told me I have moderate well compensated aortic regurgitation (2-3/4) as well as a mildly dilated aortic root and ascending aorta (41mm). My most recent echo indicated stable echo parameters:
Normal Left ventricular size. LV volume – 130mls
Low normal overall left ventricular systolic function . EF – 54 (up from 53 six months ago)
No evidence of left ventricular hyper trophy.
Spectral Doppler shows impaired relaxation pattern of LV diastolic filling. Indeterminate LV filling pressure
Normal right ventricular size, wall thickness and systolic function RVS’- 15cm/s
No resting regional wall abnormalities
Mildly dilated left atrium – 23cm2
Right atrium – normal in size -19cm2
Mild aortic valve sclerosis without stenosis. PPG 12mm/Hg. Resting LVOFT SV – 125 ml. Indexed – 62 ml/m2
Tricuspid Aortic valve with localised prolapse of the anterior half of the right coronary cusp resulting in eccentric posterolaterally directed aortic regurgitation – 2-3/4 aortic regurgitation
1/4 mitral valve regurgitation
1/4 tricuspid regurgitation
Normal pulmonary artery systolic pressure , RVSP – 31mmHg
Normal pericardium
Questions
1) is an ejection fraction of 54 normal? I keep reading on the internet that 55 – 70 is the normal range and that that there is some uncertainty about whether 50-54 is normal or not. While six months ago my EF was 53 amost 18 moths ago it was 62. What would account for this reduction or is this simply a normal variation? I have had a relatively recent stress echo (April) which indicated my heart performed well under stress. I understand my EJ went up to 62.
(2) Given my echo dimensions remain stable my cardiologist wants to see me in a year for a further echo to monitor the valve and aortic dimensions. Does this seem reasonable?
(3) After experiencing chest pain earlier this year (April) my cardiologist is very confident the pain is non cardiac related particularly as I passed the stress echo with flying coloursI still experience almost constant mild chest pain which is not exercise related. Does this seem reasonable?
(4) based on my latest echo results ( stable) is it likely I won’t need a new
Valve in the short- medium term?
Mark
Follow up questions (1) Is it possible my aortic regurgitation will remain moderate and my mildly dilated aorta remain stable and as such I may not need a new aortic valve. I am 57 years old. (2) will TAVR be a potential option down the track to treat aortic regurgitation and not just aortic stenosis? Mark
Dear Dr Ahmed
My husband is 44 and has been diagnosed with severe AR and enlarged heart. His results are as follows:
CXR : Mild hyperinflation, normal CTR
ECG SR 54bpm, Axis 60, QRS 180ms, LBBB pattern
Cardiac Cath: unobstructed coronaries, dilated LV with severe AR, reduced ejection fraction
Bloods : WCC 6.51, Hb 14.7, MCV 87.5, platelets 248, Na138, K 4.1, Urea 6.2, Creatinine 72
Cardiac Echo : Dilated left ventricle with moderately impaired systolic function EF 43%, left ventricular hypertrophy with type 1 diastolic dysfunction, Left membrane, thickened aortic valvetips with severe aortic regurgitation and no aortic stenonis
Other symptoms : Clear, normal vesicular breath sounds, Abdo Soft and non tender
He scheduled for surgery in December but is becoming very tired lately even when walking short distances.
What is the prognosis for his condition and what is better a cows valve or prosthetic valve.
Would surgery cause his heart to shrink and would he be able to live a normal life.
I thank you in advance.
He has severe symptomatic aortic regurgitation with LV dysfunction and therefore if a candidate surgery is advised here. In terms of which valve that is a lifestyle decision here, it depends on the preference of blood thinning medications lifelong for a metal valve vs. chance of reoperation. See the other post on this site called mechanical vs. bioprosthetic valve. In aortic regurgitation, after surgery in man cases there can be significance ‘shrinking’ of the heart to normal and improvement in pumping function.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
I have previously sought your advice on my echocardiogram report and I thank you for your excellent advice. I have a couple of more specific questions. After once again reading my echocardiogram report I noted that my height has been recorded as 165 cm my weight as 96 kg and BSA as 2.03m2. I am actually 182 cm tall and was wondering if this impacts on the reliability on any of the findings of my echo report. Secondly my resting EJ is currently 54. In May 2016 my resting EJ was 66. In April this year my resting EJ was 53 and with a stress echo it was 62. Although my cardiologist told me he is not worried about this (and wants to see me in a year) I am curious to know if this is a normal occurrence and/or what factors can account for these EJ variations. I would have to say that my cardiologist is one of if not the best in my State.
By way of summary I have moderate aortic regurgitation (2-3/4), normal left ventricular size (130ml); no evidence of left ventricle hypertrophy; impaired relaxation pattern of LVdiastolic filling, but indeterminate LV filling pressure; low overall normal systolic function (EJ of 54 percent); no regional wall abnormalities; normal right ventricular size and systolic function – RVS- 15 cm; mildly dilated left atrium ( 23cm2); Resting LVOFT SV- 125 ml. Indexed – 62 ml/m2
mild dilation of aortic root and ascending sorta (both 41mm); normal pulmonary artery systolic pressure- RSVP – 31mmHg; normal pericardium; mild tricuspid and mitral regurgitation (1/4).
I am not sure if Dr Ahmed has answered my questions yet. Can you please confirm.
On another issue, what is impaired relaxation pattern of LV Diastolic filling and is it anything to worry about in my case. Also would you agree that my heart is compensating quite well with the moderate aortic regurgitation?
Lionel Jones
Can you please advise where I can find Dr Ahmed’s response to my questions. This is an excellent service provided by Dr Ahmed and as a busy cardiologist he should be commended for going way beyond the call of duty. Most of us struggle in coming to terms with the complexities of aortic regurgitation and its effect on overall heart function and the timing for AR. Dr Ahmed has a rare gift in being able to explain these complexities in layman’s terms. Many cardiologists either do not take the time to explain things to their patients or use complex cardiology terms which leaves the patient even more anxious and searching for answers.
The moderate aortic regurgitation appears to be stable. Ejection fraction on the echo is not necessarily a very reproducible number unless the test is done in a lab obsessive to detail and that uses recommended techniques for chamber quantification. It is very reassuring that the EF goes up with exercise. The physician treating is not concerned either and that is reassuring also. The key here is regular follow up.
you can follow my twitter at @MustafaAhmedMD
Thank you Dr Ahmed. One final question about my recent echo results. I wasn’t sure if the reference to ‘impaired relaxation pattern of LV Diastolic filling’ is anything to worry about in my case, or is it simply something that needs to be monitored as well. None of this was explained to me, presumably because my cardiologist is not overly worried about it.
Lionel
Its likely of no clinical significance.
Dear Dr. Mustafa Ahmed,
I’m a 27 year old male. After an echocardiogram I was diagnosed with trace/mild aortic regurgitation and high blood pressure. The heart and the valves look structurally normal and the cardiologist said it was an accidental finding. It scared me pretty bad though and I’m having bad anxiety ever since.
In earlier replies you said that mild AR in isolation is nothing to worry about. Can you please elaborate a bit on that. Do you mean this is a common finding in healthy people and generally doesn’t progress? Or is it something that is nothing to worry about right now, but is an indication that it might progress into severe AR in time?
You also said in an earlier reply it depends on the mechanism of the regurgitation. If the high blood pressure is the cause for the mild regurgitation, what does that tell you about the expected progression? Can mild AR possibly disappear over time, say, when my high blood pressure is treated?
Thank you.
Kind regards,
Jan
In general, mild AR is very common and of no clinical significance or concern.
Thank you Dr. Ahmed. Can you please tell me if mild AR can possibly disappear over time?
Hello Dr. Ahmed. I’m a 48 year old male. I’ve had a new aortic valve replacement . Congenital valve one year ago ! My operation didn’t go as planned . Came out of the operation with complete heart block and on top of that a thrombosis was found in my heart. Had a stay of five weeks in the hospital . Until they where happy to fit a single lead pacemaker after clearing the thrombosis . For seven months i was unhappy with my health after the operation continued breathlessness dizzy . Worse than before the operation. Much worse ! After a heated discussion or two with doctors cardiologist . Finally managed to have the pacemaker checked out. Pacemaker was found to be working as it should !. Then an event monitor was fitted. The outcome was that i should have had a dual lead pacemaker fitted. The cardiologist words not mine !. Throughout all this since the operation my ejection fractions have been good. I now have my second pacemaker. Felling far better than with the first one. But hear i am still out of breath and dizzy at times. Worse than before the valve operation. I understand the chance of all this happening were around 2%/3%. And it just happened to be me ! Sorry iv’e taken so long to get to the point. My questions is it possible that the extra strain on my heart over this year due to the heart block and wrong pacemaker fitted Seven months. !…. Could !. Or would have it caused more harm to my heart…. As if it could get anymore damaged ! …. On top of the 48 years with the congenital valve. I have new appointments coming up with my cardiologist soon . Your thoughts would be much appreciated. Thank you…. kind regards Adam.
Its a complex situation and i would need to know and see a lot more to begin to give you an accurate answer. If its pacemaker related issues it should be correctible with the modification of the system. Reassuringly the heart systolic function is normal although in many AS patients there can be ongoing relaxation abnormalities of the heart muscle that can result in residual symptoms such as shortness of breath. That can be investigated and treated appropriately however.Of course, all this is assuming valve function is normal.
you can follow my twitter at @MustafaAhmedMD
Hi doctor
My echo report shows M.R – 1+ ,A.R-2+,T.R-1 + , I am 29 years old male
Thank you
You have mild leaks of the mitral and tricuspid valves likely of no significance and a mild to moderate leak of the aortic valve that will likely be monitored over time. These are unlikely to be of immediate clinical significance unless you have been told otherwise by your provider.
you can follow my twitter at @MustafaAhmedMD
Dear Dr Mustafa,
I have a bicuspid aortic valve and mild aortic regurgitation.
My symptoms 3 months ago began with slight skipped/jumpy heart beats & slight pulpitations. Over the 3 months symptoms increased in severity & became more frequent and continue to do so. Symptoms: What feels like hot pressure from my neck upwards to the brain, dizziness, light headedness, contant fatigue, breathlessness, any form of movement/exercise anything will make my heart pound heart and fast. What also feels like a golf ball sometimes inside my chest & inside the back of my chest, chest pains, shooting pains in chest, what feels like electrical charges through chest/on heart, waking up with left leg and left arm numbness, loudness inside my head/ears. These symptoms appear to be more than mild regurgitation. Feel like severe and unsure how much time i have left before my legs blow up and im in the ER fighting for my life. I am trying to persuade my GP’s to hand me a referral for a cardiologist, from the beginning it was passed off as anxiety. This is not anxiety. Can you assist ??? I am not sure which route to take, but feel im a ticking time bomb in my body. Thank you for reading. Kind regards, Suzie
With regard to general management decision, any assistance provided in such a forum should be very limited in directing clinical care. In general bicuspid valve with only mild regurgitation is unlikely to be of any clinical significance and so the symptoms would likely not be related. If it would reassure you to see a cardiologist, it may be worth making a direct referral yourself.
Hello Dr Ahmed,
I have been diagnosed with significant dilated aortic root. AV:Annulus~ 28-29mm. Sever AR,Sinuse :69mm.ST.J:77mm, Dilated ascending aorta with till major branch,Arch not involved. AV: Biscuspid with fused left and right formats-type-I BAV – non calcific AV cusps. Significant dilated L.V LVEDV: 170-180 ml, LVEF~50%
Fusiform aneurysm in root of aorta (DeBackey-Type II , standford type A)
I have been operated in India for above on 13 Oct 2017 for Aortic valve repair+ Aortic Root Remodelling + Ascending Aorta replacement surgery.
Need your suggestion that how much this surgery is effective and what will be the life expectancy after this surgery?
Will i will be able to live a normal life?
Is there any chance that in future i will need another surgery for AR? right now after the surgery i have mild AR.
The surgery itself on the aorta should be good over the long term. If the aortic valve was repaired then it needs to be surveyed over the long term. Your description was of an effective surgery which is good. Just make sure you are followed up appropriately.
Thank you sir. I really appreciate your response.
I live in USA and want to know that which is the best hospital and doctor I can follow in future.
Vaibhav Jain…good afternoon
Can you please share the total cost of valve surgery and name of hospital .
Because I am also having bav and moderate avr and need operation in future.
Dr Ahmed, Thank you for your thoughtful replies. For many years (20) I was diagnosed with mild to moderate regurgitation in my aortic and mitral valve. Suddenly, 2 years ago it jumped to borderline severe. The Dr thought it was time for replacements but my Dad was dying and I kept postponing. In the meantime I had an ultrasound every 3 months. Suddenly, after 2 years my ultrasounds were back to almost normal. (Im now 59 years old). The Dr had no explanation for this but I was grateful for the reprieve.
My question is: should they go back to severe, what might my life expectancy be if I dont have surgery? My grandmother died of Alzheimer’s at 72 and my 86 year old mother has it now. It’s a dreadful disease. I dont want to put my family through it. I’d rather die in my early 70’s from my heart than be diagnosed with Alzheimers. If my next ultrasound shows the valves are back in the moderate to severe range, could i still live 10 years or more (granted, the heart disease would cause me to slow down)? My blood pressure has always been low but i am now taking lisinopril 2.5 mg as well. Thank you.
Firstly close surveillance of the valves in this setting is important. It makes no sense that severe disease would become normal, it would be good to have some form of explanation of mechanism for such. Regardless its good news if the recent scans were normal. With regard to the future, the field of structural heart disease is advancing incredibly. Already we are treating a growing number of patients with minimally invasive non surgical methods so it may not be as big a deal as thought to have corrective valve intervention over the next decade or so.
you can follow my twitter at @MustafaAhmedMD
Male, 27
Tri-cuspid aortic valve regurgitation and irregular heartbeat since very little. Never had limitation and pretty consistent check ups. Only recently after finding high blood pressure(runs in the family) did this stuff start to scare me. Had a 3-month long issue with panic attacks.
Finally got in to see a cardiologist who did an echo, ekg and stress test. She said everything looks fine, and there are no changes to my prognosis(surgery not till 50s or 60s). My aortic stem growth was like 1.3 of 4? My bp is 130/140s over 70s/80s but we are finding a med to lower that right now.
Now a couple months later the panic attacks are back because I’m worried about my “episodes” /irregular heart beat. I’ve had the same “episodes” since I was a little kid… when my heart starts pounding fast and hard— it only goes on for a few seconds sometimes, maybe a few mins but I lay on my back and “catch my heaetbeat”. Hasn’t really ever bothered me much but now my increased awareness has me freaking out it’s AFib or something worse. I never have my episodes during the tests, even when I was a kid. Which makes me think they are missing something serious… The episodes come super randomly and often when laying down or bending in weird directions. Almost never when exercising or anxious…Could these be just palpations? Surely if it was BAD, it would show on my tests or blood work?
Don’t want panic attacks, so if you can help eliminate my immediate concerns of death, cardiac arrest or stroke, that would save me!!!Help?!
The good news is that your testing has been reassuring so far and your cardiologist is not concerned. This means that high risk findings appear to have been ruled out so far. In order to reassure you, maybe ask for a longer term monitor to characterize your episodes.
I’ve been having panic attacks anout my diagnosis. I’ve had a tricuspid leaking aortic valve and atrial fibrillation(we think, but I’ve never had en episode while being tested so it’s hard to confirm AFib) since I was a kid. No real limitations. But I recently found out I had high blood pressure and for some reason this feels like a lot to have at 27 and I’m scared it puts me at high risk for a stroke, heart attack etc. I’m getting my bp under control with meds now but without meds run 130s/140s over 70s.
I recently had an echo, EKG and stress test. My cardiologist said there is no change to my original diagnosis as a kid (surgery to repair valve not likely till 50s/60s) and my stem is only enlarged to a 1.4(is that good?)
Basically I’m just looking for some encouragement that my diagnosis doesn’t need to come with such doom and gloom and fear of fatal cardiac episodes(google is a dangerous place and it freaked me out reading too much)!!
Looking for some help: encouragement, I could really use it, but remember, please be cautious with any response as I have pretty intense panic attacks about this stuff.
Thanks so much I can’t wait to recommend this site and your service to ppl I know!!!
I had a recent echo which indicated I had 2-3/4 aortic regurgitation. Does this mean I have moderate aortic regurgitation or mild to moderate aortic regurgitation?
Sharon
It is difficult to know without looking at the images themselves. The grading scales are somewhat subjective and it’s important to take an integrated approach when offering an opinion regarding the severity of regurgitation. In general however two to three out of four would signify a moderate type of disease.
you can follow my twitter at @MustafaAhmedMD
My daughter age is about 6 years and she undergo a successfull PAVSD repair last year in april.at first and second follow up visit the echo reported that there is minimal Lt and Rt AV valve regurg. But at Third follow up visit the echo report showing there is mild Lt and Rt AV valve regurg. I am worry please gude me in detail wheather it is harmfull or not.
29 male, Bicuspid aortic Valve with mild regurgitation. Just had an echo, ekg, blood test, 24hr monitor and stress test and was told no limitations or changes in diagnosis . I have 4 questions.
1. Just recently found out I have high blood pressure. Given the new guidelines and my condition, my doctor wants to get me to 120s/70s(I’m currenrly 130s/80s.) does that sound appropriate? It seemed like the new guidelines were saying we need to get below 120s or risk gets severe. Worried that my heart condition on top of these findings makes me high risk.
2. My doctor told me I have a 1.3Aortic root. She said that is normal. Is that considered an aneurism? Is there a chance that it doesn’t grow larger? At 1.3 there is no need to worry about a rupture or dissection is there?
3. I’ve had heart arrhythmia episodes since I was young. They are infrequent(couple times a week) lasting between 1-10mins usually happen when laying down or at night in bed or from stress/ change in posture. Doctor said she’s not worried about them being AFib because although I wasn’t having an “episode” during tests, she would see some signs or pwave activity during the echo, 24hr monitor, stress test or ekg. Does that sound logical? She doesn’t worry about them unless they get much worse and didn’t even think we need to do event monitor.
4. Too much googling and now I’m afraid I have an Aortic aneurism or Impending dissection. Also afraid of having a heart attack, Stroke, cardiac arrest, etc. since I had an echo, ekg, stress test, blood test and 24 Holter monitor, can I rule these things out as immediate danger? If I was close to any of this there would be signs, correct?
Can anyone see the Dr’s answer to this question? It isn’t showing on my forum
I can’t see it but would like to get these answered also.
Good day Dr. Ahmed , My husband who is 36 years old is recently diagnosed with severe aortic regurgitation.
here is the conclusion of his result
Aortic regurgitation 3+
anterior mitral valve prolapse with trivial mitral regurgitation
eccentric left ventricular hypertrophy
The doctor suggested that he undergo valve replacement
My question is how urgent is the surgery given the condition of his heart
and are there any options or care needed while waiting for the surgery
Thanks
I will have our aortic surgical specialist review and answer with regards to the surgery itself. Also the question is does the valve need replacing or can it be repaired.
you can follow my twitter at @MustafaAhmedMD
Hello Dr. Ahmed,
I’m a 27-year-old woman who was diagnosed with a bicuspid aortic valve with a murmur as an infant and have had the condition monitored my whole life. I’ve only ever had trace to mild aortic regurgitation until my last bi-annual check-up, when my cardiologist informed me that the condition has progressed to moderate (the exact amount of regurgitation I have yet to confirm with the doctor). She recommended a follow-up appointment in a year. Other than my heart condition, I exercise regularly, eat well, and have a healthy weight.
When I asked her about the likelihood of the condition progressing to better understand how worried I should be, she said it was impossible to know. Can you point me to studies showing the average rate of the disease’s progression? I want to understand how likely it is that I’ll need surgery in less than five years or more like 15 or 20 years.
Thank you so much for your help!
I wouldn’t worry too much about what the future holds as if followed appropriately and with the correct intervention at the right time the outlook for you is good.
Bicuspid valve, when compared to tricuspid valve is more prone to degeneration with either tightening or leak. In your case it is the leak. The indication for intervention on severe leak is development of symptoms or significant heart enlargement and impairment of function. Follow up is key. Initially the key is to ensure the stability of the disease, for example if your valve is the same year after year then its likely to remain stable for many years. If however it worsens between relatively close time intervals then its considered more aggressive. Studies are difficult because patients are enrolled at differing severities and time points. I have seen patients go years and years with stable disease. I agree there isn’t a good answer to give you for an individual instance. Its also important to follow the size of the aorta as that ultimately needs to be monitored and can affect long term management. Also of note is that in the correct center there is a potential to repair and not replace the valve ultimately.
you can follow my twitter at @MustafaAhmedMD
I recently had an echo done and it showed a small LV cavity, mild AR and mild MR. I also have tachycardia. What should I be doing and what might I have to be concerned about later on?
Why was the study done and what are the specifics of the report, would need specifics to comment .
Hello doctor. I am 26, female.
My Ecg report shows Borderline ECG (sinus tachycardia and probable left artial enlargement).
ECHO-
EF- 67%. E/A of MV Flow- 1.70.
E/E- 6.30.
MILD MITRAL REGURGITATION.
MILD TRICUSPID REGURGITATION (TR PG 13mmHg)
AORTIC SCLEROSIS. MILD AORTIC REGURGITATION.
24hrs HOLTER – MAX 169, AVERAGE 89 MIN 56. The basic rhytm was Sinus. One premature atrial contractions were noted.
I feel fatigue, palpitation and shortnes of breath. Almost fainting like when climibing stairs or exercise. Also i am bit worried about my 3valve regurgitation. Can they progress with time?. My pulse rate can go high upto 160 at a time and normally stays around 100 to 120. My Bp normally remains normal around 110/70. My cardiologist said all is fine but two years back my echo was completly normal with Ef 70%. I have past history of rheumatic fever.
As things stand you don’t have a significant valve issue, it will not necessarily progress. You will need regular follow ups and yearly physical.
you can follow my twitter at @MustafaAhmedMD
My doctor gavme inderal 20 twice. By regular follw up how much time interval gap u mean. I am student and i am worried about symptoms. MY Ef decline by 3% in two years.
Hello doctor. I am 26, female.
My Ecg report shows Borderline ECG with possible left artial enlargement sinus tachycardia.
ECHO – EF 67 %. E /a 1.70 and e/e 6.70. MILD MITRAL REGURGITATION, MILD TRICUSPID REGURGITATION. Trpg 13mmHg. AORTIC SCLEROSIS with MILD AORTIC REGURGITATION.
My 24hrs holter report – MAX 169, AVERAGE 89 and MIN 89bpm. Sinus rhytm with 1premature atrial contractions.
I feel fatigue, palpitation and shortnes of breath. Almost like fainting when climbing stairs or doing normal exercise. I have past history of rheumatic fever. My cardiologist said all is fine. I am worried about my 3leaky valves that over time it might get worse cause my 2years back Echo was completly normal.
Hello Dr. Ahmed.
My Echo results:Mild AL enlargement, mild aortic regurgitation
Normal LV and RV wall motion, thickness and function.
Impaired LV relaxation or early diastolic dysfunction.
MIld AI.
LEFT VENTRICLE
Normal LV size, wall thickness, and systolic function. LV EF is 60%. There is normal LV regional
wall motion. Impaired LV relaxation.
Symptoms short of breath, palpitations variable, blood pressure fluctuations to high side but then settles to normal. White coat HBP. Chest wall tightness, anxiety
Norvasc and metropropol prescribed. Dr. wants a CT scan and heart monitor for 6 weeks.
Is this all necessary? I would like to try to get my bp down on my own if that is not too dangerous to wait with these results? Is is appropriate to ask just to to take Norvasc. I don’t want to start a beta blocker if I can help it. History of Rhematic fever. Can I wait this out a bit? What does all this mean. Was told getting bp under control was key. Otherwise unsure of why heart monitor and ct scan.
Thank you.
Difficult to comment without knowing more about the initial visit. In general a monitor would be used to characterize the palpitations. The ct scan depends on what type is ordered, there are many reasons.
you can follow my twitter at @MustafaAhmedMD
Dr. Ahmed , also I am 59 years old. LV EF is 60%. I have borrelia / Lyme and co infections. malaise/fatigue severe daily.
Hi,
I’ve had 4 echos since 2009, the last one in 2016, was mostly normal despite the “thickened mitral valve” comment…..What is significance or not of thick mitral valve with TRACE regurgitation.
Findings:
Diastolic Diameter: 4.4 cm (3.5-5.5 cm) Aortic Root: 2.5 cm (2.0-3.7 cm)
Systolic Diameter: 3.0 cm (2.5-4.0 cm) Left Atrium: cm (1.9-3.8 cm)
Septal Thickness: 0.8 cm (0.7-1.2 cm)
Post. Wall Thickness: 0.8 cm (0.7-1.1 cm) EF%: 55-60(55-75%)
TWO DIMENSIONAL ECHOCARDIOLOGY:
Left ventricular size is normal. Left ventricular wall thickness is normal.
Segmental left ventricular function is normal. Overall left ventricular
function is normal. There is an estimated ejection fraction of 55-60 %.
Right ventricular function is grossly normal. The right ventricular TAPSE is
2 cm (normal > 1.6 cm). Left atrial size is normal. The left atrial volume
index is 23 ml/m2 (normal 48; Revised J Am Soc Echo 1/15). The left atrium
is normal size. The right atrial area is 15 cm2. The right atrial size is
normal. The aortic root size is normal. The ascending aorta is normal at 3.1
cm. The mitral valve is thickened.
SPECTRAL DOPPLER:
There is trace mitral regurgitation. There is trace tricuspid regurgitation.
Hello Sir;
I am living in Spain and have been diagnosed with aortic regurgitaion and had an ultra sound and they want to operate. Can you PLEASE interpret the ultra sound reading. Systolic function, depressed Fe 55%. Diastolic function, DD1. Segmental movement, generalized light hypokinesia. Tapse vd, 100. Thickness 14/14. Diameters, DTDVI 73, DTSVI 51, AI 38, AO. Rao 37, chest 61, ao sac 46, cayado (crook?) 35, ao desc 33 mm. Valves, dysplasia of V AO, it looks like a trivalve, acts lika a bivalve, IAO moderate to severe, VC 10 mm, flow inversion. IM light masses or spills, no tap 145 ms. IAO 2 dilatation of chest and a dysplastic valve. If I need an operation I want to come back to the US for it. Thank you in advance. Nick
Your report is not entirely clear, its a complex issue as your aorta may be involved, in that case aortic surgery with valve repair vs replacement are the options. Make sure these issues are discussed at length and all options entertained.
you can follow my twitter at @MustafaAhmedMD
Hi. I have an extra heart beat and aortic regurgitation. Will I need surgery and can you please tell me how long I will live for. I am 49 and was just told today.
Do you have more details?
I was diagnosed with pericardial effusion in Sept. 2015. Heart doctor came in looked at echogram because nurse left room while in progress to bring him in to look at it. He wasn’t in there but a few seconds and walked out, I never saw him again. My regular doctor is an internist told me the results of the test and that was the end of it. I have had chest pains for over a month, shortness of breath (had to use my inhaler a lot) otherwise no, extremely tired so I saw my doctor’s nurse practitioner. He did an EKG which was fine but ordered Nuclear imagining of heart, shot instead of treadmill because my health is too bad too run treadmill and chest XRAY. XRAY was fine they said called me later and said “the right side of my heart was leaking blood”. Test were done on March 30,2018. Got results today. Could the pericardial effusion I was diagnosed with in 2015 that was ignored all these years caused what is wrong with my heart now?
Its possible the effusion with pains that you had were a process known as pericarditis. Its unlikely its related to the valve issues.
you can follow my twitter at @MustafaAhmedMD
Hi Dr I’m a 65 year old woman. for many years I’ve been diagnosed with mild MVR recently I did another echo and indicated that now I have mild to moderate AVR. too. I also suffer from high bld. pressure on treatment. I have normal LV dimensions with normal LV. I am very worried, another echo is needed in 18months do you agree and is there a normal life for me. thank you a lot for your help
No reason you cant have a normal life. Important to have regular follow up and ensure the issues remain stable.
you can follow my twitter at @MustafaAhmedMD
Dear Dr.
I am a 46 year old female who had a TIA 3 months ago. Yesterday my cardio doctor told me I had a leaky valve. My symptoms that have been increasing since my TIA are extreme shortness of breath upon physical exertion, and extreme fatigue. If I run I feel pain in my chest. My doctor has ordered a stress test next month. Do you think my leaky valve would require surgery? Thank you.
Lets start by seeing how leaky it is.
Dear Dr. Mustafa Ahmed,
Thank you for your reply. I will have an echo stress test tomorrow, which I think will reveal the extent of my problem. Although my test was due on the 15th of May, it was brought forward to the 10th due to my progressing symptoms, which at times debilitate me. My shortness of breath, alongside extreme lightheaded fatigue, and a very subtle localized pain in the middle of my chest which upon exertion seems to hurt as if I have acquired an internal bruise were becoming unbearable. I will hopefully be healthy enough to let you know what the outcome is. Thank you for your help and concern. I feel blessed to have a doctor I can access freely online.
I wish you all the very best.
Yaprak Ceyhan
Hello i have aortic regurg LVH both for many yrs i have echo each yr but tis time my cardiologist wants to see me i am now getting lotsvof dizzy spells lightheadness
I am 63 year old male on B P medication for the last 13 years. Recent Echo test result:
1. Concentric LV hypertrophy
2. No RWMA at rest
3.Gr 11 LV diastolic dysfunction
4. Mild AR
5. Trivial MR
TMT Stress test:
1. Negative for inducible ischemia
2. Good effort tolerance
3. No anginas/arrhythmias
4. Normal BP and HR response
Doctor, your valuable comments, please.
Advice is to diet, exercise, control bp, prevent diabetes, dont smoke, regular medical checkups.
I am 83 yo woman with moderate aortic stenosis, moderate mitral regurgitation, moderate
tricuspid regurgitation, and moderate aortic insufficiency. Do I need surgery yet?
Not necessarily, it depends on the extent of the disease after careful evaluation, the state of symptoms, and the condition of the heart. Would need to see films to review that. Would recommend specialist valve evaluation.
you can follow my twitter at @mustafaahmedmd
I have a slight blood leakage am 42 what does this mean
Dear Dr Ahmed,
I had a mild MI about a year ago and was diagnosed with arrhythmia and 2 leaky heart valves. I have been treated with blood thinners and beta blockers. After 6 months ı became allergic to the blood thinners with red spotting on my lower legs. ı was then given in turn 3 new beta blockers, I was allergic to all of them. As my doctor washed his hands of me as I would not take the medication that I was allergic to I decided to come off the medication and go for Ayuvedic treatment. ı spent 2 weeks in an Ayuvedic clinic.
ı now feel much less ‘foggy’ and free of all of the many unpleasant symptoms that I was experiencing. I am adhering to the Ayuvedic regime, which includes taking herbal replacements for my drugs and I have become largely vegetarian practicing yoga twice a day. I intend to have 6 monthly examinations with both my conventional and Ayuvedic doctors to monitor my state of health. My question is with slow and careful exercise what percentage of my original health and fitness would it be reasonable for me to expect to be able to attain?
(corrected version)
Dear Dr Ahmed,
I had a mild MI about a year ago and was diagnosed with arrhythmia and 2 leaky heart valves. I have been treated with blood thinners and beta blockers. After 6 months ı became allergic to the blood thinners with red spotting on my lower legs. ı was then given in turn 3 new blood thinners, I was allergic to all of them. As my doctor washed his hands of me as I would not take the medication that I was allergic to I decided to come off the medication and go for Ayuvedic treatment. ı spent 2 weeks in an Ayuvedic clinic.
ı now feel much less ‘foggy’ and free of all of the many unpleasant symptoms that I was experiencing. I am adhering to the Ayuvedic regime, which includes taking herbal replacements for my drugs and I have become largely vegetarian practicing yoga twice a day. I intend to have 6 monthly examinations with both my conventional and Ayuvedic doctors to monitor my state of health. My question is with slow and careful exercise what percentage of my original health and fitness would it be reasonable for me to expect to be able to attain?
What is the nature of the heart valve disease and function.
Dear Mustafa Ahmed MD,
My 3,5 year old son was diagnosed with mild aortic regurgitation and trace mitral regurgitation at 3 years old. I was told this wont happen as congenital problem, something must have happened like rheumatic fever and I didnt notice. I was told he had murmurs when he was 2,5 years old but because his growth was very well I didnt take him to dr and waited in case it might fade. So then when we took him to cardiologist at 3,5 years old and he was diagnosed accordingly.
When he was 2,5 years old he got sick and he had fever then he had coughs at night and he had a walnut size lymph on the size of his neck and he had 1mg antibiotic injections 3 days in row. Its all I can remember happened bad.. would I know by any chance what have caused this?
Also could you pls tell me if he would have any problems in adulthood?
Kind regards.
Its difficult to know without knowing much more of the story or reviewing the images. Have you reviewed the case with a pediatric cardiologist locally?
Yes, I went to a few. Since I didnt go while smt was happenig, they can’t say what caused this, they are saying. The last one I went said she considered this physiologic inefficiency and sying she doesnt think this will cause anything.
Would airtic regurgitation in childhood can disappear through adulthood?
Hi, I dont get answer to my question neither here nor on Mustafa Ahmed md’s twitter account..
I look forward to his answer..
Kind regards.
Hi, I dont get answer to my question neither here nor on Mustafa Ahmed md’s twitter account..
I look forward to his answer..
Kind regards.
I have moderate regurgitation. Last doctor said I had mild to moderate. Is that a big difference or maybe just subjective? One dr could think one and one the other while looking at the same test?
i was told as a kid intervention wasn’t likely until 50s or 60s…Given I am 28 now with moderate regurgitation, would you say I’m still on that track?? How long does one usually stay there? What stage is it?
If my ejection fraction is 55-60% why does that mean?
i put the conclusion from my test below for reference. ANY help would be appreciated.
CONCLUSIONS:
1. Normal LV size, normal wall thickness, normal systolic function, normal LV diastolic function.
2. Left ventricular ejection fraction is approximately 55-60%.
3. Normal right ventricular size and normal systolic function.
4. Bicuspid aortic valve morphology with moderate regurgitation.
5. Normal pulmonary artery systolic pressure.
6. Mildly enlarged mid ascending aorta (4.0 cm) without coarctation.
Still no surgery till much later? Am I in ok shape?
I saw my cardiologist this morning for my annual echo cardio gram to monitor aortic regurgitation. My regurgitation has remained right in the middle of moderate 2-3/4 and my systolic function is low normal – EJ of 50-55. There is no heart enlargement. Dr said my heart continues to compensate well and in some ways is evident of a current benign nature. Based on current echo findings and relatively normal Cardiology clinical assessment, what is my likely prognosis?
Prognosis is typically good as long as a careful watchful strategy is undertaken with careful surveillance.
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How quickly does moderate regurgitation progress? I’m 27 and have moderate regurgitation with no other issues or symptoms. Am I still likely to only need surgery in my 50s or 60s like originally diagnosed?
No good way to predict, can often stay stable for long periods of time. It may not progress too severe although moderate is at more risk of progressing than mild for example. The key is regular physical examinations, and surveillance and report symptoms. For moderate regurgitation alone I would not in general feel someone would have to attenuate activity significantly.
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I have a long standing issue of moderate 2-3/4 aortic regurgitation. My latest echo indicated that my regurgitation and overall heart function is stable. My report notes the following:
(1) Low normal ejection fraction – 50-55
(2) Mild enlargement of Left ventricle – volume of 155 – up from 132 last year
(3) Mild enlargement of left and right atrium
(4) Normal right ventricular and systolic function
(5) tri-leaflet aortic valve with 2-3/4 aortic regurgitation – previous echo suggested a bicuspid valve but cardiologist convinced it is tri-leaflet with a prolapsed right Coronary cusp. Mild aortic sclerosis but no stenosis
(6) Stable mild dilated ascending aorta -41mm
(7) Sclerotic mitral valve
(8) Clinical examination completely normal other than murmur ie no collapsing pulse etc
Questions
A) Is the increase in left ventricle volumes significant?
(B) is the change in diagnosis from bicuspid to tri-leaflet aortic valve with right coronary cusp prolapse significant and does it affect prognosis/treatment options
(C) concerned that ejection fraction continues to be in the low normal range – 3 years ago it was 66 and for the last two annual echos it has been in the 50-55 range. Cardiologist is not concerned -Should I be?
(D) Based on your classification would you agree that I fall within Stage B?
(E) Cardiologist suggests the stable nature of the regurgitation reflects in many ways the benign nature of my condition – at least in the short to medium term.
(F) Is there any way to predict likely progression of regurgitation and need for valve replacement.
(G) Given advances in surgical techniques is valve repair now a potential option.
Latest Echo results and clinical examination.
(1) Stable moderate aortic regurgitation (2-3/4)
(2) Valve is tricuspid with prolapse if right Coronary cusp
( 3) LVEDD – 155 mls ( up from 132 mls last year
(4) Very mild enlargement of Left ventricle
(5) low normal systolic function with EF of 50-55
(6) mild dilation of left and right atriums
(7) normal right ventricle size and function
(8) mild regurgitation of mitral and Tricuspid valves -1/4
(9) Schlerotic mitral valve
(10) Normal clinical exam other than moderate Aortic murmur; no collapsing pulse or other clinical signs of worsening regurgitation.
(11) Cardiologist not concerned about EJ of 50-55 despite fall on level 2 years ago which was 66. It is the same as last year. I have no physical exercise limitations.
Questions
(A) is an increase in LVEDD from 132 to 155 clinically significant?
(B) Based on my current echo parameters do I fall within stage B of your classification level
(C) Progression of my aortic regurgitation has been very slow and cardiologist suggests in some ways could be suggestive of its benign nature at least for the moment.
(D) I was originally diagnosed with a bicuspid valve but this was changed to a tricuspid prolapsed valve. Does this mean there is less chance of the regurgitation progressing?
(E) How likely is it that my regurgitation will require valve replacement in the short- medium term
(F) Finally – any likelihood that TAVR will be suitable for pure aortic regurgitation in the near future
Im pretty sure they mean LVEDV and not LVEDV in general its not exact year on year for EDV, MRI would be more reliable. But not critical The EDD is more reproducible and can be tracked also. Both may be important. In our center we would generally try to repair your valve rather than replace it when the time came. TAVR may reach that stage, we have done this, however should be reserved at this time for non operative aortic regurgitation candidates.
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Thank you Dr Ahmed -I apologise for my typos. This is a fantastic service.
Just a couple of quick follow ups.
1. Given my overall echo parameters have remained stable can you explain possible reasons why my EJ has declined other than technician error?
2. Do I fall within Stage B of your classification system?
3. Is a LVEDV of 155mls within normal range for a 58 year old male
4. Generally speaking is regurgitation associated with a bicuspid aortic valve more likely to progress faster than regurgitation associated with a trileaflet prolapsed Aortic Valve?
Thank you
I am a 56-year-old woman. I contracted sepsis and endocarditis on 5/22, and on 8/13 my ct revealed that I had severe aortic valve regurgitation. I’m having a transesophageal echocardiogram next week. The only symptom I have is occasional, momentary light headedness. I have a once-in-a-lifetime trip to Europe scheduled at the end of September. I’m going to a special event, so it truly is once in a lifetime. Do you think it’s safe for me to go?
Depends on your evaluation by the cardiologist. A lot depends on the stability of the disease process.
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I have sent in a request for advice from Dr Ahmed on my moderate aortic regurgitation.
I wasn’t sure if Dr Ahmed has or will respond to my questions. I know this does not constitute actual medical advice but Dr Ahmed provides an excellent service in terms of his learned observations/ insights on aortic regurgitation.
Further to my recent request (in case Dr Ahmed did not receive it) the following is a summary of my latest Echo report
(1) Moderate well compensated aortic regurgitation (2-3/4 grading) – prolapse or fenrsyration tear of the anyerolaterak aspect of the right coronary cusp; PPG 11mmHG
(2) Stability withoutvevidence of adverse left ventricular remodelling; mildly increased left ventricular internal cavity size.
(3) LVEDV – 155 mls and ejection fraction by visual estimation in the range of 50-55. Low normal overall LV systolic function
– IVS d 0.9cm; LVPW d 1 cm, LVID d 5.6 cn
4) Normal right ventriclular size and systolic function – RVS 13cm/s
(5) Mildlyvdilated left and right atrium -25 cm2 and 21cm2 respectively
(5) 0-1/4 mitral and Tricuspid valve regurgitation
(6) Aortopathy stable and neglible with diameter of 41mm for both transcsinus and ascending aorta levels
(7) Pulmonary pressures normal – RVSP – 31 mmHg
(6) Normal pericardium
(7) Normal sinus rhythm, carotid pulse volume on upstroke normal, no collapsing pulse.
Questions
1 Based on my echo parameters do I fall within Stage 2 of your classification system?
2. Progression of my aortic regurgitation has been very slow. Is this typical of a dysfunction aortic valve prolapse as opposed to a bicuspid aortic valve?
3) I note my LV volume has increased from 130 ml to 155 ml. Is this significant?
(4) My overall systolic function remains low normal – EF of 50-55. Two years ago my EF was 65. While Cardiologist is not concerned I don’t understand how it could drop by 10 points? Any clues?
(5) Cardiologist suggests I am unlikely to need a new valve in the short- medium term – particularly given the stable nature of my condition. Aortic valve repair is not currently a common treatment measure in Australia. Generally speaking could a prolapsed valve be suitable for repair and given my echo parameters would you agree I am unlikely to need a new valve in the short- medium term.
I wasn’t sure if DR Ahmed had already or was was able to respond to my questions.
Can Dr Ahmed confirm whether he has responded to my previous request.
Hi. I have a BAV with moderate regurg. and a 4.5cm dilated aortic root. I follow a plant-based vegan diet and have been running to keep my weight down. I run 7 to 10 miles a day and would like to train for further distances. I feel great and have no symptoms. I don’t have all the specifics from my echo – the 4.5cm is the only number that stands out to me. Do you think distance training be too strenuous? Is there an increased risk further dilation with distance running (maintaining aerobic zone heart rate)?
Due to liability and such cant really answer such a question over the internet.
In general, most would advise against more than moderate activity in this setting and avoidance of competitive type situations. Its not what most people want to hear but its what most would advise. The key is monitoring of aortic size and close surveillance.
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Hi doctor, recently went to the doctor for occassional daily palpitations with no symptoms, got an EKG and Echo done and was diagnosed with a Bicuspid Aortic Valve with trivial leakage. I’m 21 years old have been active all my life and do enjoy drinking (as i am a college student) and smoking occassionally. My main concern is if i do carry on drinking will this effect my condition? Do i have an increased risk for sudden death? i have been spinning since i got the diagnoses. Major anxiety sufferer here. Thank you!
Not much data to advise regarding the effect of drinking on heart valves. In terms of follow up, no cause for immediate concern but would recommend periodic cardiology follow up and recognition of symptoms of a worsening valve such as fatigue, shortness of breath and such.
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I was diagnosed with minimal aortic valve leakage after wearing a monitor for 30 days. I have palpitations, short of breath, coughing, fatigue, chest pressure, dizzy and be light headed. I have episode when they come on and some time the last for hours at a time. I have told my doctor and he say it’s not anything to worry about. This is not normal and it’s very scary.
Hello. I have a bicuspid aortic valve with mild regurgitation . I had an echo that showed mild diffuse hypokinesis of the left ventricle at rest . My ejection fraction was 50 at rest and 60 at stress. My cardiologist didn’t seem concerned but I’m worried that it could be a cardiomyopathy ? I am a 32 year old female. It also showed ischemia on the ekg but not on the stress test . Except at rest there was the diffuse hypokinesis.
I would recommend discussing this with the reading physician and asking them to quantify the measurements to be sure.
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Hello! My baby boy was born with TGA, he had his arterial switch when he was 14 days old.. Since surgery he have trivial aortic regurgitation,please tell me what i need to take care of,and can that be gone as he grow up? Pleas help me explain,and give me advice,i worry a lot, he is 9 months old. Thank you so much!
Hi Sir,
My daughter 3 years old had done VSD surgery due to moderate AR,
Surgery done last year .
After surgery we have 3 echos , AR was trivial .
Recently we done an echo , its shows AR is mild.
Daughter is asymptomatic.
Could you please advice the frequent of AR progress
Depends on stability over time. In general mild AI will not necessarily progress unless valve characteristics change over time.
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Hello Dr,
Based on the report below, any reason to follow-up a year and half later? In particular, I am concerned about the mild/trace, but MULTIPLE valve regurgitations (all 4 have this) and the grade 2 diastolic dysfunction, as well as the enlarged LA. Would the combination of all these 3 things be cause for concern?
Thank you for all the helpful info you’ve given on this site.
Brian
Echo Report (6/2/17):
Summary:
LV systolic function is normal with an ejection fraction of 66%
No significant valvular abnormalities
LA size – mildly enlarged.
Findings:
Mitral Valve
No evidence of mitral stenosis.
Trace mitral regurgitation.
Aortic Valve
No aortic stenosis
Trace aortic insufficiency.
Tricuspid Valve
Mild tricuspid regurgitation.
The estimated pulmonary artery systolic pressure is normal at 28 mmHg
Pulmonic Valve
Mild pulmonic regurgitation.
Left Atrium
LA size – mildly enlarged.
No evidence of ASD or PFO by color flow interrogation of interatrial
septum.
Left Ventricle
Normal left ventricular size.
Normal left ventricular wall thickness.
LV systolic function is normal with an ejection fraction of 66% measured
using biplane.
No regional wall motion abnormality is seen.
Grade 2 diastolic dysfunction
Right Atrium
Normal right atrial size.
Right Ventricle
Normal right ventricular size.
Normal right ventricular function.
Pericardial Effusion
No pericardial effusion is present.
Miscellaneous
IVC is normal in caliber and responds to respiration.
Aorta
Ascending aorta size normal in the views provided.
Based on this report you have no significant valve disease and no concern regarding the valves, its basically normal valve findings.
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Thanks very much again, Dr. You are providing a great service to all of us current or potential heart patients.
Barna
hi doctor, i just want to ask if my condition is still okay? because i have a shortness of breath these days, and mild pressure on my chest just like someone is pressing me on my chest, btw Im just 22 years old and my doctor told me that my heart is normal and I dont have any problem and now im very anxious of my health because she didnt explain my 2d echo results. My echo results are
eccentric left ventricular hypertrophy with preserved ejection fraction 62%
mild mitrial/tricuspid regurgitation
aortic regurgitation 1+
normal pulmonary artery pressure with pulmonic regurgitation
T/C bicuspid aortic valve
hi doctor, i just want to ask if my condition is still okay? because i have a shortness of breath these days, and mild pressure on my chest just like someone is pressing me on my chest, btw Im just 22 years old and my doctor told me that my heart is normal and I dont have any problem and now im very anxious of my health because she didnt explain my 2d echo results. My echo results are
eccentric left ventricular hypertrophy with preserved ejection fraction 62%
mild mitrial/tricuspid regurgitation
aortic regurgitation 1+
normal pulmonary artery pressure with pulmonic regurgitation
T/C bicuspid aortic valve
And i just want to ask also what is the meaning of T/C bicuspid aortic valve?
hi doctor, i just want to ask if my condition is still okay? because i have a shortness of breath these days, and mild pressure on my chest just like someone is pressing me on my chest, btw Im just 22 years old and my doctor told me that my heart is normal and I dont have any problem and now im very anxious of my health because she didnt explain my 2d echo results. My echo results are
eccentric left ventricular hypertrophy with preserved ejection fraction 62%
mild mitrial/tricuspid regurgitation
aortic regurgitation 1+
normal pulmonary artery pressure with pulmonic regurgitation
T/C bicuspid aortic valve
I just want also to ask what is the meaning of T/C?
hi doctor, i just want to ask if my condition is still okay? because i have a shortness of breath these days, and mild pressure on my chest just like someone is pressing me on my chest, btw Im just 22 years old and my doctor told me that my heart is normal and I dont have any problem and now im very anxious of my health because she didnt explain my 2d echo results. My echo results are
eccentric left ventricular hypertrophy with preserved ejection fraction 62%
mild mitrial/tricuspid regurgitation
aortic regurgitation 1+
normal pulmonary artery pressure with pulmonic regurgitation
T/C bicuspid aortic valve
I just want also to ask what is the meaning of T/C?
I have a Bicuspid Value with moderate aortic insufficiency. My last echo showed the following:
MMODE/2D MEASUREMENTS & CALCULATIONS:
Aortic root: 4.3 cm
Left atrium: 3.5 cm
Interventricular septum: 1.1 cm
Posterior wall: 1.0 cm
Left ventricle diastole: 5.8 cm
Left ventricle systole: 3.7 cm
FINDINGS:
The aortic root is mildly enlarged. Aortic valve is structurally normal. The left ventricle is mildly
enlarged. The wall thickness is at the upper limits of normal. The ejection fraction is low-normal at 50%. The mitral valve is structurally normal. The left atrium is normal size. The right atrium is normal size. The right ventricle is normal size. There’s normal right ventricular ectopic function.
On Doppler study there is moderate aortic insufficiency. The pressure half-time is 300 ms. There is an eccentric jet which may underestimate the severity of the aortic region. The right ventricular systolic pressure is 35 mmHg.
I do experience fatigue and have been experiencing frequent palpitations over the last two months. Any concerns or limitations I should be considering?
Has the valve been assessed by a valve specialist?
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I went to the Cleveland Clinic on 11/30/18 to have them do tests on my leaky aortic valve that I was diagnosed with about 20 years ago. I am 62 years old as of this October. For 18 years I had a great cardiologist, he said from the first day that he would have to replace that valve, it may not be today or in 1 year, or 5 years or 10 years but it will need to be replaced. He monitored the left ventricle size over the next 18 years. It slower became larger, but the last 3 years from 2015-2017, the ventricle measured 7.3; 7.0 & 7.0 centimeters. After the 2016 check up he told me he might never have to replace that valve, as I had no symptoms and the ventricle actually got a little smaller over the past year. Now 2017 comes along and I get a wired blood infection (streptococcus sanguinis) which I was admitted to the hospital for 4 days, I went in on a Friday night and they couldn’t do a TEE until Monday, I was released on Tuesday with a port in my arm, I had to have antibiotic treatments at home for the next 3 weeks. My cardiologist of 18 years had to retire, for health reasons of his own. So 2 new Cardiologists that saw the TEE results wanted to replace the Valve last summer. They never compared the Echo’s from the previous years with 2017. I had no symptoms and the Dr I trusted had told me until I had symptoms they would keep monitoring me. Now the Dr at the Cleveland Clinic says, he agrees, that the valve should be replaced. My EF has dropped to 48 now, my understanding is anything under 52 is not good. My question is why don’t I have any symptoms, I can work out in the yard for 6-10 hours in the hot sun with no abnormal fatigue. I go for long bike rides with no abnormal fatigue.
Can I wait until I have symptoms or should I believe the 3 Dr’s that tell me it is time. I plan on going to Tampa General soon to get a final opinion, if surgery is needed, I prefer to go to the Cleveland clinic, but it would be easier on my family if I had the surgery done in Tampa.
Please let me know what you think. I can provide the test results if needed.
Thank you for your time and consideration.
Its not possible to comment accurately without reviewing the case and images in its entirety. To simplify its worth noting the following. Your pumping function of the heart has dropped (lower ef) and your ventricle has clearly remodeled (elevated ventricle size) and therefore in most cases surgery would be recommended to prevent further decline to an irreversible stage. In terms of the surgery itself, this should be done where you feel comfortable taking in to account family and personal needs and comfort with the treating team. The decision to operate needs to be made by the treating team with experience in heart valve disease.
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Dr. Mustafa Ahmed,
Would you be willing to look at the report, I can email it to you. I have a hard time understanding why it appears to be urgent now, when I really have no symptoms, other than a leaky valve, or maybe I am trying to fool myself because the thought of having my chest cut open and having my leaky valve replaced with a mechanical or pig valve, scares the life out of me. I know a few people that have had open heart surgery, but it is hard for me to accept.
Thank you again for your knowledge and for you taking the time to be concerned.
John
Dr Ahmed
Fantastic site. Appreciate your views on the following issues associated with aortic regurgitation and ejection fraction.
(1) In terms of classifying and/or clarifying the level of severity of aortic regurgitation can you explain/clarify what the following measurements mean as stated in echo reports I have seen:
AR 0-1
AR 2
AR 2+
AR 2-3
AR 3
AR. 3-4
AR 4
AR 4+
Echocardiogram guidelines do not appear to be consistent – depending on what part of the world you live in.
(2) There are also conflicting views about what constitutes the lower level of normal ejection fraction ie is it EF 50-55 or EF 55 +? Mayo Clinic and Cleveland Clinics suggest that 55 is the lower threshold of normal while European guidelines indicate an EF of 50 and above should be considered normal. In Australia an EF of 50 is the cut-off point for normal. Should there not be a uniform and agreed global definition of normal EF.
(3) My echo report states that I have a visually observed EF of 50-55. Previous reports seem to provide a more definitive number ie EF of 53. How accurate are visual observations as opposed to more definitive quantitative measurements?
My husband had acute endocarditis due to untreated high blood pressure and a dental infection. Is being monitored now for aortic valve regurgitation. He’s 72 years old. Will he ever be a candidate for TAVR or is this only for younger people?
If the infection is cleared he will almost certainly be a candidate for a TAVR
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I had foot surgery 5 months ago and had limited mobility during recovery.
4 months ago I developed Pulmonary Embolisms in both lungs. Significant in the left lung and minor in the right.
Male, 57 years old, general health before this was good. Not athletic by any means, but not a couch potato.
I have experienced a few bouts of irregular heart beat. But I have tachycardia (up to 150 bpm at rest) and bradycardia (down to 48 bpm) almost every day. The episodes typically only last 2 to 3 minutes. I have not felt lightheaded or dizzy and no breathing problems.
These episodes were first discovered with professional monitoring and now I am aware based on reports from my Apple Watch.
My local cardiologist ordered a echocardiogram and found that I have mild aortic regurgitation. The plan is to monitor that situation as you have explained on this site many times.
I am taking Eliquis 5 MG twice per day and propranolol 20 MG 3 times per day.
But he still can’t explain the Tachycardia and Bradycardia which I experience most days. It also seems that my diastolic blood pressure is lower now. Typical reading is 135 / 65 I know that is not a bad reading but 6 months ago my reading (taking Micardia) was 135 / 75.
Any thoughts? Thanks in advance!
Hi! Im 29 yo. Diagnosed with BAV 5 years ago, last year (September) on my ultrasound heart check up cardiologist said that its leakage is moderate and I had a total thyroidectomy (August). on medication now (125micg) I havent have any palpitations after the TT surgery, but 4 days ago i started feel pain on my left side and had longer palpitation. I had a break from working out, Id like to know what kinda exercise im allowed to do? Thanks for the answer in advance
This needs to be addressed by the physician following this and typically depends on the size of the aorta and degree of leak. In general any activity as tolerated is ok if aorta normal and no symptoms. If aorta large then typically heavy 1 to 3 rep max lifting is avoided.
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I was recently diagnosed with Aortic regurgitation by echocardiogram.
Local Doctor thinks we can monitor it and not take any action unless heart enlarges or I become symptomatic. I don’t have any of the common symptoms such as chest pain or difficulty breathing.
What I have is bouts of Tachycardia – typically 3 or 4 times per week, average 140 bpm as reported by Apple Watch.
More often is Bradycardia – typically 4 to 6 times per day, average 45 bpm without symptoms -reported by Apple Watch.
What really concerns me is the Bradycardia often occurs during exercise. The Bradycardia will sometime follow the Tachycardia by only a few minutes as well.
While I am using the Apple watch now, all this was verified in December with professional monitoring.
In a nutshell, is the Aortic regurgitation the likely cause of the Bradycardia?
Is low heart rate (45 bpm) during exercise a cause for additional concern and/or testing?
Any more thoughts or suggestions?
Thanks,
Tim Aslin
My first attempt at posting a question was fouled up somehow – here it goes again:
I had foot surgery 5 months ago and had limited mobility during recovery.
4 months ago I developed Pulmonary Embolisms in both lungs. Significant in the left lung and minor in the right.
Male, 57 years old, general health before this was good. Not athletic by any means, but not a couch potato.
I have experienced a few bouts of irregular heart beat. But I have tachycardia (up to 150 bpm at rest) and bradycardia (down to 48 bpm) almost every day. The episodes typically only last 2 to 3 minutes. I have not felt lightheaded or dizzy and no breathing problems.
These episodes were first discovered with professional monitoring and now I am aware based on reports from my Apple Watch.
My local cardiologist ordered a echocardiogram and found that I have mild aortic regurgitation. The plan is to monitor that situation as you have explained on this site many times.
I am taking Eliquis 5 MG twice per day and propranolol 20 MG 3 times per day.
But he still can’t explain the Tachycardia and Bradycardia which I experience most days. It also seems that my diastolic blood pressure is lower now. Typical reading is 135 / 65 I know that is not a bad reading in and of itself but 6 months ago my reading (taking Micardia) was 135 / 75.
Any thoughts? Thanks in advance!
The good news is the mild leak of the aortic valve is likely totally unrelated and can simply be watched and most likely will never be an issue. The heart rate of 48 is not concerning, i suspect it happens at night. The faster heat rates if just happening out the blue would be interesting to see on an ekg, yet still not likely a large concern if not symptomatic im not sure I’d worry about the diastolic dropping by 10 points, particularly if the aortic leak is simply mild.
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Hi Dr Ahmed
I am a 25 year old male – for the last 2 years I have suffered with mild palpitations and shortness of breath / dizziness on exercise.
2 weeks ago I had an ‘event’, where I experienced very high BP and chest pain. I went to the ER. The echo noted I had a mild amount of AR. since then I have had an increase in symptoms, shortness of breath on exercise, Bounding Pulse and tiredness.
The Echo showed a normal aorta, no significant valve problems apart from mild AR (labelled insignificant by the heart specialist) but I have positive mullers sign and Quincke’s sign on examination + I am symptomatic with a wide pulse pressure 145 / 80
Since the echo was clear, is it likely that the AR is not causing these symptoms?
Mild AI, if truly mild does not cause symptoms.
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Can cabag been done more than one time in 15 years period?
Yes.
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I have cardiomyopathy and low ejection fraction of 10% and leaky mitral valve doctor trying to get send me to get leaky valve fixed so may help ejection fraction. Will this help or what should I do? He wants to send me to UAB. Please respond I am scared
I run the valve program at UAB. Ill be happy to evaluate you in person.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I am 68 years young, I have been diagnosed with moderate aortic stenosis, I have a 6 month follow-up plan and all test associated, over the last 3 months I have developed some kind of edema in both legs, they are extremely painful, red, warm to hot, itchy, and very swollen. All test have ruled out Kidneys, Liver and any other organ. I have been on disability for 8 months for a shoulder issue and I went from being very active to really very little activity, My intuition has me thinking that the leg issue is tied directly to the heart. I have been back to the Cardio Doctor and there has been no change per the echo gram to the heart, he does not think the legs are tied into the heart. I am going nuts with only what is isn’t and not what it is. I have tried compression products, to tight, hurt the legs, raising hurts the legs also, Any thoughts from you, what would you suggest, Maybe a 2nd opinion?
The moderate aortic disease is unlikely related, have tests on blood flow to the legs been been performed?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Dr. Mustafa
I’ve done 2D echo in 2 times in 2 different clinics and got the results below:
Clinic 1 (LATEST) : Normal left ventricular dimension with mild hypokinesia of the anterior interventrisular septum and lateral left ventricular free wall from mid to apex with adequate systolic function. Normal left ventricular ejection fraction of 76% .
Clinic 2 (taken Dec. 2018): Anterior mitral valve leaflet prolapse . Normal left ventricle with adequate wall motion and contractility with good systolic function.
Yes, I’ve been experiencing shortness of breath, palpitations (even just sitting/doing nothing) and sometimes crushing /somehting squeezing my heart / or pinching my heart / chest.
Is there any difference between the 2 results and should I be alarm of something? Thanks.
The function appears normal, most likely normal study, i would start by having someone else review the original echo.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi :
Ithink this is bad.I am 54. weigh 310 5 foot 8 down from 400lbs I have sleep apnea and edema very swollen legs and body and tired and short breath. What is going to happen, what is life expectancy and treatment thanks so much AWH
HISTORY: PRIOR HISTORY: Hypercholesterolemia.
PROCEDURE: This was a routine study. The transthoracic approach
was used. The study included complete 2D imaging, M-mode,
complete spectral Doppler, and color Doppler. The heart rate was
107 bpm, at the start of the study. BP taken sitting. The
patient’s rhythm was sinus tachycardia. Blood pressure was 135/
85. Image quality was adequate.
LEFT VENTRICLE: Size was normal. Systolic function was normal.
Ejection fraction was estimated in the range of 60 % to 65 %.
There were no regional wall motion abnormalities. Wall thickness
was increased. DOPPLER: E/A was decreased. Left ventricular
diastolic function parameters were normal. E/E’ was mildly
elevated.
RIGHT VENTRICLE: The size was normal. Systolic function was
normal. DOPPLER: Systolic pressure was mildly increased.
Estimated peak pressure was 43 mmHg.
LEFT ATRIUM: Size was normal.
ATRIAL SEPTUM: No defect or patent foramen ovale was identified
by color Doppler.
RIGHT ATRIUM: Size was normal.
MITRAL VALVE: Valve structure was normal. There was normal
leaflet separation. DOPPLER: The transmitral velocity was within
the normal range. There was no evidence for stenosis. There was
no regurgitation.
AORTIC VALVE: The valve was trileaflet. Leaflets exhibited
normal thickness and normal cuspal separation. DOPPLER:
Transaortic velocity was within the normal range. There was no
evidence for stenosis. There was moderate to severe
regurgitation. The regurgitant jet was directed centrally.
TRICUSPID VALVE: The valve structure was normal. There was
normal leaflet separation. DOPPLER: There was no evidence for
stenosis. There was mild to moderate regurgitation.
PULMONIC VALVE: Leaflets exhibited normal thickness, no
calcification, and normal cuspal separation. DOPPLER: There was
no regurgitation.
AORTA: The root exhibited normal size.
SYSTEMIC VEINS: IVC: The inferior vena cava was dilated.
Inspiratory collapse was less than 50%.
PULMONARY ARTERY: DOPPLER: Systolic pressure was mildly
increased. Estimated peak pressure was 43 mmHg.
PERICARDIUM: There was no pericardial effusion. The pericardium
was normal in appearance.
SYSTEM MEASUREMENT TABLES
2D
Asc Ao: 3.48 cm
AVA Planimetry: 4.45 cm2
Ao Diam: 3.49 cm
LA Diam: 3.88 cm
%FS: 25.64 %
EF Biplane: 56.97 %
IVSd: 1.2 cm
LVIDd: 5.02 cm
LVIDs: 3.73 cm
LVPWd: 1.39 cm
IVC: 2.63 cm
CW
AR PHT: 360.88 ms
AV Vmax: 1.43 m/s
AV maxPG: 8.21 mmHg
TR Vmax: 2.85 m/s
TR maxPG: 32.57 mmHg
PW
LVOT Vmax: 1.22 m/s
E’: 0.09 m/s
E/E’: 9.19
MV A Vel: 1.08 m/s
MV Dec Slope: 5.24 m/s2
MV DecT: 159.86 ms
MV E Vel: 0.82 m/s
MV E/A Ratio: 0.76
IMPRESSIONS:
The echocardiographic study was abnormal.
SUMMARY:
– Left ventricle:
– Systolic function was normal. Ejection fraction was estimated
in the range of 60 % to 65 %.
– There were no regional wall motion abnormalities.
– Wall thickness was increased.
– Right ventricle:
– Systolic pressure was mildly increased. Estimated peak
pressure was 43 mmHg.
– Aortic valve:
– There was moderate to severe regurgitation.
– Tricuspid valve:
– There was mild to moderate regurgitation.
– IVC, hepatic veins:
– The inferior vena cava was dilated.
– Inspiratory collapse was less than 50%.
– Pulmonary arteries:
– Systolic pressure was mildly increased. Estimated peak
pressure was 43 mmHg.
You have a leakiness in the aortic valve that is being watched for now and may one day need attention with an operation. I would concentrate on continuing to do a great job with getting your weight down to near normal levels and improving fitness and overall health to where if you ever need an operation you are in a much better position to undergo this.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dr. Ahmed:
I am a 69 year old male and a few months ago had an echodardiogram done as as follow-up to a TIA. My non-cardiologist primary care physician subsequently told me that the echocardiogram showed no evidence of blood clots in the heart and that my “heart is very strong”.
Three days ago I obtained and reviewed the echocardiogram report, which contains several items which concern me, not the least of which are notations of ” four chamber cardiac enlargement” and “moderate aortic insufficiency”. The report findings are below.
2D ECHO
LA Systolic Diameter LX 4.6 cm 2.1-3.7 cm LVPW Diastolic Thickness 1.1 cm 0.6-1.1 cm
Aortic Root Diameter 4.4 cm 2.0-3.7 cm RV Diameter 3.2 cm
LV Diastolic Diameter Bas 5.9 cm 3.6-5.2 Fractional Shortening BAS 30.3 % 0.18-0.42
LV Systolic Diameter Base 4.1 cm 2.3-3.9 cm LV Ejection Fraction SIM 62 %
IVS Diastolic Thickness 1.1 cm 0.6-1.1 cm
DOPPLER
AV Peak Velocity 1.7 m/s Mitral E to A Ratio 0.65
AV Peak Gradient 11.3 mmHg PV Peak Velocity 1.1 m/s
LVOT Peak Velocity 128 cm/s PV Peak Gradient 4.9 mmHg
LVOT Peak Gradient 6.6 mmHg RA Pressure (Entered Valu 3 mmHg
LVOT Velocity Time Integr 33.7 cm TR Peak Velocity 2.3 m/s
AR Pressure Half Time 579 ms TR Peak Gradient 21.7 mmHg
Mitral E Point Velocity 0.58 m/s RV Systolic Pressure 24.7 mmHg
Mitral A Point Velocity 0.89 m/s
Left Ventricle: Left ventricular ejection fraction is calculated at 62%.
Normal global left ventricular systolic function.
Left ventricular dilatation.
No left ventricular hypertrophy.
Left Atrium: Left atrial dilatation.
Right Ventricle: Normal right ventricular global systolic function.
Right ventricular dilatation. (3.2cm. Normal<2.7cm.)
Right Atrium: Right atrial dilatation.
Mitral Valve: Thickened mitral valve without stenosis.
Mild mitral annular calcification.
Mild mitral regurgitation.
Aortic Valve: Trileaflet aortic valve.
Thickened aortic valve without stenosis.
Moderate aortic insufficiency. AI Pressure Half Time 579 ms.
Tricuspid Valve: Normally structured tricuspid valve.
Mild tricuspid regurgitation.
Right ventricular systolic pressure estimated to be 25mmHg.
Pulmonic Valve: Structurally normal pulmonic valve.
Mild pulmonic regurgitation.
Aorta: Moderately dilated aortic annulus. (4.4cm-4.7cm)
Pericardium: No pericardial or pleural effusion.
Intracardiac Shunt: No intracardiac shunt.
Mass/Thrombus No intracardiac masses, thrombus or vegetations noted.
Vegetation:
Other: IVC is normal measuring 2.4cm with collapse.
CONCLUSION:
Left ventricular ejection fraction is calculated at 62%.
Four chamber cardiac enlargement.
Mild mitral annular calcification.
Mild mitral regurgitation.
Moderate aortic insufficiency.
Mild tricuspid regurgitation.
Mild pulmonic regurgitation.
Right ventricular systolic pressure estimated to be 25mmHg.
Moderately dilated aortic annulus (4.4cm-4.7cm)
No cardiac source of emboli noted.
No prior echo available for comparison.
My physician says that no follow-up is needed, and that I need not be concerned. Do you agree?
Thank you.
You need some form of follow up for aortic annular dilation and moderate aortic insufficiency.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dr. Ahmed,
What is your opinion on exercising with moderate aortic valve regurgitation? My cardiologist says no weightlifting or even body weight type exercises, and says only aerobic exercise is fine. I’m worried I will lose muscle mass if I can’t do any type of lifting, though. Would love your opinion. Thanks!
Was any information on the aorta given? It is not usual to tell someone with moderate aortic regurgitation to not exercise.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I have a strange story.
I’ve been diagnosed with severe aortic insufficiency (regurgitation) since age 73 (now 79) First four years had yearly echo, with no exacerbation. About a year and a half ago, felt some minor out of breath when going up hills, so had a wide array of diagnosis tests. I was right on the border for recommendation of operation based on EF ejection fraction.
Another problem is memory decline, which runs in my family. While my surgeon refused to acknowledge the real danger of pos- operative delirium, which can exacerbate memory loss I am well aware of this, as, along with many people, do not consider a life with major dementia worth living.
Now this is strange. A year ago, based based on a recounting of a repressed painful childhood experience, I felt my heart weakening. For two days, my voice, my gait was impacted -as this was real. Now I can walk a moderate rate of four miles, but for several weeks I couldn’t do a half mile.
As of now I have no sensation in my heart area, and my exercise ability seems to have returned to what it was several years ago. I’m on no medication at all.
I was about to have open heart repair, since the TAVR procedure I’m told has a 15-25 mortality being only for research now.
I’m considering requesting a stress EKG, to see if somehow it shows improvement, What I had never heard of before (I have searched the literature extensively) that what is subjectively a “remission” could actually happen with this condition, and if so how rare is it.
Hi sir, My dad was diagnosed with mild AR….whether it is fatal? Or can be bring to normal by medications. No other problems are there. Only mild AR
Mild AR is not in general a cause for concern.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dear Sir,
I am from Pakistan & My 4 year Son was diagnosed with below Issues.
small to moderate perimembranous outlet VSD.
Prolapse of RCC
Mild AR
Dr advised for the open heart heart surgery, Please advise?
I am a 49 y/o male with coronary heart disease and recently had a cardiac MRI to evaluate a bicuspid aortic valve and aortic aneurysm. Below are the results. Would you say that surgery is needed to repair the BAV and possibly stent the aortic aneurysm?
FINAL IMPRESSION:
Normal LV size, wall thickness, and function. LVEF 55%. Normal RV size and function. RVEF 57%.
No abnormal delayed enhancement. There is no evidence of myocardial infarction or scarring.
Bicuspid aortic valve with fusion of the right and le? coronary cusps (Sievers Type 1, L-R). No aortic
stenosis. Mild aortic regurgitation.
Mildly dilated ascending thoracic aorta measuring 4.1x 3.8 cm in diameter. The rest of the thoracic aorta
is normal in size with no evidence of dissection or aneurysm.
LEFT VENTRICLE: Quantitative LVEF 55%. LV wall thickness is normal. LV cavity size is normal. LV systolic function is
normal. There is no LV mass/thrombus.
VIABILITY: Hyperenhancement is normal.
RIGHT VENTRICLE: Quantitative RVEF 57%. RV wall thickness is normal. RV cavity size is normal. RV systolic function is
normal. There is no RV mass/thrombus. No RV pacemaker/defibrillator wire.
LEFT ATRIUM: LA cavity size is normal.
RIGHT ATRIUM: RA cavity size is normal.
PERICARDIUM: There is no pericardial effusion.
PLEURAL EFFUSION: There is no pleural effusion.
AORTIC VALVE: Aortic valve is bicuspid. There is fusion of the right and le? coronary cusps (Sievers Type 1, L-R). Peak
aortic valve velocity 116.01cm/sec. Aortic regurgitant volume 3.46ml. Aortic regurgitant fraction 7.16%.
Peak aortic valve gradient 5.38mmHg. There is mild aortic regurgitation.
MITRAL VALVE: Mitral valve leaflets are normal.
TRICUSPID VALVE: Tricuspid valve leaflets are normal.
PULMONIC VALVE: Pulmonic valve leaflets are normal. Pulmonic regurgitant volume 0ml. Peak pulmonic valve velocity
87.69cm/sec. Pulmonic regurgitant fraction 0%. Peak pulmonic valve gradient 3.08mmHg.
OTHER FINDINGS: Normal coronary artery origins.
Thanks you for your guidance.
I am a 49 y/o male with coronary heart disease and recently had a cardiac MRI to evaluate a bicuspid aortic valve and aortic aneurysm. Below are the results. Would you say that surgery is needed to repair the BAV and possibly stent the aortic aneurysm?
FINAL IMPRESSION:
Normal LV size, wall thickness, and function. LVEF 55%. Normal RV size and function. RVEF 57%.
No abnormal delayed enhancement. There is no evidence of myocardial infarction or scarring.
Bicuspid aortic valve with fusion of the right and left coronary cusps (Sievers Type 1, L-R). No aortic
stenosis. Mild aortic regurgitation.
Mildly dilated ascending thoracic aorta measuring 4.1x 3.8 cm in diameter. The rest of the thoracic aorta
is normal in size with no evidence of dissection or aneurysm.
LEFT VENTRICLE: Quantitative LVEF 55%. LV wall thickness is normal. LV cavity size is normal. LV systolic function is
normal. There is no LV mass/thrombus.
VIABILITY: Hyperenhancement is normal.
RIGHT VENTRICLE: Quantitative RVEF 57%. RV wall thickness is normal. RV cavity size is normal. RV systolic function is
normal. There is no RV mass/thrombus. No RV pacemaker/defibrillator wire.
LEFT ATRIUM: LA cavity size is normal.
RIGHT ATRIUM: RA cavity size is normal.
PERICARDIUM: There is no pericardial effusion.
PLEURAL EFFUSION: There is no pleural effusion.
AORTIC VALVE: Aortic valve is bicuspid. There is fusion of the right and le? coronary cusps (Sievers Type 1, L-R). Peak
aortic valve velocity 116.01cm/sec. Aortic regurgitant volume 3.46ml. Aortic regurgitant fraction 7.16%.
Peak aortic valve gradient 5.38mmHg. There is mild aortic regurgitation.
MITRAL VALVE: Mitral valve leaflets are normal.
TRICUSPID VALVE: Tricuspid valve leaflets are normal.
PULMONIC VALVE: Pulmonic valve leaflets are normal. Pulmonic regurgitant volume 0ml. Peak pulmonic valve velocity
87.69cm/sec. Pulmonic regurgitant fraction 0%. Peak pulmonic valve gradient 3.08mmHg.
OTHER FINDINGS: Normal coronary artery origins.
The findings of the scan suggest the aortic valve and the aneurysm are at a stage where typically they would be watched and not near needing an intervention. It important to have these followed closely by a cardiologist that has a special interest in the valve / aorta space.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My daughter, who just turned 12 years of age, was diagnosed with mild aortic valve deficiency. Her mom had a mitral valve prolapse when she was in her teens but has since been undetectable. I’m just starting to read about this condition but I’m very impressed with your diligence to respond to everyone who has posted on this site. I will be following, Thank you!!
Hi,
I am set to have my aortic root and aortic valve replaced at the University of Washington on 12/19/19. Presently, I am struggling to get a good night sleep as I toss and turn and feel like I can’t catch my breath. I am thinking at 57 now, almost 17 years since my original AorticDissection Type A, that it’s definitely time and that my sleeping is not sleep apnea, rather early symptoms of congestive Heart failure. I am going to get a chair to try and sleep in until my surgery on 12/19/19, I am just hoping that the chair will help until my bio bental procedure by Dr. Gabriela Adea and Dr. Christopher Burke.
Hello, when i was a baby i was diagnosed with heart problems i was 12 months old when i had surgery coarctation of the aorta, i also have a leaky martial valve and one day has to be repaired, I’ve never really understood any of this properly, or when to know i have to have surgery I’m now 30 and am meant to be going to heart specialist every year i haven’t been back for three years and now have made an appointment as I’ve started getting light headed, to the point i at times feel I’m not even in my own body, also short breathed and when ever i have a drink my face gets very hot what are symptoms that could mean something is wrong
Shortness of breath, swelling, fatigue, dizziness, hard to lay flat, less energy and exercise tolerance.
Good that you are getting checked out.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I am 26 years old i have rheumatic fever Pneumonia when i was teen. And right now i have a aortic regurgitation my doctor not to worry about my concern is i still have shortness of breathe and fatigue what is the problem?
Ischaemic heart disease
Stemi 2017 with primary pci
Recurrent angina
Hypertension
Emphysema
And now I have moderate aortic regurgitation
What does this mean and what’s the future prognosis please
I have moderate to severe AR resulting from a quadricuspid valve. I was diagnosed with this a few years ago after fainting for no known reason. Since then I have had no other known symptoms of AR.
Then, several months ago I began having almost constant extreme fatigue. I’ve had testing of my thyroid levels as I was diagnosed with hypothyroidism several years ago; the tests came back in the normal range. My B12 and Vit D levels were also tested; both came back normal. I was tested for Lyme disease; the test came back negative. There have also been a few (possible several) times where my heartbeats felt strange, almost like it were skipping beats.
Is it possible that even though my AR is not severe, the symptoms I am having are attributable to AR?
How was the AR quantified? Was a TEE or MRI used. If symptoms are progressing in the absence of another cause these tests may often be used if it makes sense.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello dr
age 34 … Weight 79
I have a recent echo because I have pain in the chest area. What do you think, should I replace the valve or just the continuous follow-up?
Report ..
SEPTAL WALL THICKNESS:11mm
LV: Normal size.mild LVH. No clear evidence of regional wall motion abnormality at rest. Good LV systolic function. Grade 1 diastolic dysfunction.
Normal LA size.
Normal mitral valve structure and function.
Aortic valve: Bicuspid, thickenned and calcified with moderate STENOSIS, mild
REGURGITATION.
Intact IAS and IVS
Normal RV size and function. Normal RA size.
Normal tricuspid and pulmonary valves.
No pericardial effusion.
NCLUSION:
Moderate AS, Mild AR
Hello I am 33 years old and was diagnosed with mild aortic regurgitation. Ejection fraction is 60% stress test and holter were fine. I have been so scared about this. Is this something I need to worry about?
In general no you shouldnt be worried. The ordering dr should be asked about the appearance of the valve and the mechanism of the leak.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dr. I am a 68 year old female, hypothyroid and last year switched from Armour to Naturethroid now Levothyroxine due to shortages and recalls. Primary care only checks labs if I ask and goes by land alone. Recently diagnosed with mild asymptomatic aortic regurgitation that the office called and told me after an 2D echocardiogram. I have always had low blood pressure 110/60 for many years and then several years with BP 100/60 approx. I had done some weightlifting heavy bench presses 65 lbs 12 reps 3 sets and two days later woke up with chest pain that did not have any signs of a ❤️Attvk fortunately but thought when I go for my wellness visit should tell dr. She only did an ekg nothing else and send I should see a cardiologist which I did in Tucson. He did EKG and said I had a weak p wave so referred me for echo and stress test which I am having 1/14/22. His office then called and the young girl said milk aortic regurgitation no action needed will wait for stress test and follow up with you in 6 months if all ok. Of course knowing little about condition I researched and I have to say I am stressing. I am currently out of state and while my resting heart rate runs 56 today it was 77 and the last few days I haven’t felt myself and wondering if it could be stress because I get discomfort just below my sternum and thought it was my sliding Hypatia l hernia etc but now I wonder if it is an aortic aneurism as my father had one 4.5 cm and my mom had two strokes which they found a pinhole in her heart and put a stent via her groin. I have a feeling that somehow my changing to Levothyroxine maybe contributing to palpitations etc.
I have had two surgeries in my heart first one was my vsd and then was the sub aortic membrane in 2007. Now im 22 year old right now and i had my last echo done in 2017 after that i never got my self checked up that time my echo showed mild AR and now since last 10 days im experience pounding heart beat as if my heart skipped a beat and sometimes spinning of head i also have had covid last month but exactly after that this happened and i go to the gym also could that be the cause of concern or it is a simple infection or an inflammation?
hello, pls help me understand this echo results
LV – cavity size normal, diastolic function normal, LV wall thickness normal, systolic func is normal, ejection fraction 65-70%
LA- volume is normal
RA – normal
RV – size is normal, systolic function is normal
Aortic value : the aortic valve appears thin, appers with an undetermined number of leaflets, and opens normally. This is consistent with no aortic stenosis. The aortic value is not well visualized. Trace aortic insufficiency
Mitral value: leaflets appear thin, no evidence of stenosis. Trace mitral valve regurgitation
tricuspid value: normal in structure. trace regurgitation is present
pulmonic value: not well visualized
pericadrium: no pericardial effusion is seen
aorta: the aortic root appears normal
venous: the inferior vena cava and hepatic vein were normal in the study
summary:
1. LV ejection fraction is estimated to be 65 to 70%
2. normal right ventricular size and systolic function
3. aortic valve is not well visualized. there is trace aortic insufficiency.
Please help as i am concerned with the below
1. Trace aortic insufficiency aortic valve thin
2. trace mitral valve regurgitation, thin leaflets
3. trace tricuspid regurgitation
4. pulmonic valve not well visualized
5. aortic valve not well visualized
thank you for your help.
Looks pretty normal to me. Please ask for clarification from the reading dr.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I am a 36 year old female. I don’t drink or smoke and am not overweight. I do take 10mg propranolol TD for anxiety symptoms. I have had on and off abnormal ecgs since age 20 so decided to have an echo which picked up mild aortic regurgitation. The echo results state…
Normal LV function and dimensions,
Biplane EF 55%
Normal right heart
Mild aortic regurgitation, no other valvular abnormalities.
Please could you tell me, will this regurgitation get worse? Could it remain mild my whole life if I adopt a healthy lifestyle and exercise plenty? Is it ok to continue on the propranolol permanently if I have this?
Thanks for listening
I am a 36 year old female. I don’t drink or smoke and am not overweight. I take 10mg propranolol TD for anxiety symptoms. I have had on and off abnormal ecgs since age 20 so decided to have an echo which picked up mild aortic regurgitation. The echo results state…
Normal LV function and dimensions,
Biplane EF 55%
Normal right heart
Mild aortic regurgitation, no other valvular abnormalities.
Please could you tell me, will this regurgitation get worse? Could it remain mild my whole life if I adopt a healthy lifestyle and exercise plenty? Is it ok to continue on the propranolol permanently if I have this?
Thanks for listening
If the rest of the echocardiogram is felt to be normal such as the function and the structure which it appears to be in this case and there is only very mild regurgitation there’s typically no cause for worry, it would be wise to follow up with someone in the future periodically to maybe listen to the heart and at some point get another cardiogram to ensure stability. But for mild regurgitation and the absence of any obvious cause watching and waiting is the typical standard of care and no intervention needed. Of course this needs to be confirmed by a competent Dr that has assessed you.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Thank you so much for your reply.
Everything else on the echocardiogram was normal I believe.
Is there any way that I can reverse the mild regurgitation through healthy diet and exercise?
Thank you so much for your reply
Everything else on the echocardiogram was normal I believe.
Is there any way that I can reverse the mild regurgitation through healthy diet and exercise?