Doctors Lounge - Cardiology Answers
Forum Name: Valvular Heart Diseases
Question: aortic stenosis/BAV
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|sue26 - Sun Oct 07, 2007 11:05 pm|
am a nurse inquiring about my husband: 60 years old, past history includes well controlled Hypertension since early 20's; severe gallstone pancreatitis about 4 years ago with development of type II diabetes (diet/exercise) about one year ago secondary to above. Echo about one year ago (59 yrs )showed probable BAV; echo results included following:
aortic root 3.43 cm; ACS 2.06 cm; LA size 5.0 cm; LVID end systolic 3.9 cm; end diastolic 5.6; IVAd 1.05 cm; LVPWd 2.05 cm; M-mode showed aortic root and aortic cusp calicification; systolic excursion somewhat limited; mitral leaflets some sclerosis with calcification of mitral annulus; no evidence of MV prolapse or stenosis; IV septu;m/posterior wall contracting fairly well. 2-D echo - LV normal size with LV hypertrophy/adqeuate EF. moderate/marked LA dilitation; RA normal; again MV some sclerois with calcification of annulus; tricuspid valve normal; considdrable aortic root and cusp calcification with somewhat limited systolic excursion; structure of valve not adequately id'd but BAV cannot be excluded.
Doppler: mild mitral and tricuspid regurg; systolic flow velocity across AV 282 cm/sec may correspond to max. gradient around 32 mmHg and valve area of 1.4 cm2. Conclusions pretty much as above: concentric LVH, MV as above; moderate to marked atrial dilatation; possible BAV with considerable aortic root and aortic cusp calcification; suggestion of moderate AV stenosis and moderate insufficiency. Mild tricuspid regurg. My husband is essentially asymptomatic at this point. Had normal stress test.
Where do you think we stand at this point? Sees an internist regularly. In past few months, BS's have been increasing and I believe he will be starting oral meds at next visit this week. How significant is "considerable" aortic cusp and root calcification. I know the root dimensions are WNL but does the calcification have any implications? Should echo be repeated annually? Should my daughter and son be screened for BAV? Thanks so much for your time.
|sue26 - Sun Oct 07, 2007 11:33 pm|
found results of stress test of year ago; reached 78% max. HR; 48% ejection fraction'; calculated EDV 139 ml and ESV 72 ml. Thanks.
|John Kenyon, CNA - Wed Jul 16, 2008 8:40 pm|
Hello Sue26 -
Sorry to be so late in replying to this post, but I am trying to get the topic caught up and thought that while you probably know where this was going by now (hopefully in a good and stable direction), other readers might benefit from there being an answer posted.
Last things first: your daughter and son probably should be screened for BAV, which is a fairly common familial trait. It doesn't always deteriorate and become a problem, but if it's present one ought to know about it so it can be followed over time.
As for the patient himself, what I am most curious about is the reported "adequate" ejection fraction (EF). At 48 it would be adequate, and would probably be a major factor in follow up exams. So long as it could be maintained at or near that level and nothing else needed work, the valves (aortic and mitral both) probably would be maintaining adequate function. The "considerable" calcification of the aortic root and cusp, as well as additional calcification of the mitral annulus, would require close monitoring, especially since the calcification would appear to have been limiting the excursion of the leaflets of at least one of the valves. Calcium deposits build up over time, and this would have to be monitored regularly from here on out. Given the overall health of the heart muscle (based on the echo report) the diminished EF is no doubt due to calciferous stenotic disease of the aortic valve and eventually this may also cause some problem with the mitral valve as well, although it is a more flexible apparatus and not quite as prone to calcification in most patients. If the aortic stenosis becomes significant enough to warrant some sort of intervention it may be possible to open it by means of balloon dilation, but if not (and with calcium this is not usually a good option), if surgery for replacement becomes necessary at some point, it may be suggested that both aortic and mitral valve be replaced at the same time. This is a call that would depend on the condition of the mitral valve at that time, as it seemed to be functioning pretty well as of your post.
Please update us on things since your post.
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