5 years after 2nd AVR with homograft....

[mwalkerrn]

I am a 41 year old female with general good health.  I excersize 4 - 5 days a week.  I had a congenital aortic valve;  I had endocarditis in 1991 and a porcine replacement in 1995.  I again had endocarditis with a pregnancy in December, 2002 and had a homograft with root in March of 2003.  I notice that I have extreme fatigue for approximately 4 - 5 hours following excersize with cardio and weights.  My physician is located 2 hours away, so I do not have regular check ups.  What could this be?

[Cleveland Clinic]

It's difficult to judge these findings based on tte.  tee is a better test for that.  you are right that most of the time there is stenosis, but regurgitation is also common due to valve degeneration and may not necessarily mean that it's due to perivalvular problems such as those you are concerned about.  I still think that you should have a stress test, not just a simple echo in order to figure out your symptoms.  2+AI does not explain these symptoms unless the degree of regurgitation is underestimated.  As I mentioned earlier, depending you your anatomy, TEE may be needed.  

[Cleveland Clinic]

The homograft that was put in 2003 should still be ok, but the fact that you are having exertional symptoms is very worrisome.  Someone of your age should not have these symptoms.  On the other hand the fact that you can exercise at all is very encouraging.  I think that at this point, in order to figure out where your symptoms are coming from, as it may not necessarily be your heart (thyroid, anemia, vit deficiency etc are other possibilities) you should have an echocardiography stress test.  This is the one where you exercise on a treadmill and then have echocardiography after peak exercise.  this does not need to be done by your doctor, although, it would probably be better if it were since he or she already know you and have previous studies to compare.

[mwalkerrn]

I actually had an echo this afternoon which shows AI of 2+ (I thought that the process of the homograft was to have stenosis...) My last echo, I believe, was 0 - 1.  There is also some question about the way the insufficiency is coming through the valve.  Apparently to the side of some sort......  I pray not the suture line or the root, any ideas?