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mild to moderate aortic valve regurgitation

32 year old male, with no major health issues, before two weeks ago.
about three months ago, I was admitted overnight to the hospital, for having neck pain and jaw pain, because the docs wanted to do a stress test and blood tests to see if my heart was causing these symptoms.  All results were great, except for what cardiologist #1 said was "mild" regurgitation of the aortic valve.  
I went back to my pcp who wanted a second opinion, and went to another cardio with all of the equipment in his office building to do the same things that I had done at the hospital 10 weeks earlier.  Stress test was great, with no pvc's or altered rhythm, and everything else was well until the ultrasound.  I met with cardiologist #2 the Friday after thee test.  he said that I have an enlarged left ventricle and moderate aortic valve regurgitation.  I don't know who to believe and what to look for.  
Both told me to stop lifting weights, which I have, and only stay on light cardio, which I have.  Here is the issue, what is considered moderate and what is considered mild?  one says one thing then three months later, another says something else?  Can the leakage of the valve progress this quickly?  Would stress (like losing my job which had just happened) be a contributing factor?  Trying to look for reasons why this is happening and that I am getting two different versions.  I am now on 25mg atenolol and baby asprin and 5 mg lisinopril.  how can I make this aortic valve shrink back down?  my bp is 120/64 and hr is in the 60's all day.
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Avatar universal
In Egypt,there are many surgeons who done a very big number of valve replacement operations.Iknow one who had 30,000+ replacements.The cause is the high incidence of rheumatic heart disease in Egypt.
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Dear Ayman, what is the name of this good surgeon and what hospital does he work? Many thanks for your advice.
Avatar universal
Find the best surgeon and take his advice on the valve.  Your choice of surgeon takes priority over everything else.  Truly.  I had a poor surgeon and ended up having to have my surgery redone a year later.  Fortunately, my second surgeon was the best, Dr. Joseph Coselli in Houston TX.  I got a tissue valve the first time, because I didn't want to be on Coumadin.  I got a mechanical valve the second time, because I didn't ever want to have an other aortic valve replacement again.  The mech valve is still doing well, 10 years later, and being on Coumadin is not that big a deal.  

I see that you live in the Roanoke VA area, if your profile is correct.  That's not, by any means, out in the sticks, so you should be able to find a competent surgeon.  It will be important to find a surgeon who is associated with a thoracic aortic center or a teaching hospital.  My best advice is that the first thing you should do is to look around at the hospitals in your area and identify the one (there probably won't be more than one) that has a thoracic aortic center, where they specialize in doing surgery on the thoracic aorta.  That is the quickest and easiest way for a novice patient to identify a surgeon and team who are qualified.  Not just any "good heart surgeon" has enough experience at aortic valve replacements to be highly skilled at it.  

If there is not a thoracic aortic center in your area (they are usually associated with teaching hospitals), then you want to look for a hospital that has a nationally recognized heart surgery program -- the kind of program that gets listed in the top 50 in the US News and World Report annual list of honor-roll hospitals.  It doesn't have to be in the top five or top ten.  Any heart surgery program on that list is going to be excellent.  But I definitely recommend going to a top-flight program, even if you have to travel farther to do it.  That greatly increases your chances of having an optimal outcome, compared to using a small local hospital and a surgeon who mostly does coronary artery bypasses.

If you want to, you can PM me, and I will give you tips on how to use the internet to figure out whether a program/surgeon has done the large numbers of aortic valve replacements that you are looking for.  Numbers are everything.  Crucial experience in handling all the complications that can come up in treating bicuspid aortic valves can only come from treating large numbers of patients.  Operating occasionally on someone with a BAV is not good enough.  Having someone like that as your surgeon is how you end up with the two-operation treatment plan like I had, instead of the one-operation treatment plan like you want.

Sorry to hear that you have to deal with this, but it can be dealt with.  It is a very major aggravation, not to mention a scare, but it's not the end of the world.  Lots of people are walking around with artificial aortic valves and doing just fine.  Actually, the preferred first-line treatment is repair, but you would have to go to one of just a small handful of programs in the US to be evaluated for that.  There are very, very few surgeons who have significant experience with aortic valve repair, but if you can get to one of them, and if the surgeon thinks you are a good candidate, I would opt for that.   Dr. Coselli in Houston does it.  There is at least one surgeon at Cleveland Clinic who has a lot of experience with it.  The the level of surgical skill that's required for aortic valve repair is the best of the best, and sometimes repair just not possible under any circumstances, but if it's an option for you to go absolutely anywhere, then I would try for a repair rather than replacement.  The repair will eventually give way, but if it lasts as long as a tissue valve would have, then you bought some time, and you still have all of your options open to you down the road.
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Avatar universal
so, i ve had the CT of my thoracic cavity and another ultrasound that showed moderate to severe aortic valve regurgitation.  i need to research replacement valves.  any help?
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Avatar universal
echo on the 23rd of April an follow up on the 25th.  We are moving two states away in June, so this could make or break that plan for sure.  I'll let you know how it turns out.  Thanks for the help!!

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Avatar universal
Let us know how you're doing, if you feel so moved.  Good luck on everything.
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Avatar universal
that's ok.Ive been ok for a little while now. Just tryingto live life witout lfting anything more than 10 lbs.  I was also let go from my job in January and have no insurance to get another echo done.  I wll in about 90 days and hope to schedule on for that time.  Thanks for the help!
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Avatar universal
No, I don't think that's the EVO.  I see now, LVOT VMAX = 1.21, and LVOT velocity = 1.2.  The LVOT velocity is one component of a formula that they use to estimate the size of the valve orifice.  So no, it doesn't look to me like that number is the actual EVO, which is good.  I didn't mean to scare you.  I still think the difference between the two measurements does not mean anything, FWIW.  If the doctor only talked about regurgitation as the problem and didn't mention anything about the valve opening being too small or being calcified, that's good.  I take it there's no problem with that, in that case.  Sorry I brought it up.  
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Avatar universal
You're welcome.  As you have clarified the difference, I don't think it is clinically significant.  I'm not sure that it couldn't even have been a round-off on the second one.  I would consider the two measurements to be the same, for all practical purposes.  Not worse on the second measurement, which is good, but not better, either.  

Is this the area of the aortic valve orifice?  An effective valve orifice of 1.2 square cm is too small.  It should be approximately 3.0 to 4.0 sq.cm.  If that is what is signified by the 1.2, it puts a different light on things.  Does it say EVO on the report or anything else to make you think that this is the actual area in centimeters of the valve orifice that your blood is flowing through?  
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Avatar universal
very good. thank for the help.the only numbers that I was told actually matter is the opening measurement for regurgitation.  the first was1.21 and the second was1.2, so it was actually better on the second one, Echo scheduled for June just before we move, so I hope that we will be good to o by then.  thank you very, very much or your comments.

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Avatar universal
I wish someone who knows more than I do about reading echo reports had responded to your results that you posted on this thread.  I only have a couple of general observations.  One is that is does not look to me as if you have provided comparable data, across the two tests.  The exact same measurements would have to be compared.  If I misunderstand, forgive me.  The other thought I have is that an echocardiogram is only a snapshot in time, and there can be a certain amount of random difference between two echoes.  

Actually, I do have a third thought about it.  The administration and interpretation of echocardiograms is subject to skill and experience.  The doctor's judgment about how to characterize the results and what they mean is a bit subjective, although I'm sure a cardiologist wouldn't want to hear me describe what he does by using that word.  From the two echocardiograms you had and the two different doctors who interpreted them, you got two opinions that are somewhat different -- but only somewhat.  

I would look at the commonalities among the two opinions.  Both cardiologists thought that the aortic valve was regurgitating sufficiently that you should avoid heavy weightlifting.  Since you are on antihypertensive medication, they evidently thought you should control blood pressure, also.  I would focus on what they told you that was the same, follow that advice, and go back in a year for another echo.  

FWIW, I think it's extremely unlikely that your valve deteriorated greatly or that your LV enlarged significantly in a two-and-a half- or three-month period of time.  I think it's more likely that the variation in what you were told is due to your heart's having been imaged on two different days by two different technicians and the images' having been interpreted by two different doctors.  That's a lot of room for difference to creep in.  

But it's what you need to do that's important and really not whether the regurgitation is mild or moderate, at this point.  If it's mild or moderate, you need to do the same things:  avoid heavy weightlifting, control your blood pressure, and continue to have your condition monitored.  Standard monitoring in the US seems to be an annual echo.  That's what my cardiologist does, and that seems to be what is most commonly prescribed for other people I know who have valve disease.  Naturally, if you continue to have the neck and jaw pain, you're going to need some kind of care before that.  I do hope that the pain has gone away and that it stays away.    

The best echocardiogram interpretation for your situation is going to come from a cardiologist who has a high level of professional interest in echocardiography and/or aortic valve disease.  In addition, the echo technician sometimes has to have unusual skill to give the doctor the best "picture" of what is potentially a bicuspid aortic valve.  The subspecialist doctors that I am talking about usually have great techs, however, because they don't put up with getting inadequate images.  

When you get back to the US, I would look for a cardiologist who has a particular interest in aortic valve disease to be my long term cardiologist.  That way, you will have someone whose opinion you don't have to second guess.  Good luck.
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Avatar universal
in other words, the second one was better than the first one
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Avatar universal
ivsd: 13 cm
lvidd:5.3 cm
lvpwd: 1.3 cm
edv (teich): 133 ml
lvids: 3.3 cm
esv (teich): 44 ml
ef (teich) 67%
sv (teich) 89 ml
aodiam: 3.5 cm
ladiam: 4.2 cm
avcusp: 2.3 cm
mv e vel: 1.02 m/s
mv dect:185ms
mv dec slope: 5.5 m/s2
mv a vel:0.60m/s
mv e/a ratio: 1.70
LVOT VMAX: 1.21 m/s
LVOT maxPG: 5.83 mmHg
av vmax: 1.39 m/s
av max pg:7.78mmHg
AR Vmax: 4.98 m/s
AR maxPG: 99.27mmHg
AR PHT: 453 ms
aR Dec Time: 1561 m/s
AR DEC SLOPE 3.2m/s2
TR Vmax: 2.13 m/s
TR maxPG:8.20 mmHg
RAP: 10.00 mmHg
RVSP:2820 mHg

septum 1.3cm
post wall 1.3 cm
lvedd 4.1cm
lvesd 2.9cm
aortic root 3.5 cm
l atrium4.5cm
rv diast: 3.8cm
lvot velocity 1.2m/s
peak velocity 1.3 m/s
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Avatar universal
thank for the replies. they help.
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Avatar universal
If the LV is enlarged, that is a sign that the regurgitation could be more than mild.  The most common cause for this, in a young male, is a bicuspid aortic valve.  The advice about weight-lifting was good.  Otherwise, just live your life.  Don't stress, don't worry, just monitor the condition as directed.  
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63984 tn?1385437939
I'm not a health professional, but I'd simply back off the exercise for 3 - 6 months, just moderate it, and be re-tested.  The  difference between mild and moderate leak is significant.  Mild is pretty normal, Moderate is a signal to be alert, in my opinion.  That said, I exercised for about ten years daily with weights and aerobics with a diagnosis of moderate, now I have a diagnosis of severe.
I'd back off strenuous exercise as the Echo is the gold standard test for valve leakage, and ask to be re-evaluated in 3-6 months, if possible.  Stress is certainly a contributing factor!
Keep us informed.  Great post.
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