Abnormal Echo Results

I am a 44 yo male, 6',2'', 205lbs. I had a echo following a recent episode of A-Fib.  Results were:
LA: 4.1, AoR: 3.9, LVd: 5.3, LVs: 3.1, IVS(d): 1.2, LVPW(d): 1.3, Ejection Fraction estimate: 60%, Pulmonary Artery Pressure estimate: 36mmHg, VALVES: Aortic valve normal w/no evidence of stenosis or regurgitation, Mitral valve normal with mild mitral regurgitation, Triscupid valve normal with small tricuspid regurgitation. IMPRESSION: 1) Normal left ventricular function, 2) Mild mitral regurgitation, otherwise age-related valvular changes, 3) Left atrium at the upper limit of normal most likely due to mild mitral regurgitation.  RECOMMENDATION: SBE prophylaxis and repeat echo in several years.  

I have a had paraxomal(sp) A-Fib starting when I was 21 yo. Last episode was about 4.5 years ago.  Always converts back to NSR. Previous echo's (last one ten years ago)have been normal.  I have HTN (controlled with meds) for several years.  Otherwise in good health, normal weight, and very physically active.

QUESTIONS:
1.  What caused the regurg? I don't remember having rheumatic fever.  Have not had a heart attack.
2.  I strenous exercise still safe, or making the problem worse?
3.  What is the prognosis? Will it get worse?
4.  Given that the left atrium is "at the upper limits of normal" should I consider having the mitral valve repaired/replaced before further damage occurs?
5.  Why would the report say the mitral valve is "normal" if I have regurgitation.
6.  Isn't pulmonary artery pressure of 36mmHg too high?

Thank You

[Cleveland Clinic]

1. What caused the regurg? I don't remember having rheumatic fever. Have not had a heart attack.

The valves that separate the chambers of the hear can sometimes leak in people. Abnormal valvular struture or prolapse can cause this and often is something people are born with.

2. I strenous exercise still safe, or making the problem worse?

Probably, but I would get a thorough evaluation with your physician. I do not make exercise recomendations without a thorough history and physical examination.

3. What is the prognosis? Will it get worse?

Mitral regurgitation needs to be followed over time. In some people it never progresses beyond what is initially found.  Things to watch for are worsening degrees of regurgitation, development of symptoms such as shortness of breath, edema, or fatigue  


4. Given that the left atrium is "at the upper limits of normal" should I consider having the mitral valve repaired/replaced before further damage occurs?

Timing of mitral repair or replacement is a difficult question for people with significant mital leakage. However, if you really have mild regurgitation, it is not indicated and it isnt the primary cause of your atrial dilitation.

5. Why would the report say the mitral valve is "normal" if I have regurgitation.

The structure is normal. It just has a little bit of leak. This is not an uncommon finding, it also distinguishes it from someone with valvular abnormality such as prolapse with a mild degree of leak.

6. Isn't pulmonary artery pressure of 36mmHg too high?

It is elevated.  Echo measurement of pressures in the heart is not always accurate and can be influenced by a few factors such as blood pressure and heart rate.  It should be further evaluated by your physician.