Ambiguous MVP/MR diagnosis w PSVT

[dave3422]

32/M with history of PSVT since age 10.  Managed well (no meds) with very infrequent episodes. Otherwise healthy and exercise regularly.  
1998, I went for a routine follow up w/echo.  Echo showed "some prolapse of the anterior mitral leaflet without mitral regurgitation".  

Jan-2006 I went for another routine follow up, was given another echo:

LVSd:  .95cm
LVPWd: .95 cm
LVIDd:  5.2cm
LVIDs:  3.4 cm
Ao root diam:  2.8 cm
LA dimension: 2.9 cm

LV:
Normal size, wall thickness, wall motion and function.EF approx. 60-65%.
RV:
Normal size, wall thickness, wall motion and function.
Atria:
LA size normal.  RA size normal.  No thrombus or ASD demonstrated.

Mitral Valve:
Mild annular and leaflet fibrosis.  No stenosis or vegitation. Borderline posterior leaflet prolapse.
Mild mitral regurgitation.

Conc: The study shows borderline MVP with mild leaflet thickening and regurgitation.  Otherwise normal.

Original study was done by a cardiologist at a regional medical center.  Took the echo CD to a cardiologist at a major educational/research institution. He and one of his colleagues reviewed the echo and said I have no prolapse and no regurgitation.

Questions:

1)  What are "normal" values for echo results?
2)  What accounts for the discrepancy between interpretations?
3)  What does "mild leaflet fibrosis mean"?
4)  Does no regurgitation then showing (supposedly) regurge indicate a worsening condition?  
5)  PCP said I need antibiotics before dental work.  Cardio who reviewed echo in 2006 says no antibiotics necessary.  How do I know?

Thank you

[CCF-M.D.-MJM]

Hi Dave,

1) What are "normal" values for echo results?

From what you have written above, your echo sounds pretty normal.  The "boarderline posterior leaflet prolapse" is probably not of any clinical consequences ( I say probably because I haven't seen the study).
2) What accounts for the discrepancy between interpretations?

The interpretations aren't as different as you might think.  Mild or trace mitral regurgitation can be seen on most people that have an echo -- the test is too sensitive.  Mild leaking is usually of no significance.

3) What does "mild leaflet fibrosis mean"?

I think they probably meant "restrictive" rather than "fibrosis."
They probably meant that it isn't moving as freely as they thought it should --- but remember that called it boarderline, which means they almost didn't comment on it at all.

4) Does no regurgitation then showing (supposedly) regurge indicate a worsening condition?

No.  As I mentioned above, this can be seen on most echos.

5) PCP said I need antibiotics before dental work. Cardio who reviewed echo in 2006 says no antibiotics necessary. How do I know?

I would probably side with the cardiologist, but I would need to see the study.   Cardiologist tend to have more experience with these issues.  On the written report above there is nothing that would indicate a need for antibiotics.

I hope this answers your questions.     Good luck and thanks for posting.

[dave3422]

To clarify:

Auscultation yields no clicks or murmers.
Echo in 1998 yielded "some mitral prolapse of anterior mitral valve without mitral regurgitation".
Echo in 2006 yielded "borderline posterior leaflet prolapse" and mild "fibrosis" and mild mitral regurgitation by first cardiologist to review.
Cardiologist at a different (larger) center looked at the echo and found no prolapse and no regurgitation and said I do not need to take antibiotics prior to dental work.  

Question:  Why the discrepancies and three different interpretations?  I am wondering if I have MVP/MR or not.

Thank you again!

[anacyde]

Hi there.  I also have PSVT, controlled without medication, induced by exercise.  I was wondering if you could share with me more about your PSVT experience?  I was curious about frequency and duration, and also if you have any known triggers.

Thanks ;)