Echo Results

[DavesMom]

I'm a 55 year old female who was born with a bicuspid valve.  After a commissurotomy at age 20 I had  AVR/aneurysm repair in '99 - went with a mechanical valve.

Well, after years of perfect reports the following things were noted on today's test that the doctor who wrote the report said should be "considered for TEE if clinically indicated."

I have a CT scheduled to check the aneurysm in my ascending aorta (currrently at 4.4) and then an appointment with my cardio at the end of the month.  In the meantime, can you shed any light on what these means?

"A 0.6 x 0.4 cm independently mobile echodensity on the aortic side of the prosthesis. Differential includes vegetation (in the appropriate clinical setting, e.g. fever, bachteremia, etc.) An echodensity is also noted on the atrial side of the mitral valve on one still picture."

"On the right ventricle, a linear mobile echodensity is also noted in the RVOT which most likely represents a chordal structure."
  
I knew something was up when the tech said she saw "something shiny" on my valve.  She said it might've just been a shadow but to be safe, she had my test read before she'd let me leave. Could it just have been some kind of tech error?"

If it is indeed vegetation, can this destroy the valve?  

Thanks in advance for any information.

[DavesMom]

Thank you so very much for your help!

[CCFHeartMD 12]

I do not read cardiac CTs for a career, but based on my experience, a CT would not be able to have the resolution to clearly identify small objects near a metal valve.  TEE is really the only way to clearly define what was seen on the TTE.

[DavesMom]

Thanks so much for your reply.  I've been feeling no different so I really don't think there's any kind of infection.

I've got one other quick question if you don't mind. I have my yearly CT in a couple of weeks to check on my ascending aortic aneurysm, which never shows up on the echo. Did I read your answer properly that a clot or vegetation would NOT show up on the CT? Since the tech wasn't able to visualize my prosthesis very well I thought the CT might do the trick.

Thanks again!

[CCFHeartMD 12]

Not having access to the actual images of your transthoracic echocardiogram (TTE), I would only venture some GUESSES about the interpretation.  

1. "A 0.6 x 0.4 cm independently mobile echodensity on the aortic side of the prosthesis" -- this is often concerning for several things 1. clot, 2. old suture material, 3. infection/endocarditis.  #1 and #3 being more concerning than #2.  For it to be an infection/endocarditis, there really needs to be "appropriate clinical setting" -- feeling ill, weak, feverish being the most common.  Alternatively, a clot can sometimes form even though you take your coumadin religiously.  We often do not do anything to the valve if a clot was discovered .  

2. "An echodensity is also noted on the atrial side of the mitral valve on one still picture." -- not sure what this is all about, but being on only ONE still picture is not exactly convincing that ANYTHING is there (i.e. might be an artifact).  

3. "On the right ventricle, a linear mobile echodensity is also noted in the RVOT which most likely represents a chordal structure" -- a chordal structure is a completely normal part of the heart.

I believe that if you do NOT have any concerning symptoms for infection, the TTE report do not strongly suggest endocarditis.  But since it would be really important for you to be SURE, I recommend going through with the transesophageal echo (TEE).  This unfortunately happens quite often (taking asymptomatic people to TEE because of some dubious finding on TTE), but it would be a great sigh of relief when the TEE refuses the concerns of the TTE.  By the way I do not think a CT scan would help you for this particular situation.  

Good Luck!

[DavesMom]

Just wanted to add that every echo report has mentioned that my valve is "hard to visualize."  I am a very tiny person, so could this be why it's hard to see?  My valve is a #21 Carbomedics.

Thanks again for your time.