Pericardial effusion - scared and confused

I just had a yrly echo and I really would like some input on this.  I have a history of Mitral valve prolapse (moderate) with Moderate to severe regurgitation.  Not sure if a repair is in my near future.  

My left atrium went from 2.7 to 4.0cm in one year.  The EF is 55%. Aortic valve is normal.  Trace tricuspid regurgitation (which I know is nothing to worry about).  The mitral valve is myxomatous with moderate-severe rugurgitation and moderate prolapse of posterior valve leaflet.  I also have an intra atrial septal aneurysm with no shunting.  There is mild pulmonary insufficiency.  The newest finding is I have a small pericardial effusion which I've never never had before.  I am a 42 year old female.  

Should I be pressing my doctor to get this valve fixed now rather than later.  Why is there an effusion?  He is on vacation for 1 1/2 weeks and I've gotten no input from him yet.

Thank you soooo much.  I look forward to your posts.

[kenkeith]

I have had moderate to severe mitral valve regurgitation for more than 6 years (time diagnosed), and my doctor is waiting to see if and when there are symptoms....shortness of breath, etc.  A leading valve surgeon at the Mayo Clinic states the biggest problem he sees is the patient has waited too long.  If one waits too long the left ventricle can enlarge and the EF can drop into the abnormal pumping range .  If that happens the surgeon states it is difficult if not impossible to return the left ventricle to pump effectively again....that is the risk you have to consider. The heart works harder in order to supply the body with the proper amount of blood flow. This extra work can cause the muscle of the left ventricle to thicken, and/or the ventricle may become enlarged. Eventually, this can lead to heart failure.

The left atrium can increase (mine is around 4.1 and hasn't cahanged very much) as the extra blood that regurgitates back into LA and the increased pressure will enlarge the LA.  These changes in the left atrium can lead to shortness of breath, and can also produce atrial fibrillation. Your EF is normal indicating your left ventricle is pumping with normal effectiveness, but the 55% EF (percentage of blood pumped with each heartbeat into circulation) is less than 55% because some blood goes back into the LA.

Usually an increase in LA is gradual or stable so quick increase may be significant for some intervention!?.  You are relatively young and the condition won't improve so to wait doesn't seem worth the risk of waiting.

Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity (sac that surrounds the heart.. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function. The heart's function would be impaired due to the inability of the heart to effectively relax and expand to admit blood into the chamber to be pumped.
Causes: Pericarditis, Viral infection(coxsackie virus), Infection, etc.

Hope this provides you some insight that can help you discuss your options with your doctor.  There doesn't appear to anything critical or serious enough to have any immediate concern.  Thanks for sharing and take care.

[ocean12]

Thank you very much for the information.  I do have a lot to decide for the future.  Would you happen to know why I all of a sudden have this effusion that showed up?  I do not have any illnesses, cancer, viruses, etc.  Does the effusion have something to do with the regurg being moderate to severe?  Still trying to figure out what that's all about.

[kenkeith]

Your posts do not show anything to help finding a source of the mild pericardial effusion.  Your MVR wouldn't be the underlying cause unless it is/was an underying cause for heart failure (blood backs up in the lungs and fluid leaks into tissues and pericardium.  Kidneys could be problem, etc.  A blood test can rule out an underactive thyroid that could be the underlying cause. Sometimes the underlying cause is unknown (ideopathic).
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In an asymptomatic individual, a pericardial effusion of less than 10 mm on the echocardiogram may be an incidental finding, and individuals do not require invasive studies nor treatment is required. A follow up echocardiogram is probably warranted to see if the echocardiographic findings are unchanged. Further investigation or treatment of these patients is not necessary if the echo findings are stable.

[ocean12]

Trying to figure out how I got this effusion is a "mystery" espeecially since it's the first time it's been on any echo report.  I've had them done since I was 18 to monitor the MVP.  .  I do have a thyroid problem, but I have hyper and not hypo.  Since my doctor didn't even tell me about the effusion or even schedule a follow-up is what bothers me.  If I didn't obtain the report, I would have not even known about it and that to me is really bothersome.  Also, the echo doesn't provide the amount of the pericardial effusion.  Shouldn't it have been measured?  I'm going to call the office on Tuesday and request a follow-up echo......Thank you again for providing this information.  I appreciate it.  

[kenkeith]

I agree!  You should have been told about the finding...the doctor may not know the cause and doesn't consider it significant and did not want to unnecessarily alarm you may be the answer.

[ocean12]

My husband did have a question that I couldn't answer.  How quickly can an effusion change in size and start to get larger.  The last echo that I had done was back in December 2009 and there was no effusion present then.  Could this be the very beginning of chf, especially since I've got severe MVR / myxamotous mitral valve / enlarged left atrium 4.0cm.  Is an EF of 55% good?  I just found that on my report.  

[kenkeith]

Your left vetnricle is normal and pumping 55% of the blood received from the lungs.  However, if the rightside (failure) is not pumping sufficient blood to the lungs there can be systemic heart failure as the left ventricle is not receiving a good supply of blood/oxygen from the lungs and the cardiac output is low.  Also, some backflow of blood to left atrium can also reduce the amount of blood pumped into circulation and leftside heart failure will ensue.  Worst case scenario.

If you had a serious heart problem, it is likely you would have shortness of breath, fatigue, chest pains, etc.  

Accumulation time can be acute or chronic. Clinical manifestations of pericardial effusion are highly dependent upon the rate of accumulation of fluid in the pericardial sac. Rapid accumulation of pericardial fluid may cause elevated intrapericardial pressures with as little as 80 mL of fluid, while slowly progressing effusions can grow to 2 liters without symptoms.

Hope this helps you have a perspective, and the probability is high there is no serious problem.

[ocean12]

Again, thanks for providing such information that is easy to understand.  You really are education in this field and sounds like you study alot about this stuff.  Do you have a medical background?  I guess I need to start reading more about this stuff because knowledge is POWER!!!!!  

[kenkeith]

Your welcome.  I have been answering heart related questions (over 6000 now) for about 6 years.  Take care and thanks for the response.

[ocean12]

I'm wondering what you are thinking of doing with your MVP/MVR.  I know your posts have said that you have had this condition for about 6 years.  I'm sure you are in the same boat as me and kind of know in the back of your mind that the repair is inevitable.  Have you ever had a TEE done?  I'vel had 2 done in the past 5 years (although I've had MVR since I was in my early 20's).  Both TEE's showed mild regurg while all of the thoracic echos I've ever had done showed mod-severe.  One of my doctors has the theory that versaid and other meds do change the hemodynamics of the heart and function;therefore underestimate the regurg.  I've not been able to find anything on the web that supports his theory.  Everything that I've read says that TEE's are the gold standard, but they never match the regular echos and that bothers me a great deal.  The doctors always want to go by the TEE's.  Somethine just seems quite confusing with this.  What is your take on it and are you thinking of a repair in your future?  I appreciate your time as always.

[kenkeith]

Yes, I am concerned about my MVR.  Six years ago, when I had my first evaluation, the left ventricle was enlarged and an enlarged LV can cause MVR (ischemic related).  There was a probability to reverse remodeling of the LV and that could have a positive effect on MVR...but it didn't. Medication has returned my LV to normal size but the MVR remains...I have not had a TEE, and I have no symptoms.

There seems to be an advancement in repair and replacment in the last 6 years, and I am seriously considering getting a second opinion and evaluation by doctors at the Mayo Clinic. It may involve a simple procedure to reduce the size of the orifice with a ring implant.  If my doctor is correct, the oversize LV skewed the valve opening so the leaflets do not seem to be a problem.  

I have responsibilities that makes it difficult to have any physical (possible mental)impairment that an operation would bring on.  I keep putting it off and that may be a mistake.  Thank you for the information.