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Re: Aortic Insufficiency
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Re: Aortic Insufficiency

Posted By CCF CARDIO MD _ CRC on August 31, 1998 at 15:13:52:

In Reply to: Aortic Insufficiency posted by Don on August 30, 1998 at 23:05:48:






I am a 36 yr old male with a history of Aortic Incompetence.  The condition
was discoverd when I was 22 during a flight physical for the Air Force.  An
echocardiogram was performed with the following results.
(1984)
Aortia  36
Left Atrium  28
Right Ventricle  22
Left Ventricle (ed)  61
Left Ventricle (es)  41
No LVH (or abnormality of mycarial contraction) but the aortic valve was bicuspid and incompetent.
The Air Force performed additonal echos during my time in the service
(1987)
LV (D, ID)  5.5
LV (S, ID)  3.5
LVPW        1.5
IVS         1.1
No LV enlargement.  But aortic valve appeard tricuspid.  Still Mild Aortic insufficiency.
(1992)
No dimensions available
Aortic valve have very mild thickining w/preserved orifice opening.
LV normal in size and function.
mild/mod aortic insuff. by doppler.
Separated the Air Force, and I now see a civilian doctor.
(1997)
LV dias  6.2
LV syst  4.3
IVsept   0.8
Post wall  0.9
L Atrium 4.0
Aortic root 3.8
mild LV enlargement.
Aortic root mildly dilated
Aortic valve bicuspid.
Mod (II/IV) aortic insufficiency.  Trivial Mitral regurgitation.
good RV and LV systolic function.
Other info.  I run 4 miles/day 5 times a week, and 6-7 miles once on the weekend.
Air Force Ergonomics (while in the reserves) results 1998 - score of 55 which is the top 99th percentile of the Air Force. This is
     a bicycle test based on endurance and heart rate.
At rest heart rate lying down ~ 40, sitting 44.
Mild hypertension at the doctors office ~ 160ish/70ish (white coat syndrome), 130ish/60ish outside the doctors office.
In the last year, mild premature atrial contractions (feels like my heart is flipping over in my chest)
   typically when my heart rate is low (below 50).  I'm controlling this with excercise, and limiting
   cafeen intake.
Questions:
I have a hard time getting straight answers from any of the cardiologists
I have seen, hence I address your forum.
Can you explain the differences in the echos.  It appears that initially
there was some enlargement in the LV, then it measured as normal, then large again.
Also, inconsistencies in the diagnosis of bicuspid-tricuspid-bicuspid aortic valve.
Is there a large cause for concern?
How does this condition affect life expectancy?
My current physician recommends I take medication for the mild hypertension.
Would this reduce the amount of backflow into the LV?
At what point should the valve be replaced?  Size of the LV?  Amount of
insufficiency?
Could the PAC be caused by the aortic insufficiency?
From my own research I know of 3 replacements, aortic valve from human, valve from a pig, and
a mechanical valve.  Are there other options?  Can the valve be reconstructed/repaired?
What is the error of measure for echocardiograms (plus or minus 2 mm, etc.)?
On a scale of 1 - 10, with 10 being severe, how would you rate my condition.
Thank you for your time and effort!



  ________  
Dear  Don,
Questions:
I have a hard time getting straight answers from any of the cardiologists
I have seen, hence I address your forum.
Q: Can you explain the differences in the echos. It appears that initially there was some enlargement in the LV, then it measured as normal, then large again. Also, inconsistencies in the diagnosis of bicuspid-tricuspid-bicuspid aortic valve.
A: Echo measurements will vary somewhat depending upon the training of the persons doing the echo and the quality of the echo.  If a tricuspid valve was truely visualized then that is what it is and the one that said bicuspid was incorrect.  In some difficult cases a transesophageal echo is used to better visualize the heart.
Q: Is there a large cause for concern?
A: This is definately something that bears watching and having close follow-up.  At some point it may become necessary to replace the valve.
Q:How does this condition affect life expectancy?
A: No good studies have address this question but from what we know it has no effect on life expectancy.
Q: My current physician recommends I take medication for the mild hypertension. Would this reduce the amount of backflow into the LV?
A: Decreasing the blood pressure will make the work the heart has to do less and may prolong the life of the valve.
Q:At what point should the valve be replaced? Size of the LV? Amount of insufficiency?
A: This is not an easy question to answer and is one reason that close follow-up is recommended.  In general the valve should be replaced before the heart muscle starts to fail.
Q: Could the PAC be caused by the aortic insufficiency?
A: Possible.  
Q:From my own research I know of 3 replacements, aortic valve from human, valve from a pig, and
a mechanical valve. Are there other options? Can the valve be reconstructed/repaired?
A: Not at this time.

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist

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