TEE

  After seeing the same cardiologist for over three years, and having been diagnosed with a case of severe aortic regurgitation (left ventricle enlarged by 4.4 cm for the past 2 echos), and showing no other symptoms, my cardiologist (in passing) mentioned that he was thinking about a transesophageal echocardiogram. I understand what this test is, but I can't think of any reason why, at this juncture, he would even consider it. Consultation with a noted cardio-vascular surgeon confirms that we're in a waiting period until we see left ventricle enlargement to over 5.5 cm. I am in good aerobic condition (racquetball twice a week and treadmill twice a week with a max. heartrate of 170 beats per min. Without being a "mind reader", do you have any idea why my cardio would even have brought this up now? Thanks.

[CCF CARDIO MD APS]

Dear Rick,
The only thing I can think of for assessing the valve by TEE would be to better
define the mechanism such that there can be consideration of repair not replacement.
The current thought in cardiology and cardiothoracic surgery is that by all means
try to repair the valve, not replace, unless of course you are left with no option.
And in general the repair attempt is most successful when it is considered a tad earlier
than replacement.  You must know of course that there are not many surgeons out there
who are not only skilled but experienced in valve repair, our Dr. Cosgrove, Chairman of
Cardiothoracic Surgery here at the Cleveland Clinic is one of the pioneers of valve repair.
Mind you also that repair of the aortic valve is technically more difficult and therefore
less successful than is repair of the mitral valve.
Please discuss this issue of repair with your cardiologist.
It is pretty much the norm to wait for LV dilation before replacing the valve,
however should you develop any symptoms before this "dilation" of your valve occurs,
then the time to repair/replace is NOW, since technically the patients who do
best long term are those that had their valve replaced prior to symptoms and or
dilation of the LV.
Also discuss this issue with your cardiologist, that is, your planned follow-up and
the parameters that will send you to surgery.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.