When to know rather or not a mitral valve needs replcaing

[pms_barbie]

Hello and thanks for taking my question.  I asked my local cardiologist when they would know my mitrl vavle needed  replacing.  The four things he said were heart enlargement naturally.  If I went into atrial fib.  Swelling of the ankles and feet and congestion in the lungs.  My question is isnt it already past the point of replacement if the hearts enlarged and your into atrial fib?  I mean shouldnt  sever reg be enough to warrnt a replacement or repair?    There seems to be some controversy over why I have mvp one drs says plain old mitral vavle prolapse another says rhuematic fever at some point in time.  I know no one wants to hear about pvcs but I already suffer from them and I sure dont want another rhythm problem on top of them.  I am curios as to the criteria for a repair versus a replacement.  My local cardio said if I could find a good surgeon its possible they could repair mine.  I have mvp and thickening of bothe the leaflets.  Any help would be greatly appreciated.

[Cleveland Clinic]

barbie,

Your cardiologist is pretty much right on target.  To determine the best time to repair a valve, we compare life expectancy after valve repair in different scenarios.  From multiple studies, we know that people can tolerate even large degrees of regurgitation as long as those conditions your cardiologist mentioned are not present for very long.  In some people, repair or replacement is never needed.  This is why you have followup echocardiograms. There are some cases where severe regurgitation is present that we just go ahead and fix the valve.  

The criteria for repair and replacement really depend on the mechanism of the regurgitation and the experience of the surgeon performing the operation.  For that reason, its best to try to seek out a very experienced surgeon when it comes to that point.

It is impossible to say specifics of when your repair should be without reviewing the data.  It would probably ease your concerns if you were to obtain a second opinion of your valvular disease and he timing of surgery.

[Momto3]

Here is a link for the ACC's guidelines for patients with valvular disease. It may help clarify your doctor's position.

http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm


connie

[pms_barbie]

Thanks very much for the link its greatly appreciated.

[DottyCece]

Hi,

If your valve can be repaired and it is the professional opinion of your cardiologist that it is time, then do it.  Having a valve replacement instead of repair carries with it life long coumadin which is no fun.  PVCs are common in this scenario..I sure had them most of my life and believe me it is nothing to contend with in comparison to rapid uncontrolled atrial fib and heart failure stuff.  Until you have all of that, it is difficult to comprehend the gravity of it and the life altering experiences of having to contend with all of that.  Atrial fib is very common with mitral valve regurg etc.  

By the way, if you are moving forward with the repair, make sure you go to someone who has an expertise in repair and has done many of them such as Cleveland Clinics.  This is extremely important...believe me, I been there!!!

[hankstar]

Hi,

   I have been diagnosed with a redundancy of the mitral leaflets from 1983, last echo 2001 showed the same redundancy of the mitral leaflets without frank mitral valve prolapse and no leakage at all, yet I just read that a redundancy of the mitral leaflets put ones at high risk for sudden death, needless to say this has left me scratching my head and somewhat worried. I know I can't ask a question for the next 6 months and I would have to place an overseas call to my cardiologist to get this one question answered, I am wondering if anyone could chime in on this , maybe even the CCF doctors.

Thanks to anyone that can help!

Regards,
  Hank.

[uptowngirl]

Hi. I also have redundancy of the mitral valve (anterior leaflet only I believe).  Diagnosed in 1996, also have moderate prolapse and mild leakage, which has changed very  little, I am glad to say.  When I asked the cardio about the risk of sudden death he said I only had a 1-2% higher risk than the general population, unless I was involved in competitive sports then the risk would go up to 5%.  That was his take on it, with my situation. Your situation may be different of course.  I also take two meds.  Do you take any meds?
Are you involved in competitive sports?
Hope that helps.
Uptown

[hankstar]

Hi, Thanks for responding, I take atenolol 100mg daily in divided doses, 25mg 4 times daily and cozaar 50mg daily , also apirin 325mg daily and diazepam 5mg twice daily. I have a connective tissue disease(ankylosing spondylitis) for which I take the diazepam and aspirin , the other two atenolol and cozaar are for palpitation and B/P control.

I want to know why this redundancy of the mitral valve is s marker for increased risks, espeecially when I have been told that I don't meet the criteria for a diagnosis of mitral valve prolapse and erson with mild MVP are usually given no restriction , I am told that my risk are about the same as general population, yet while reading these latest findings are I am a bit anxious!

  I have never participated in competitive sports due to abnormal response in heartrate( not really that abnormal, but I was very symptomatic even with a normal increase in heartrate and only sinus tachycardia) to exercise, but I do moderate exercise, all test indicate that I have a structural normal heart, exercise stress(BRUCE)  also have shown that I have excellent exercise tlerance , can you believe that!! Walking upstairs , lifting anything heavy , bending suddenly has aggravated most of my symptoms. I know this can be associated with an SVT called AVNRT, sometime I wonder if i have it, almost could bet I do.

  I worked side by side with some good doctors and nurses( I worked in the medical profession myself , I'll just leave it at that without elaborating), I have looked at my echo and ECG tracings myself and should know better as they all appear fine, but I'll let you in on a little secret , or maybe a BIG one, persons who work in the medical profession especially doctors and nurses make the worse patients, they can help others, but are not much at helping themselves, no disrespect intended to them, but I know this for sure! As they say sometimes IGNORANCE IS BLISS.

Take care and thanks for responding, just curious do you have a prolonged QTc with your mild mitral valve proplapse, that is the only thing i could think of that would put you at such a risk or some degree of hypertrophy.

Best wishes,
     Hank.

[dafan]

Hi Mom to three..im so sad to hear of your problems... I guess it makes mine not bad at all... However.. and i hate to post on pvc's I just went to the emergency room yesterday morning with a terrible bout of them. I started having them in February only in the evening. They had almost vanished... maybe 10 to 20 a day... Until my wife had gall bladder surgery. i was really stressed out that morning and i had a flurry of them for an hour. that was a week ago. And now they are with me constantly, to the tune of about 2 to 6 a minute. I am feeling what i think are couplets,very often. But they didnt show on the ekg that they took. My pcp put me on atenolol but yesterday but it hasnt done a thing to suppress them. I had an echo, holter in March and my cardio said my heart was normal. Did your ebb and wane like that? Im kind of concerned now and im going to go get a second opinion. thank you so much.

[Barbarella]

I understand your concern.  I've been having PVC's off and on for the last 40 yrs. Ten yrs ago I had PVC's so bad it was like every other beat for a very long time, especially after a meal. I was afraid to eat.  Meds only helped a little.  After being checked out by a doctor and a Cardiologist (numerous tests), plus numerous tests while in the ER my Cardiologist told me not to worry and to "ignore" them.  Yeah, easier said than done. The Cardiologist told me that stress, fatigue, and not enough sleep will bring out the PVC's also to much caffeine, alcohol and cigarettes. I found out that when I'm stressed and I don't have enough sleep they will come out at its worst.  What helps me the best, more than tranquelizers or beta blockers which I cannot take due to my pulse dropping to 34 bpm, the best for me is to take one or two Tylenol PM at night, you can buy "Simply Sleep" which is the same without the Tylenol.  I sleep the whole night after a stessful event, and I am free of PVC's the next day.  The Tylenol PM are not habit forming btw.

[Barbarella]

Hi Barbie,

Did you ever have a "TEE" (Transesophageal Echocardigram)test done?  The reason I'm asking is because I had an echocardiogram done last January and it showed "severe mitral insufficiency". Of course I freaked out and couldn't wait till the day of the TEE test.  This TEE test showed the total opposite which is "MILD Mitral Regurgitation".  The Cardiologist said I don't even need a follow up, that lots of people have this.  Of course I asked him why the echo showed "severe" and the TEE test showed "mild" and he said sometimes if a person has severe anxiety during the test (which I had) the way this person is breathing  can screw up the echo result and he listed other reasons which I don't remember.  He said that is why he ordered the TEE test because an echo was NOT the final test if it shows severe mitral insufficiency.

[dafan]

Hi there Barb.. thank you for the response.. no i had a regular echo, but it had good imaging according to the report??

[dafan]

Thanks for the advice on the Tylenol pm. The funny thing with mine is when i excercise they go away. Just like now, I had them all morning and i went to the gym at lunch.. ran a mile and lifted weights and im still pvc free! I wonder... my pulse rate is naturally low mid 40's to 50's at rest. Could it be that they tend to occur more at rest with that? Also im not sure if the really calming effect of the xanax might bring them on?? just a guess. Even tho at one time i thought the xanax helped.

[Erik36]

Redundant mitral leaflets are consistant with Mitral Valve prolapse itself, yet you have no leakage. I have never heard of This redundancy causing an increased risk of sudden death. That must mean that it could cause sustained Ventricular Tachycardia. I have never heard of a connection between the two. The only thing I have heard is that MVP can cause Atrial Arrhythmias. The Beta Blocker you take would reduce whatever risk you do have of Arrhythmias. I'm sure what you read is something that is controversial. I doubt there is any strong connection between Redundant Mitral Leaflets and sudden death. They say that Paxil can cause prolonged QT Interval. But most Cardiologists would deny this. Paxil has never caused me this phenomenon, yet I suffer from PVC's PAC's and A-Fib. It's been several months since I've asked a question. If you don't get any feedback from the forum doctor I will ask this question because I want an answer to this question too since I have a close relative who has the same redundancy.

Erik

[hankstar]

  Thanks,I really wish you could post the question. I read it on several different abstracts lately. I left(medically retired because of AS) the health services over a year and a half ago and seldom have any contact with persons that work there now, also my regular cardiologist is overseas, though not far away.

  Believe it or not after working at a hospital for over 18 years, I even hate going there even to get my medication now. I still tend to think this is referring to mitral malve prolapse with leakage and not to just a redundancy of the mitral leaflets without frank mitral valve prolapse. I really don't  see the mechanism for such an malignant arrhythmia to be triggered, unless the thickened leaflets tend to irriate the ventricles and thus trigger the arrhythmia, who knows maybe I got my wires crossed on this one.

Thanks.

[Momto3]

Dafan,

Not sure your post shound have been directed at me.  I have MVP and 2-3+ regurgitation of the mitral valve, but am not a candidate for surgery.  I've had the mvp/mr for over 20 years, including through 3 pregnancies - no problem so far.  I have some thickening of the leaflets, but all in all, I am doing OK. Doctors watch closely for any changes.

I HAD pvcs for over 20 years. Holters indicated 24% of my beats were ectopic (ventricular, no atrial), thousands of couplets, too many bigeminal cycles to bother counting, and some nsvt. They didn't really scare me, probably because I had had them for so long, it was kinda "normal for me. Getting used to a regular rhythm was actually weird.  But for the cardiomyopathy, I'd still be "living with them." I was fortunate in that I'd had them for all of my adult life, so I was not afraid of them.  Now, the leaky valve- that's a different story.  I'm hoping that if and when the time comes for surgery, a repair is possible.  

If I remember correctly, Tenormin is the generic RX for atenolol. If that's right, it didn't work for me. Took one dose and was taken off because of a systemic reaction.  However, many others on this board have had great relief with atenolol.  My symptoms were better controlled with Inderal.  I took it on/off for years to combat the frequent pvcs, but in 1998 when I was convinced the pvcs were not going to hurt me, I weaned myself off of it (with doctor's approval) for good.  

When I later developed a cardiomyopathy, I had 2 alternatives: antiarrthymics or ablation(s). Tried the RX for several months, and finally opted to try ablation(s). Fortunately I have a team of great doctors and the procedures were very successful. My heartbeat is rhythmic and the CM has resolved.  

Yes, they definitely waxed and waned (for whatever reason).

Hope you are feeling better!

Barbarella,

I had a similar experience with a routine echo in 2000. Echo suggested "at least moderately severe" regurg. I was sent for a TEE for clarification.  Result was mild to mod regurg.  My dr. said that b/c of hemodynamic changes and individual interpretations, regular echos are subject to a range of interpretation. I just ran into the same thing last month.  The interpreting physician said "severe," but when my test result was compared to others from 2000 - 2003, nothing had changed. Therefore, the TEE performed in 2000 (considered the "gold standard" for assessing valvular disease) was used to clarify the objectivity in interpretation. Glad I had that done : )  

Glad to hear of your good report!!

Connie

[hankstar]

Hi,

   That is exactly how my PVCs occur they wax and wane ,sometimes with years in between episodes, then "bang" several a minute for weeks to months, but they tend to occur more frequently at a higher heart rate, maybe this is why beta blockers such as atenolol is effective in suppressing them in my case.

  I almost hate to say this , but your PVCs are probably what is known as vagally mediated PVCs, occuring at a slower heartrate due to your conditioning and high vagal tone, of course that is no reason to stop exercising as the last of exercise has an adverse on your overall cardiovascular health whereas, the PVCs in your case doesn't.

  Do you find yourself feeling fainty in crowded or heated room or even sometimes in a warm shower?

  Take care, my guess would be you have nothing to fear.

Best wishes.

[hankstar]

That should read the lack of exercise , not the last of exercise.

[dafan]

Thanks Hankster. Well ive only been taking the Atenolol for 1 day so i dont guess it has had time to produce any side effects. Youre probably right, im not sure that the drug will work for me. I know it sure had me dragging this morning. Thank you so much for your input here. The support and encouragement and sharing of experiences makes this place wonderful.

[dafan]

Hank, Just one more question. When they send you the report of your echo in the mail it isnt very specific. Mine just stated no effusion, Mitral and tricuspid valve normal, Ef of approximately 60% and ventricle size normal. I requested a followup appointment and was going to ask about the actual values but he stated very emphatically that there was nothing at all wrong with my heart. If you had some subtle things going on would the actual report state that even tho the card they send you says ...normal??

[NBCT]

Just some info. on Tylenol PM. It does work well and is non-habit forming....but the sleep aid in it is Benadryl which can cause a feeling of anxiousness and tachycardia in some individuals. My heart would race after taking just one and I have MVP with freguent PAC's and PVC's.

[hankstar]

Your echo would be termed essentially normal, having a normal sized ventricle and no trace or trivial regurgitation of the mitral or tricuspid valve, which even if you did have a trace, that in itself is considered a normal finding as 20-30% of the population would show this on echo, with a normal ejection fraction of 60%, which in some institutions normal ranges from 50-70% and 55-75% in others. On the whole there is nothing of clinical significance on your echo. It is completely normal.

Please note this is my understanding only of the information you provided , your doctor could advise with much more reassurance. I have medical background , but I am not certified MD., always trust your doctor, if not that is what second or even third opinions are for.

[hankstar]

NBCT is absolutely correct,(It contains diphenhydramine(Benadryl) the actual sleep aid in Tylenolol PM. PLease note persons with a prolonged QTc interval should avoid Benadryl(diphenhyramine) it can cause dangerous arrhythmias in persons with this condition and should be avoided. For other person it is generally safe, but can aggravate palpitations in person prone to them.

[Barbarella]

Thanks hankstar for telling me about the Tylenol PM.  I don't take it very often only if I had a really stressful event.

Mom to 3,

I know what you mean about "glad you got that test behind you".  But I was glad they had this test otherwise I'd believe that I had "severe mitral insufficiency".  Anything that has to do with heart and BP freaks me out.

[uptowngirl]

Hi.  Thanks for the info.  You have a wealth of information.  I guess I am glad I'm not in the health profession, but in the teaching field.  Although sometimes I research things to death!

I have only had 2 abnormal ECG's  in my life, but neither had to do with the prolonged QT interval that you mentioned, so the answer would be no.  Although I'm not quite sure what the prolonged QT situation is all about.

I also take atenelol, (and cardizem).  They have been friendly drugs for me, very few side effects.
All the best,
Uptown

[Erik36]

I take Toprol XL and Cardizem. I thought it was strange at the time when they put me on a Calcium Channel Blocker when I was already on a Beta Blocker. I take them for control of A-Fib. I was wondering what you take the Atenolol and the Cardizem for?
I too have had no side effects from either drug.

Erik

[Kristin391]

Do any of you have any experience with taking demadex (Torsimide)? I am wondering about dizzines in particular. The literature says dizzines is often the reason people discontinue taking this drug.

[uptowngirl]

Hi.  I've taken atenelol for almost a decade for the associated palpitations and PVC's that seem to accompany the moderate MVP. I've only been taking the Cardizem for a year and that was because I had an episode of A-Fib last December (I thought it was just stress/holidays).  Even though I've never had another episode like that, the Dr. said I should stay on it for preventative reasons and cut back the atenelol to 25mg.  I guess the Cardizem prevents A-fib from re-occuring.  Does that sound correct?  Anyway, I take the atenelol in the A.M. and the Cardizem at night. That works out fine.  Do you space out the beta blocker and the channel blocker?  I also notice the Cardizem gives me better exercise tolerance.  Have you noticed that?  Thanks so much.
Uptown

[Dynomite]

Could someone please tell me what is redundancy of the mitral valve.  I have MVP with moderately severe regurg.  six months ago a cardio told me I needed to have the operation.  I went to 6
other cardios for opinions.  The majority all thought as my left vent and left atrium were not enlarged and I do not need an operation right now.  I am having anither echo on Monday for my 6month check up and would like to ask my doctor about redundant mitral valve as soon as I know what it is.

[Erik36]

What a coincidence! I had one episode of A-Fib three years ago and was put on Cardizem to prevent future episodes. I had already been taking the Toprol for years for PVC's and PAC's. Even though I have never had any more episodes my doctor also kept me on the Cardizem to prevent another episode of A-Fib. I also space out the Toprol with the Cardizem. I take the Toprol in the AM and take the Cardizem in the evening too. I exercise frequently and I have very good exercise tolerance. Maybe it is from the Cardizem. The cardizem must prevent the A-Fib from happening.                                                            
Once you've been in normal Sinus Rythm for a year it feels great. Now that I've been in it for more than three years I feel almost as safe as I did before the first episode. I kind of had a dark cloud hanging over my head during the first year. I was so afraid that I was going to go back into A-Fib. Did you feel similar? I swear I thought I was dying when I went into A-Fib. Let's stay out of A-Fib permanently!

Erik

[hankstar]

A redundancy of the mitral valve usually mean that leaflets are excessively thickened and floppy,(lets look at it like this some persons have thick lips and others have thin lips) Look at the redundant leaflets of the mitral valve like thick lips. It is usually associated and occurs in MVP, others can apparently have a redundancy of the mitral leaflets without MVP. I have been told I have a a redundancy of the mitral leaflets but no frank mitral valve prolapse or no leakage whatsoever.

Your case is different if you have moderate to severe regurgitation, surgery might be required , as I far as I am made to understand the slightest change in your heart such as left atrial enlargement or dilation the ventricle would warrant surgery, it is always best to have surgery before damage starts.

Trust your doctors to advise you accordingly, if in doubt get an opinion from a reputable center that specializes in mitral valve repair or replacement.

Good luck.

[uptowngirl]

Hi.  Thanks for your response.  Wow, that's great that you've been in sinus rhythm for 3 years. That is encouraging to me.

Yes, I was somewhat concerned (alright, maybe alittle scared!) of going back into that rhythm again, however, I'm comin up on a year here in a couple of weeks, and hopefully I'll stay that way forever.  My Dr. says I'm on a tiny dose (120mg) but it appears to be working well.  I started on a higher dose, but it dropped my BP too low (88/58).  Just curious to know what kind of a dose you are on??

Thank you,
Uptown

[Dynomite]

I live in NYC and 6 months ago I saw the head of thorasic surgery at NYU Medical center.  He is very well known.  He scared me to death.  I had the feeling he would have operated on me right then in his office.  I am sure that one day I will need an operation but the thought of going on bypass and having open heart surgery terrifies me.  According to every ekg I have taken in the past 10 years my heart is in perfect condition.  I only found out less than 10 years ago about MVP at that time it was minimal however mine has progressed. I go for another echo on Monday and hope for the best.  I have had a tee in May and a thalium stress test in July.  MY cardio was very pleased with the stress test results.  It showed I got my heart up to 85%and my pressure never rose.  If I had not gotten a terrible migraine I would have gone longer than the 12 minutes on the treadmill.

[pms_barbie]

Sorry it took me a while to answer .  Yes I had a tee done in June.  It said only mild  I think its a 1+.  The tee wasnt fun at all:(

[Erik36]

I was started on 180mg of Cardizem at the time of my episode and I have stayed on that dose for three years now. What you and I had was probably Lone A-Fib. It may never come again. Thank God!!

Erik

[Barbarella]

Hi Barbie,

I know what you went through.  I was so nervous I was not even sedated after all the stuff they put in my veins.  I felt everything, but wanted to get it over with.  I closed my eyes and pretended I was asleep.  Maybe they knew that I wasn't asleep, maybe they didn't.  But they went ahead and did the procedure.

If I were you I'd ONLY pay attention at the result of the TEE test.  This test is a lot more accurate than the echo.  Your TEE test showed "mild".  If I were you I'd not worry about it.  I'm not worried about mine.  I had mine done by a very good Cardiologist in a big "Heart and Lung" hospital, and he told me and my husband "not to worry, I don't even need a follow up".  I know doctors can make mistakes, but I've to trust a Cardiologist who does this procedure frequently that he knows what he is doing and what he is talking about.  I don't think he'd put his signature at the end of the dictation of the result of this test if he were not sure.  There are to many malpractice suits out there.  If this was a very new "experimental" procedure I might would worry more, but this Test has been around for a long time. And the Cardioligists are doing these tests very frequently.

I admit, that at the back of my mind I think like you and wonder will it some day get worse?  But that same goes for my arteries.  I sometimes think "I wonder if and how much they are blocked".  Of course I could get a heart scan for $450.00 to see if I have calcifications or blockages, but I rather not know.  All I would do is worry my head off.  I know of a person who had a 90% blockage in one artery for 20 yrs, he refused bypass because he was scared, he never had a heart attack and died at the age of 78, he had Parkinson's when he died.  My boss's sister in law died in her sleep at the age of 34, NO heart problems, never a day sick in her life.  An autopsy which they did not have done might had shown why she died in her sleep.

[va_tony]

Wow.  There are a number of interesting discussions going on simultaneously in this thread!

Uptowngirl.  You asked about cardizem for afib. My impression is that cardizem is used mostly to treat high blood pressure and it's relatively ineffective in preventing reoccurances of PAF. It's likely the cardiologist prescribed this for you to lower your heart rate and so tolerate episodes better when they occur. Still, if it has prevented a reoccurance for you and Erik, then great! I've been on 240 mg/day cardizem for many years for high BP but, unfortunately, it didn't prevent me from going into continuous afib a few years ago. Since then I added Rythmol, which was started in the hospital, and the afib now is under control, though I still have self-terminating episodes every couple of months.

Erik. My understanding is the the term 'lone afib' doesn't refer to the number of incidents (e.g., one) but to the fact that there doesn't appear to be an underlying cause (say enlarged atria, MVR, high BP, etc.)-- it's just another way of saying idopathic afib.

Barbie.  I'm sure glad you asked the question about the timing of mitral valve surgery.  I was diagnosed with "mild MVR" with an echocardiogram a few years back. My cardiologist has told me it's nothing to be concerned about and that he'll keep an eye on it.  However, I already have three of the four criteria that your doctor mentioned that indicate valve surgery is needed - afib, enlarged atria (LA dia. of 5.2 cm) and ankle swelling on occasion. Presumably these criteria have greater significance if you have severe MVR and not just mild MVR. However, just reading over the thread's discussion on this topic now has me worried that perhaps the "mild" regurgitation could have been misdiagnosed, especially after Barbarella mentioned that a TEE was needed to accurately determine MVR "severity". Does anyone know the reliability of a standard echocardiogram to accurately assess MVR severity? In particular, does it sometimes happen that one is diagnosed with mild MVR when in fact the MVR is severe(several have mentioned the opposite case)?? Any opinions would be welcomed!

Regards to all,

Tony

[Erik36]

You are correct in that "Lone A-Fib means there is no cause for the A-Fib that can be identified. Also, I too was under the impression that the Cardizem was for rate control during episodes but I have heard a few things from Cardiologosts that Cardizem may be able to prevent A-Fib from starting in some individuals. take care.


Erik

[hankstar]

Please see my post to you under ablation procedure, I posted it under the wrong thread, got my wires crossed again. I swear I am losing it!

Regards.

[Momto3]

Hi Tony,

I was told that mitral valve surgery is seriously considered if the above mentioned criteria are occurring. I had the same experience as Barbarella in that an echo was not sufficient to diagnose the proper amount of leakage. Apparently, all of the clips contained ectopics and the pictures were "fair."  The TEE was able to provide up close and personal pics of those pesky valvs.  Does your doctor perform serial echos to monitor for any changes?  Have you ever had a TEE?  

My doctor has said that BP control and serial check ups are important for watching for any changes in the atria as well as any sign of decreasing function of the left ventricle (EF).  If I remember correctly, she said that a-fib is a bit more prevelant (and significant) in patients with mitral regurg.  Has your doctor mentioned that?  Were you in a-fib at the time of your echo?  I have not experienced A-fib and I am very thankful for that.  From what I have read, it can be tricky to manage and uncomfortable for sure.

I do agree that the criteria have greater significance if you have severe MVR.  

Good luck!!
connie

[va_tony]

Thanks for your input. No, I've never had a TEE.  It sounds positively awful but I guess I should try to arrange one, if for no other reason than to reassure myself that I don't need immediate valve repair.

I have been going to my cardiologist for nearly twenty years, before 2 1/2 years ago just to take a stress test every 3 years, which I generally aced.  I did see my GP on a yearly basis. Several GPs have told me in the past that I had MVP but previous echos (longer than five years ago) showed no sign whatsoever. I even took a stress test and echo from another cardiologist about ten years ago and he saw no valve problems.

For the last 30 years I have been compaining to my cardiologist and other cardiologists (and GPs) about an arrhythmia I felt on occasion.  But we could never catch it on Holters. I suspect it was afib though at the time I was reassured it was likely harmless PVCs. Apparently, some time 3 years or so ago, the PAF advanced to the continuous stage and it was finally detected on an ekg. About 3 months after I was cardioverted and back in NSR, I had a stress test and echo.  It was at this point that the enlarged atria and mild MVR were noted (though, apparently, earlier echos did show an atrial size on the high end of normal). My cardiologist's opinion was that the enlarged atria was caused by being in afib continuously for several months and high BP (even with meds I had an BP of about 140/90 for a decade or more because I refused to take a diuretic - -stupid decision huh?--was afraid that running to the bathroom all the time would interfere with my life-- as it turns out, I seem to go less often now that I'm on HCTZ, especially at night, and now my BP is 120/80). About six months after the first stress test/echo I took another set and there were no changes noted.  I was disappointed at the time that the left atrium size had not decreased as was expected. My cardiologist didn't seem concerned.

But the possible connection between the MVR and the enlarged LA has been weighing on my mind since. For some reason, it never occurred to me (before reading this thread) that the echo might not have accurately assessed the severity of the MVR.

I'm seeing my cardiologist next month. He was planning to do an echo/stress test to keep an eye on my mitral valve and LA. I'll mention that I'd like a TEE as well and see if he goes along with that.

Thanks again!

Regards,

Tony