MVP question

Sorry if this has been posted, but I haven't found this searching yet; so I wanted to ask if anyone knows. I asked on the heart disease forum also; but hoping since the discussion was here someone may know.

During a discussion on mvp someone said the "gold standard" to dx mvp is an echocardiogram; forgive me for being obtuse here but is that a 2D or 3D, or is there even a difference in them enough to make one more accurate?

I'm trying to find on my test results where it shows I have valve problems.  

It says technically difficult 2D echocardiogram
Concentric L Ventricular hypertrophy with a normal EF of 55-60%
LV septal wall thickness 12 - normal is (6-11),  L atrium is at 39 - normal is (19-40)

What am I not understanding about this? I really don't see how that can diagnose mvp; maybe there's something else I'm missing?

Should I ask for a 3D or something else to get a more accurate diagnosis? I go to my dr on Jan 7th, so I want to be prepared to ask for the right thing.

Thanks in advance.

[Jerry_NJ]

I've looked back in  my records and found three reports.  all were:
1) 2D echocariography - the latest two also says "M-mode". (Aug 2009 and Jan 2008)
2) Color, pulsed wave and continuous wave Doppler - this is where the subject of MVP comes up.  

The oldest of these three is from July 2007, and is pre-surgery.  Under "2" on this report I find:  "Across the mitral valve there are two regurgitant jets.  There is no stenosis.  PISA measurements estimate a RV of 100 ml and ROA of 76 square mm consistent with severe mitral regurgitation."

The above is what resulted in me being referred to a surgeon for mirtral valve repair.  There is no mention of 3D and all doctors, including the surgeon seemed satisfied that the echo on July 2007 and some other tests:  a catheter heart exam and an examination that was done down my throat, some kind of an echo too as best I can remember (I haven't researched my records).  All these tests were considered in the medical decision recommending to me I undergo mitral valve repair/replacement.  The surgeon was able to do a repair, I still have my mitral valve, supported by a ring that reduces the size of the opening mitral valve has to close when the left ventricle pumps.  

[itdood]

Hi Lisa, the valve protrudes like a parachute into the left artium.  It can be indirectly observed as a late systolic mumur, but that's not sure proof.  If someone heard a late systolic mumur, confirmed it on echo, and showed enlargement of the LV, MVP w/regurge would become suspect.

Directly observing it on a 2d echo is feasible.  3d holographic is better, but not required to observe the prolapse.

[Mom2four85]

That's what I don't understand, there's nothing in the measurements that says the valves, unless there's something I missed that shows anything about valves even being visualized.

In the dx says Trace MVP & Trace/Mild MVP; I don't think that's good enough to confirm a concrete diagnosis is it?  Especially when it says the 2d echo was technically difficult.  It says also, this was a fair to poor quality study from the parasternal window and fair quality study from the apical and subcostal windows.

That's what's throwing me too; there have been no click, gallops or murmurs on anything from my doctors.

I know I do have enlargement of the LV, but I thought they told me that was due to my pvc's and cardiomyopathy, could that be?  How likely is user error of the tech to show something like trace mvp with such a poor quality echo?

I'm going to ask for it to be redone and ask about the more accurate test.

[itdood]

Then they must've directly observed it.   That means they saw the valve protruding in a pic.

Here is a pic from an echo, that shows a prolapse into the atria.  

http://www.medison.ru/uzi/img/s422.jpg

The leaflets are concave.  If this type of bulge exceeds just 2mm, it's a prolapse.  From there it's evaluated for any regurge.  Hope this helps.

[Mom2four85]

thanks for that picture, yes it helps

I'm still racking my brain trying to find this answer - if it's only an insignificant amount of protruding (trace mvp) and nothing can be done until it's in the severe state, how is a patient treated for MVP?  I have not found any info on treating MVP other than surgery in it's later stages.    What does insufficiency mean for mvp?  I know I saw someone say stage 1-4, I believe it was.

Sorry to be such a pain, I want to know what I'm talking about when I go see my EP on the 7th.

[Jerry_NJ]

I believe "leakage" and "insufficiency" refer to the same condition - I may be getting lost in my memory - I may be talking about "regurgitation" not "prolapse".  In any case, my experience is that for leakage an echo was considered sufficient to monitor "trace" or "slight" and to detect the possibility of a "severe" condition.  When that happened I went for other testing, including by catheter to the heart and, as already reported an echo taken from a transmitter down my throat.  I was sedated for the throat work, but given only a relaxant for the catheter - but I'd been through that before.  Part of the heart catheter study was the usual check for any need for bypass... none was needed.  But I do recall it was also used to confirm the severe leakage of the mitral valve.

[Mom2four85]

Thanks Jerry.

After all of the information I've read and everyone has told me, I decided to make an appt with a cardiologist outside of this clinic of doctors I've seen so far.