mitral valve surgery and EF

[ddavey]

i have posted before concerning my mentally impaired 21yr old daughter. she had a cardiac MRI done two weeks ago, and my question now is how much of a difference is there between MRI and transthoracic echo on ejection fraction number  her last echo showed 45% ef and three weeks later the mri showed ef of 35%. she is now scheduled for TEE to further study a 1.5x1.5 mass near the mirtal aortic junction, which according to mri seems to have blood flow within it,she was diagnosed in march 05 with idiopathic dilated cardiomyopathy, with mild mitral regurgitation(this regurg has been present since birth due to the mass that they are now studying). she has prominent left cavity with global kinesis, with moderate to severe mitral regurg and now mild tricuspid regurg. from what i have gathered on my own, there is an indication for mitral valve repair or replacement, since there has been no significant increase in ef (was 35% at diagnosis) in spite of coreg and vasotec and the increase in mitral regurg. her scheduled TEE is also supposed to determine what they may due concerning the valve. i am very concerned that the longer we wait to fix this valve, the more load on her left ventricle will but her at significant risk. also, it was indicated at mri that inside the mass that the peripheral lining may indicate thrombus. any help is greatly appreciated    thank you

[CCF-M.D.-MJM]

Hello,



I am sorry to hear about your daughters health problems.  What appears to be conflicting information about your daughters health can be frustrating.  



The interpretation of imaging studies is dependent on the quality of information given.  For example, if there is any movement by the patient during an MRI the data can be difficult to interpret and if the rib spaces are too close, echos can be difficult to interpret.  This is a long winded way of saying that I wouldn't focus on the number,  I would focus on the concept.  your daughter has a decreased ejection fraction and has mitral regurg.  The ejection fraction is somewhere between 35-45%.



Regarding the possible surgery, it is usually best to be in a high volume surgery center where they tend to see a variety of cases.  



I hope this answers some of your questions.  We wish your daughter and your family well.  Thanks for posting.