Echo

[sandra kimmel]

1.  How can an echo be graded for valve regurgitation two different grades, for example 2+ 4+, or 3 to 4+.  Which is it, 2+ or 4+, or 3 or 4+.  I don't understand the grading.

2.  Could the grade of regurgitation be different from echo to echo, based on hormones at that time of the month?  Sometimes I notice irregular or more forceful heartbeats at certain times of the month and it seemed to be in relation to my period.

3.  If the echo is 4+ does that always mean surgery if you have no symptoms or heart enlargement?

Thanks for the answers!

[CCF CARDIO MD - DLB]

The usual grading scheme is 1+ (mild), 2+, 3+, and 4+ (severe). Often, a range is given such as 1 to 2+, meaning that it is between 1 and 2 in terms of severity.

Grade of regurgitation is somewhat subjective and could vary from echo to echo depending on technique and interpretor. Blood pressure can greatly affect the amount of regurgitation (elevated blood pressure leads to more regurgitation). Hormones would not affect the amount of regurgitation.

Usually 4+ valve regurgitation leads to valve repair, if possible, even in the absence of symptoms. Usually, the echo will show some abnormality, either at rest, or with exercise if necessary. The threshold for valve replacement is a little bit higher than for valve repair.

[Question to CCF]

1.  I never had an echo while exercising.  What indicates that this should be done?

2.  So, is it fair to say that timing for replacement surgery does not solely rest on the grade of the echo, even if it's at 4+, but abnormality of the heart and symptoms also are considered.  If your echo is 4+ with no heart abnormality or no symptoms, it might not be time for replacement yet.  Is this correct?

3.  Is it possible to be grade 3+ to 4+ and go for years at this grade without needing replacement surgery?  Is this a slow process?  Could it ever go to a lesser grade after being on medicine? Is that good if it does as far as possible not needing surgery?

One cardiologist tells me I'm looking at replacement in 1 to 2 years and another tells me it could be up to 15 years or possibly never.  If I knew it could be possibly never, I could calm my nervous somewhat.  It's like I'm on an emotional roller coaster. One gives me the impression that it's very serious right now and the other tells me that I worry about it too much, that it could be years from now or maybe never.  (I like the second opinion!!!)  

Thanks for taking time to answer my questions!  Have a good day!

[Gene]

On a scale from 0 to 4 where would trivial vavle regurgitation be?Thank you.Gene

[CCF CARDIO MD - DLB]

Some of the specifics depend on which valve you are talking about. I am assuming it is the mitral valve.
1. In the setting of 4+ leakage, normal resting echo, and no symptoms, I get an exercise echo to see if symptoms or heart dysfunction occur.
2. If there is 4+ leakage and no symptoms (even with exercise) and a normal echo, and a normal heart rhythm, it is reasonable to wait. However, we are moving towards doing surgery even in this situation, if the valve can be repaired, as opposed to replaced.
3. There is no evidence that medications delay the need for surgery with mitral leakage; some experts even feel medicines are bad because they mask symptoms. However, there are some patients who go several years without needing surgery; this is the exception rather than the rule.

[CCF CARDIO MD - DLB]

Trivial would be 0 to 1+.

[Comment to CCF]

I'm sorry I neglected to say aortic insufficiency 3 to 4+.

Thanks, again!

[Reply to CCF]

I'm sorry I neglected to say it is aortic insufficiency 3 to 4+.  Is there any difference in what you said regarding the mitral valve?

Thanks, again!

[CCF CARDIO MD - DLB]

That does change things a bit. Medications have been shown to delay the need for surgery significantly in patients with aortic insufficiency. I would not recommend surgery to someone with 4+ AI if they had absolutely no symptoms (even with maximal exercise) and if the echo was normal (size and function). I would monitor them and their echo periodically. It is impossible to predict the need for eventual surgery, but it is possible that surgery would not be required for years, though if you are young enough, surgery will probably be required at some point.

[CCF CARDIO MD - DLB]

See my previous post - it does make a difference in that medicines can help with aortic insufficiency.

[Thank you to CCF]

Thank you for your prompt reply and have a good evening!

[CCF CARDIO MD - DLB]

You are welcome. Good luck.