IVC

[zk]

I had an echocardiogram two weeks ago.On echo report says the following "The right atrial cavity appears mildly dilated. The right atrial cavity area is 21.0cm during systole The inferior vena cava appears dilated measuring 2.20cm.The vessel collapses with inspiration.The tricuspid valve is normal.There is trivial tricuspid regurgigation.Regurgitant velocity is 311.0cm/s and estimated RV systolic pressure is 43mmHg consistent with mild pulmonary hypertension." What causes inferior vena cava dilation.Does mild pulmonary hypertension causes IVC to dilate?At what (diameter) size is IVC usually operated on?Well I know that aorta usually needs operational intervntion if it >5.0cm, but what about inferior vena cava?Is there risk of rupture of IVC if it is dilated?What are normal limits of right atrial cavity area?Thank you.By the way I am an average 47 year old male with no other medical problems.Thank you

[bob_sixsix]

Thanks avel.
I will be in touch.

[Avel]

Hi Rob,
I want to encourage you to pursue an evaluation at one of the centers that specializes in Marfan's Syndrome. Since it appears you are on the east coast, you might consider Mount Sinai in New York, Johns Hopkins in Baltimore, or The Cleveland Clinic. The Cleveland Clinic has a very helpful web page that you may want to check out. My husband has aortic disease, although not Marfans related. We learned that it is very important to have the diagnostic tests done and intrepreted by the very best expertise possible. I can be reached at ***@**** if you have any questions. Best wishes in your search for help.

[zk]

At 3.8 cm left atrium should be normal,but did they measure left atrial cavity area during systole?

[bob_sixsix]

Yes, the report labeled the measurement as the Left Atrium Internal Diameter Systole.
Is 3.8cm (systole) within the normal range for height and weight?

[CCF-M.D.-KE]

Echo:

The findings on your echocardiogram are consistent with mild pulmonary hypertension. I would recommend asking your doctor more about possible causes.
The inferior vena cava (IVC)is a large venous structure which delivers blood into the right atrium of the heart. It is usually <2cm in diameter.  Anything that increases right atrial pressure will cause a subsequent increase in pressure inside the IVC resulting in dilation.  However, if the pressure is reduced the IVC may return to its normal size. The IVC is typically not surgically corrected for dilation because its diameter varies with one's clinical state of being. I would not worry about a rupture of your IVC. However, I would  enqire more about your pulmonary hypertension.


Thanks for your question,


CCF-MD-KE

[bob_sixsix]

Hello,
I too have been diagnosed with a dilated atrium.  Although, it is not the right atrium, it is the left atrium.  I am a triplet, 35 year old healthy(?) male, 6'7" tall and weigh 250lbs.  There is no history of heart disease in my family except for some hypertension with my father.  My physician thought I had physical characteristics that accompany Marphan's Syndrome: high arch to the roof of the mouth, arm span greater than height and double jointed elbows and fingers. He was also aware that play basketball three or four times per week, so he wanted to rule out Marphan's with a simple ECG.  I had the ECG at a small local hospital in Connecticut, Griffin Hospital.  I also went for a second opinion to Montefiore Medical Center, in the Bronx.  

Here is a summary of the results from Griffin Hospital:
LEFT VENTRICLE:
End Diastole: 5.65cm
End Systole: 3.6cm
Ejection Fraction: 65%
IV Septal Motion: Normal (1.0cm thick)
LV Post Wall Motion: Normal (1.1cm thick)

Right Ventricle: 2.4cm

MITRAL VALVE:
E-F Slope: 90mm/sec
Excursion: 16mm

Aortic Root (D): 3.1cm
Leaflets: 2.2cm

LEFT ATRIUM: 3.8cm

Their comments were:  The left ventricle appeared to be near the upper limits of normal for size to mildy dilated.  All left ventricular wall segments appeared to contract well.  Overall left ventricular systolic function appeared preserved.  The ascending appeared to be near the upper normal limits of normal for size to mildy dilated.  Upper normal limits for size to mildy dilated aortic root.  A doppler color flow exam revealed trace to mild mitral and mild tricuspid regurgitation.  A delayed relaxation left ventricular inflow pattern was observed suggesting possible diastolic dysfunction.

They also did a Chest CT with contrast because of the borderline aortic dilatation.  The findings were:
The descending aorta is normal.  The ascending aorta at the level of pulmonary bifurcation measures 37mm(normal = 32 +/- 5mm).  The ascending aorta at the level of the takeoff of the left coronary artery measures 36.8mm and the sinotubular junction measures 44.5mm (normal = 37mm +/- 3mm).  In addition, the aortic valve sinus is rather prominent.  There is no evidence of dissection or thrombus.  The hilar and mediastinal nodes are normal.  The lung windows are unremarkable and the upper abdomen is unrevealing.
Their impression:  There is slight dilatation of the sinotubular junction of the root of the ascending aorta and prominent sinus of Valsalva.

Montefiore Medical Center did an ECG and Stress ECG.  The results and measurements were fairly the same as Griffin except for the regurgitation terms.  They found it to be normal to trace instead of trace to mild.  They also did not mention anything about the possible diastolic dysfunction due to the delayed relaxation left ventricular inflow pattern.  They did also note the left atrial enlargement and aortic root diameter the upper limits.
Their conclusions were:
The patient exercised for 10 minutes (Bruce Protocol), to a maximum heart rate of 162bpm(87% of the age predicted maximum heart rate).  The exercise test was terminated due to completed protocol.  The patient was asymptomatic throughout the test.  No significant ST-T wave changes were noted during either the exercise or recovery period.  The heart rate rose adequately for the work performed (peak exercise or infusion rate achieved).  The patient's blood pressure rose from 132/80mmHg before to 220/PmmHg after test.  The exercise test indicated that your patient's aerobic capacity is 11.1 METS, which is good compared to people of similar age and gender.  This test was negative for exercis induced ischemic symptoms.  Negative for ischemic ST-segment changes.  Negative for significant arrhythmias.  Normal for blood pressure response.

My questions are:

1) Should I be concerned about the enlarged left atrium and what causes the this enlargement?

2) Does the dilatation of the aortic root signify the onset of Marfan's or are those normal measurements for someone my height and weight?

3) I do not clearly understand the left ventricular inflow pattern delayed relaxation.  Does that have anything to do with the ST-T wave changes?

4) Is the high blood pressure of 220mmHg normal at a heart rate of 162bpm for my height and weight during the stress ECG?  The recovery period showed the blood pressure to come back to 130/80 at 88bpm after 11 minutes.

5) Should I be concerned about the chest CT with contrast results which showed dilatation of the sinotubular junction of the root of the ascending  aorta and the prominent sinus of Valsalva?

6) Is it normal to have trace to mild regurgitation of the mitral and tricuspid valves or is normal zero regurgitation?

I ralize there is a lot of information here and it is a reply to someone else's question but I have been trying to post a question for months!  I apologize for not approaching this properly.

Thanks in advance.

~Rob