Echocardiogram Report - Bizarre as simply added to my NHS record.

[Adhtz21]

I had heart surgery in February, 2020 to replace a bicuspid aortic valve with severe aortic stenosis and a dilated aortic root.

Follow up as been a little lacking since discharge from the surgical team to my local hospital cardiology.

I refused to accept telephone reviews, got a new consultant but on my appointment he seemed disinterested to the point of rudeness. He did however notice a soft systolic murmur at the aortic ejection port. He agreed to send me for an echocardiogram. After a four month wait I had the echo. Then just by accident, I found the following summary on my GP record. There has not been any contact from either the referring cardiologist or my GP. Surely this cannot be right as if the rising aorta cannot be assesed by echo, it would be more suitable for a CT aorta or MRI? So in effect, I might once again have a dilated aorta but certainly appear to have a dilated aortic arch with nobody doing anything about it. I cannot see the tech notes referred to but the technician did say she was having some difficulty due to the positioning of my heart after surgery.

Any thoughts?

Andy

Coded entry - Transthoracic echocardiography (X77c2); Tissue AVR in situ - functions appropriately; Dilated aortic arch unable to assess ascending aorta (see text and tech comments); Regional wall mothion abnormality of the left ventricle,, overall good ejection fraction; Dilated right ventricle with suspicion of mild right ventricular hypertrophy Good right ventricular systolic function; Biatrial dilatation; trivial mitral regurgitation (Ongoing Episode)

[Cliff_G]

Andy, I think you're right to query this. In fact, TTE is usually thought to be able to view the ascending aorta better than the arch, though with the probe high up just below the adam's apple it can sometimes be seen.

BAV is associated with a higher incidence of (eventual) aortic dissection and assuming your tissue valve is tricuspid, that op has done you some favours in probably reducing your risk. But with dilated root and BAV history and a report of a dilated arch, you should indeed be getting a CT scan, in my view. The ventricular motion abnormality might make the aortic root move, even more than it normally does, so the CT should always be ECG-gated to freeze the motion.

What to do about it, though? I would be looking to get assessed by an expert aortic centre. Some cardiologists are well up on aortic medicine, but some are less so. I think there's a mechanism (in England at least) to be able to choose your consultant and go there. There are major aortic centres all over the UK, such as Liverpool, Barts, Southampton, Bristol, Cambridge etc. Post again if you need any guidance there. And best of luck.

[Adhtz21 in reply to Cliff_G]

Thank you Cliff. The ironic thing is that the surgical consultant who did my operation is excellent but the local cardiologists are not good. I will try and get transferred.

[Cliff_G in reply to Adhtz21]

Great. I'm afraid your experience is not uncommon. Patient knowledge and self-management of your own case gets better results. The SCTS can advise you where all the main aortic centres are, as they did for me following an AD abroad, where my local hospital didn't really have the depth of knowledge I was looking for. Horses for courses.

[Exie8]

Perhaps in the first instance you should contact the cardiologist who referred you for the echo to discuss this report rather than making your own interpretation?

[Adhtz21 in reply to Exie8]

Thanks for that most useless information. Read up on dilated aorta. I have already had the root replaced in 2020 after nearly dying! Please read my post as I stated the local Cardiologist is disinterested. My former surgical team have agreed to view and interpret the images after the very good reply from Cliff-G and my intervention.

[Exie8 in reply to Adhtz21]

I did read your post. I hope you are able to get the professional help and advice that you need.

[Adhtz21 in reply to Exie8]

Thank you Exie8