Interpreting Echocardiogram Reports After Mitral Valve Surgery: Key Insights

Interpretation of Echocardiogram Report

Dear Dr.
Wu,
I have previously suffered from infective endocarditis, which resulted in severe mitral regurgitation.
I underwent mitral valve repair surgery in early December 2021.
Below are the echocardiogram reports from two examinations before the surgery and two examinations after the surgery.
I would like your assistance in interpreting them:
1.
Is the follow-up examination report from August 25 of this year optimistic?
2.
What is the condition of the heart enlargement?
3.
Are there any precautions I should take in my daily life?
4.
Is it safe for me to engage in jogging for physical fitness?
Thank you.
1.
July 30, 2021 (Pre-surgery)
BSA: 1.9 m²
Interpretation Summary: Eccentric left ventricular hypertrophy (LVH), aortic root dilation (39 mm).
Left ventricular systolic function is preserved (cutoff 60% is normal in severe mitral regurgitation).
Ruptured mitral valve chordae of the P2 leaflet (history of prior infective endocarditis?).
Severe mitral regurgitation with pulmonary vein reversal.
EROA 0.91 cm².
LVESD 36 mm.
No resting pulmonary hypertension.
Consider surgery if LVESD progresses rapidly or exceeds 40 mm.

MMode/2D Measurements & Calculations:
IVSd: 1.0 cm, LVIDd: 6.0 cm, FS: 40.2%, LV mass (C)d: 256.4 grams, LVIDs: 3.6 cm, EDV (Teich): 180.9 ml, LV mass (C)dI: 134.6 grams/m², LVPWd: 1.0 cm, ESV (Teich): 54.2 ml, LVIDs Index: 1.9 cm, EF (Teich): 70.0%, RWT: 0.34.

Aortic root diameter: 3.9 cm, LVOT diameter: 2.1 cm.

2.
November 1, 2021 (Pre-surgery)
BSA: 1.9 m²
Interpretation Summary: Eccentric LVH, left ventricular systolic function is preserved.
Ruptured mitral valve chordae of the P2 leaflet (history of prior infective endocarditis?).
Moderate to severe eccentric mitral regurgitation.
The left ventricular systolic function is normal.
The left atrium is borderline dilated.
Mild tricuspid regurgitation and mild pulmonic regurgitation.

MMode/2D Measurements & Calculations:
IVSd: 0.75 cm, LVIDd: 6.4 cm, FS: 36.3%, LV mass (C)d: 188.0 grams, LVIDs: 4.1 cm, EDV (Teich): 209.1 ml, LV mass (C)dI: 98.4 grams/m², LVPWd: 0.72 cm, ESV (Teich): 73.4 ml, LVIDs Index: 2.1 cm, EF (Teich): 64.9%, RWT: 0.22.

Aortic root diameter: 3.4 cm, left atrial dimension: 4.3 cm.

3.
October 6, 2022 (Post-surgery)
BSA: 1.9 m²
Interpretation Summary: The left ventricle is grossly normal in size and shape.
No regional wall motion abnormalities noted.
The left ventricular systolic function is normal.
Status post mitral valve repair with artificial chordae and annuloplasty ring.
Moderate mitral regurgitation.
Mild tricuspid regurgitation.

MMode/2D Measurements & Calculations:
IVSd: 0.83 cm, LVIDd: 5.1 cm, FS: 44.9%, LV mass (C)d: 149.8 grams, LVIDd Index: 2.6, EDV (Teich): 126.2 ml, LV mass (C)dI: 77.1 grams/m², LVIDs: 2.8 cm, ESV (Teich): 30.5 ml, LVIDs Index: 1.5, EF: 75.8%, LVPWd: 0.83 cm, RWT: 0.32.

Aortic root diameter: 4.0 cm, ascending aorta diameter: 3.3 cm, left atrial dimension: 4.0 cm.

4.
August 25, 2023 (Post-surgery)
BSA: 1.9 m²
Interpretation Summary: The left ventricle is borderline dilated.
The left ventricular systolic function is normal.
The left atrium is mildly dilated.
Prior mitral valvuloplasty annuloplasty ring.
Moderate mitral regurgitation.
Mild to moderate tricuspid regurgitation.

MMode/2D Measurements & Calculations:
IVSd: 1.0 cm, LVIDd: 5.3 cm, FS: 38.6%, LV mass (C)d: 213.6 grams, LVIDd Index: 2.8, EDV (Teich): 136.3 ml, LV mass (C)dI: 112.3 grams/m², LVIDs: 3.3 cm, ESV (Teich): 42.9 ml, LVIDs Index: 1.7, EF: 68.5%, LVPWd: 1.1 cm, RWT: 0.40.

Aortic root diameter: 3.2 cm, ascending aorta diameter: 3.1 cm, left atrial dimension: 4.3 cm.

Thank you.

A D, 50~59 year old female. Ask Date: 2023/09/02

Dr. Wu Xueming reply Cardiology

Postoperatively, there is still moderate mitral valve regurgitation.
Please follow up regularly at the outpatient clinic, adhere to the prescribed medication regimen, and engage in regular exercise.

Reply Date: 2023/09/02

More Info

Interpreting echocardiogram reports, especially after significant cardiac procedures like mitral valve surgery, can be daunting. Based on the reports you've provided, let's break down the findings and address your specific questions.

1. Is the August 25th follow-up report optimistic?
The report from August 25, 2023, indicates that the left ventricle (LV) is "borderline dilated," which suggests that while it is not significantly enlarged, it is at the upper limit of normal. The LV systolic function is described as normal, which is a positive sign, indicating that the heart is effectively pumping blood. The left atrium is noted to be "mildly dilated," which can occur in response to mitral regurgitation (MR) and is not uncommon after valve surgery. The presence of moderate mitral regurgitation and mild-moderate tricuspid regurgitation is something to monitor, but overall, the report does not indicate any acute issues. Therefore, while there are some concerns, the overall outlook can be considered cautiously optimistic, especially since the LV function remains normal.

2. What about the enlargement of the heart?
The term "borderline dilated" for the left ventricle means that it is slightly larger than normal but not to a degree that is typically concerning. This can be a result of the previous mitral regurgitation and the heart's adaptation to the increased volume load. The left atrium's mild dilation is also a common response to chronic mitral regurgitation. Both findings suggest that while the heart is adapting, it is important to continue monitoring these dimensions over time to ensure they do not progress to more significant dilation, which could impact heart function.

3. What should I be mindful of in daily life?
Given your history of mitral valve surgery and the current findings, it is essential to maintain a heart-healthy lifestyle. Here are some recommendations:
- Regular Monitoring: Keep up with your follow-up appointments and echocardiograms as recommended by your cardiologist. This will help track any changes in heart size or function.

- Blood Pressure and Cholesterol Management: Continue to monitor and manage your blood pressure and cholesterol levels, as these can significantly impact heart health. Adhering to prescribed medications and lifestyle changes is crucial.

- Symptom Awareness: Be vigilant about any new or worsening symptoms such as shortness of breath, chest pain, or significant fatigue. If you experience these, contact your healthcare provider promptly.

- Diet and Exercise: Follow a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins. Regular physical activity is beneficial, but consult your doctor about the intensity and type of exercise that is safe for you.

4. Can I engage in jogging for fitness?
Jogging can be a beneficial form of exercise for cardiovascular health, provided you have been cleared by your healthcare provider. Given that your LV systolic function is normal, moderate exercise like jogging is generally safe and can help improve your overall cardiovascular fitness. However, it is essential to start slowly and listen to your body. If you experience any discomfort or unusual symptoms while jogging, stop and consult your doctor.

Conclusion
In summary, while there are some concerns regarding the mild dilation of the left ventricle and the presence of moderate mitral regurgitation, the overall findings suggest that your heart function remains stable. Regular follow-up and a proactive approach to managing your heart health will be key in ensuring long-term well-being. Always consult with your cardiologist regarding any changes in your symptoms or exercise regimen.

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