Heart Valve Summit Video #3: “What Is The Most Important Diagnostic Element To Consider PRIOR To Mitral Valve Surgery?” Asks Ken
By Adam Pick on November 4, 2011
I don’t know about you… But, when I was diagnosed with severe heart valve disease, I experienced several dislocating emotions. One of those emotions was confusion. As my cardiologist reviewed my echocardiogram, he used medical terms that were foreign to me.
To help future patients avoid a similar situation, I recently interviewed Dr. Randy Martin — the past president of The American Society of Echocardiography and Chief of Valvular & Structural Heart Disease at Piedmont Heart Institute — during the Heart Valve Summit. During our chat, Dr. Martin answered Ken’s question, “What is the most important diagnostic element prior to mitral valve surgery?”
Thanks to Ken for his question and a special thanks to Dr. Randy Martin for sharing his time and expertise with us. So you know, Dr. Martin is not only an incredible and knowledgeable cardiologist, he is also super nice guy. To learn more about Dr. Martin, please visit his website, HealthWatchMD.com.
Keep on tickin!
P.S. For the patients and caregivers in our community who are hearing impaired, I have provided a written transcript of this interview with Dr. Randy Martin below:
Adam: Hi everybody, it’s Adam and we are coming to you from the Heart Valve Summit in Chicago Illinois. We are answering your questions that were submitted at HeartValveBlog.com, I’m thrilled to be joined by Dr. Randy Martin who’s the past president of The American Society of Echo and practicing cardiologist at Piedmont Heart Institute in Atlanta Georgia. We’ve got a question.
Dr. Martin: Adam, great to be with you! I want you to know your website is fabulous, I appreciate what you’re doing for patients.
Adam: Thanks so much. We’ve got a question from Ken. He writes: What is the most important diagnostic element to consider prior to mitral valve surgery?
Dr. Martin: That’s a great question that Ken asked. You know, what we want people to know is, is the right diagnosis being made. So an echocardiogram, an ultrasound test, is really the way that most diagnosis on mitral valve problems are made, so you want to know, have I had the right diagnosis? What’s wrong with my mitral valve? How severe is mitral regurgitation? And, how does it affect both the receiving chamber in my heart and the pumping chamber, the left atrium and the left ventricle? So accuracy of that diagnostic test does tell me what the disease is and how severe it is, it’s going to be very important. (To learn more about valvular regurgitation, click here.)
Adam: And in the echo itself, I imagine there’s some criteria, there’s some specific metrics… Can you maybe share with everybody what are those key exam readings that we often see as patients but we don’t really normally understand?
Dr. Martin: I think that’s a great question Adam. And I think in mitral valve disease, where you might say you have mitral valve prolapse or something like that, you want to know what does the valve look like, how badly deformed if you will, so how much prolapse do you have, do I have a flail leaflet, you want to know what’s the pumping action of the left ventricle, so what’s the ejection fraction. You don’t want that number to get below 60%. You want to know how big is the left atrium. Is it getting enlarged? And, we have indexes that people can measure, and I think importantly, we also want to know what’s the pressure on the right side of the heart because of a leaking mitral valve, mitral valve regurgitation affects the pressure on the right side. So we really look at a series of things. All of those and a good echo should be readily available.
Adam: From what I know from the website, in addition to folks with mitral valve disease, there’s also a lot of people out there with aortic valve disease. And are the readings that you just referred to, the ejection fraction, is that list the same?
Dr. Martin: It’s a little bit different. I think the bottom line with both is: you want accuracy of diagnosis and then you want to seek out the right physicians to help you figure out what to do. And the aortic disease, we’re going to talk about narrowing of the valve, aortic stenosis, mitral is mitral leaking, regurgitation. Narrowing of the valve can really be due to 2 common causes in this country, abroad a lot of rheumatic diseases, but in this country it’s either aging changes of a normal valve or you get aortic valve calcification and thickening of the valve or you could be born with an abnormality of the valve which affects about 2% of people. What we call a bicuspid aortic valve or congenital disease. So it’s very important which you have, because it influences things. But the things you want to do is that you really want to know how narrow is that valve. So we talk about what’s called the valve area, is it getting smaller and smaller. What’s the gradient across the valve? How high is that aortic gradient? Then you want to know what is the pumping action of the heart again, the ejection faction. And, then another thing that’s very important is the aorta. As it leaves the heart above the valve enlarged, dilated or does it have an aneurysm. So look at severity of narrowing with valve area gradients, function of the heart, is it pumping well and then how big is the ascending aorta, is it dilated.
Adam: I have to ask because, when you mentioned the word aortic valve gradient, I understood – what exactly does that mean?
Dr. Martin: Excellent point, I’m sorry, I’m speaking doctor-ese and not patient-ese. We measure the blood flow across the valve and if you think about the analogy I can tell people as if you got a garden hose and you put your hand of the end of the specked the water has to come out faster to get out, so in aortic stenosis the valve gets smaller and smaller so the blood still has to get out, so the velocity of the blood increases as it goes out, we can measure that velocity and measure a pressure difference between inside he heart and outside in the aorta, the higher that pressure difference, the more severe the narrow is.
Adam: Dr. Martin, I want to thank you for being here at the Heart Valve Summit. Being one of the moderators of the sessions going on, coordinating the efforts of the surgeons and the cardiologists and apart from all that you’ve got your practice and spending some time with us. I just want to thank you for what you’re doing, I really appreciate it.
Dr. Martin: Adam, listen, as I set at the outset, I thank what you’re doing for all our patients, this is a fabulous resource, I appreciate what you’re doing.
Adam: Thanks so much! Keep on tickin!
Dr. Martin: Absolutely!