Tuesday, August 9, 2011

Accurate Measurement of the Aorta

Photo: Cherry Grove, NY as seen from my kayak out at sea

The Bicuspid Aortic Valve Foundation has a new blog. Embedded in their first post, there is an excellent video presentation focusing on diagnostic tools used to assess the condition of the BAV and the level of TAD (Thoracic Aortic Disease.) The most interesting thing I learned is that a dilated aorta is larger on systole than on diastole, and to obtain an accurate measurement CTs and MRIs should be "gated," which will reveal the aortic size on systole (maximum). This is the measurement that should be used when considering what size aneurysm triggers surgery. There is a lot more good info in the video. The blog is here:


Saturday, August 6, 2011

Life Goes On: Got Married July 24th

Jim Kelly-Evans (standing) and Dan Evans returning to Cherry Grove, NY after getting married in Brookhaven, NY.

Thursday, May 5, 2011

Status Quo

Got my latest echo report. This seems to be what relative stability/very slow progression looks like. I've got another year unless things deteriorate rapidly in the interim.

2008 gradients: 22/36 mmhg
2009 gradients: 16/27 mmhg
2011 gradients: 25/40 mmhg

2008 AVA: 1.3 cm2
2009 AVA: 1.2 cm2
2011 AVA: 1.1 cm2

2008 ascending aorta: 4.25 cm
2009 ascending aorta: 4.5 cm
2011 ascending aorta: 4.3 cm

2008 aortic root: (SOV 3.5cm, STJ 2.55 cm)
2009 aortic root: 3.7 cm
2011 aortic root: 3.0 cm

2008 EF: 55%
2009 EF: 70%
2011 EF: 65%

Monday, March 28, 2011

No Good Way To Find Out You Have Heart Valve Disease

Yellow Trumpetfish - Columbier Beach, St. Barths (click on the photo to enlarge it)

People have a wide range of experiences with valvular heart disease. Some people find out that they have a heart valve issue all of a sudden and need surgery ASAP. This can be very upsetting, to say the least. But for others, years and years can pass in between the initial diagnosis and eventual surgery. I'm in the category of knowing since childhood that I had an "innocent" heart murmur (is there such a thing?) It wasn't until age 55 that I had my first diagnostic echocardiogram (in the cardiologist's office) that was ordered before a routine colonoscopy. Then I found out that I had moderate aortic stenosis (calcification and narrowing of the aortic valve.) That didn't bother me much at the time. But four years later when I began to notice a loss of exercise tolerance I went to an advanced university heart center for an echoardiogram. Then I found out that I have a congenital aortic valve abnormality - a bicuspid aortic valve, with an aortic aneurysm (ballooning of the ascending aorta.) That shocked me more, especially when I learned from a surgeon that I wasn't "ripe" for surgery. Open heart surgery is serious business. They only do it when the risk of dying without the surgery outweighs the risk of the surgery itself.

It really bothers me that I have this congenital heart problem hanging over me and I can't get it fixed now. I'm an active guy and kind of a bull type, you know, push the car to get it started, shovel snow all the time, etc. So I want to stay healthy. But no, I have to wait until I get weaker and sicker. So I don't know what's worse, really: finding out all of a sudden that you need surgery ASAP, or lingering on coping with a slow progression of the disease for years and years, fighting to lead a normal life but you really can't, and not knowing when you might finally get the surgery you need, or keel over or blow a gasket first. There is no pleasant way for any of us with heart valve disease.

Saturday, March 26, 2011

Almost TIme For My Yearly Checkup

Taken while snorkeling at Columbier Beach, St. Barths

In about a month I'll get an echo and have a chat with my cardiologist. It's been almost a year and a half since my last echo, so the results should shed a lot of light on the aortic stenosis and aneurysm - are they relatively stable or not? I was buoyed last month when I was able to climb a steep mountain on vacation in St. Barths. Sure, I had to stop to catch my breath often, but the fact that I can still do this sort of thing without feeling faint or keeling over is a hopeful sign. Maybe the valve is stable. I'll find out soon. I love snorkeling and scuba diving. Dan doesn't want me to scuba dive, but as far as I know there is no physiological reason why I shouldn't be able to dive. We'll run this by the cardiologist in April. In St. Barths I was unable to get on a snorkeling tour. The only available option was a private escorted scuba dive - just me and the divemaster, so I took advantage of that. It was very safe because I had the benefit of one on one attention from the experienced, expert divemaster, and we did shallow dives, one in the morning and one in the afternoon. Talk about being on a high! I can still climb steep hills and I can still enjoy my favorite sport! I had forgotten just how beautiful it us down below. I saw a shark, several sea turtles and a fascinating array of spectacular underwater creatures. I don't want to give this up. Hopefully, I won't have to.

On scuba diving with heart valve issues, the web site scubadoc states:

The presence of an abnormality per se is not a contraindication to diving.

It all depends on the severity of the condition. This is determined by exercise stress testing, which I passed the last time I had it. I also just climbed the mountain in St. Barths. I didn't feel faint or keel over. The scuba diving I just did was nowhere near as demanding as climbing that hill! The diving was about as taxing as walkiing on a flat surface...not very much.

Some people who have had surgery made these comments on VR.org:

Why give up scuba diving unless you really want to? I asked my cardiologist about scuba diving and he looked at me with a puzzled look and responded that there was nothing about scuba diving that would present a risk.

Update. 11 weeks postop last Wednesday. Today returned to the sport I love so much, SCUBA DIVING!!!!! Yep, only two tanks today but was able to pick up a few shovelnose lobster and some trigger fish. Getting ready to fire the grill up and celebrate! Got the Corona on ice. If any divers are wondering...did 94'/23min and 82' 28min nitrox/computer.
Funny thing, you can really hear your heart beating down there, its a very peaceful sound. This AVR stuff aint so bad.....

Thursday, January 27, 2011

Photo: Winter snow scene in Fairmount Park

Last night we got about 16 or 17 inches here in the city. I cleaned off the front steps and made a path on the walk. Even though I'm 62 I don't fear snow shoveling because the kind of heart issues I have are not the kind that people keel over from while shovelling snow. I have been tested and my coronary arteries are fine. Actually, those with congenital bicuspid aortic valves usually do not get plaque in their arteries for some reason not well understood. Instead we have a connective tissue disorder that leads to aneurysms. That's what I have: a stenotic (calcified and narrowed) aortic valve and an aortic aneurysm. So I can't left heavy objects or do anything that raises my blood pressure quickly or excessively. But things like walking, recreational swimming, light shovelling (I'm careful not to lift too much snow and I take a lot of breaks,) these are OK forms of exercise. Surgery is in my future but I have to be "ripe"...the "numbers" have to indicate that it's time. They balance the risks of surgery against the risks of something happening to me without the surgery. My cardiologists thinks I have a year or more to go yet. I see him again in April and get an echo then.

Actually, I walk four to five miles every day but not now with the snow. So my light shoveling and cleaning off the car are my exercise for today so far. Later we will take a walk over to the grocery store. I cleaned off the car but it will be days before I can get it out of its snowed-in location. And then once I get it out I have to worry about finding a place to re-park it. City Life!

Friday, January 14, 2011

Stable: We'll Take It!

Photo: Loki, our Burmese kitten, at seven months

Everything is pretty stable. I'm still doing my twice a day 1 hour walks. I usually log four to five miles a day, seven days a week, weather permitting. I don't feel as though things are getting any worse. Of course, there is no way to feel any changes in the size of the aorta. That assessment will have to wait until the echo in April. I did have my annual physical last Monday. I need to diet... but other than that I passed it. So what else is new?