Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Do The Following Ultrasound Findings Indicate?
Question: I am a 56 year old male. I had CABG X 3 on XXXXXXX 23rd 2014. I had a echocardiogram/Doppler and my Aortic root was 4.0 CM My Dr. Said this was normal on his report for me. On the chart on his report normal went as high of 3.8 CM should this be something I should be concerned about? Also my ultrasound findings:
Left atrium mild enlargement
Left ventricle normal size and mild hyper trophy
Doppler findings:
Conclusions :
Normal chamber dimensions.
Normal left ventricular systolic function. Mild left ventricular hypertrophy.
There is mild tricuspid regurgitation.
Should any of these findings concern me? All the other results seemed normal.
Left atrium mild enlargement
Left ventricle normal size and mild hyper trophy
Doppler findings:
Conclusions :
Normal chamber dimensions.
Normal left ventricular systolic function. Mild left ventricular hypertrophy.
There is mild tricuspid regurgitation.
Should any of these findings concern me? All the other results seemed normal.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and would like to explain that you shouldn't be worried about your actual aortic root diameter.
Measured aortic root diameter values should be evaluated specifically for each individual, primarily considering certain factors that may influence which is the normal range.
The most important factor which is taken into account when considering aortic root dimensions as well as other echocardiographic parameters is the body size (body height and weight, incorporated in the body surface area [BSA]).
So, if you have a body size up to the average 38mm, probably could be near the upper limit of normality.
But if you have a bit larger body size (BSA), probably the upper limit of normal would be round 40mm.
It is also important to clarify the aortic levels of the measurement. If the measurement is performed at the level of the sinuses of valsalva, the aorta may range 29-45mm.
But, if the measurement is performed more distally at the sinotubular junction, normal ranges may vary 22-36mm.
As a general rule, when the measured aorta diameter is indexed (that is when the value is divided by the body surface area), then the normal range would be 21mm/m2 (upper limit of normal). So you shouldn't worry about it, as the normal range of aortic root dimension is highly dependent on the individual body size.
Also it is important that the measurement plane should be correctly positioned during echo test in order to provide a precisely correct measurement.
Regarding the other echocardiographic parameters, they seem to be OK.
A mild left ventricular hypertrophy is not dangerous, without any clinical significance. You just need to properly control your blood pressure values in order to stop the progression of hypertrophy.
Hope to have been helpful!
If you have any other uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and would like to explain that you shouldn't be worried about your actual aortic root diameter.
Measured aortic root diameter values should be evaluated specifically for each individual, primarily considering certain factors that may influence which is the normal range.
The most important factor which is taken into account when considering aortic root dimensions as well as other echocardiographic parameters is the body size (body height and weight, incorporated in the body surface area [BSA]).
So, if you have a body size up to the average 38mm, probably could be near the upper limit of normality.
But if you have a bit larger body size (BSA), probably the upper limit of normal would be round 40mm.
It is also important to clarify the aortic levels of the measurement. If the measurement is performed at the level of the sinuses of valsalva, the aorta may range 29-45mm.
But, if the measurement is performed more distally at the sinotubular junction, normal ranges may vary 22-36mm.
As a general rule, when the measured aorta diameter is indexed (that is when the value is divided by the body surface area), then the normal range would be 21mm/m2 (upper limit of normal). So you shouldn't worry about it, as the normal range of aortic root dimension is highly dependent on the individual body size.
Also it is important that the measurement plane should be correctly positioned during echo test in order to provide a precisely correct measurement.
Regarding the other echocardiographic parameters, they seem to be OK.
A mild left ventricular hypertrophy is not dangerous, without any clinical significance. You just need to properly control your blood pressure values in order to stop the progression of hypertrophy.
Hope to have been helpful!
If you have any other uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You didn't answer my question about mild tricuspid regurgitation? I also been feeling a little shortness of breath at times the last few days. I have been reading on the internet about these findings and it has caused me a little extra anxiety. I'm thinking that can be causing done shortness of breath at times. What do you think or suggest?
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again,
Regarding your mild tricuspid regurgitation, I would recommend to not worry at all.
Trivial (mild) right heart valves regurgitations (tricuspid and pulmonary) are frequently encountered in normal healthy adults.
They are considered normal findings.
As I explained you above, mild left ventricular hypertrophy and mild left atrial dilation may be an expression of not properly controlled hypertension.
When not promptly controlled, hypertension may lead to more progressive changes (excessive left ventricular hypertrophy and left atrial dilation) with the consequence of left ventricular diastolic dysfunction. LV diastolic dysfunction, from its part, may be responsible for increased LV diastolic pressure and pulmonary artery pressure.
All the above scenario may be a hypothetical alternative for shortness of breathing (if diastolic dysfunction is concluded important in your echo exam).
Other potentially responsible alternatives for your shortness of breath may be:
- an acute pulmonary inflammation/infection,
- anemia,
- recently high blood pressure values,
- if you are diabetic, shortness of breathing may be an expression of cardiac ischemia,
- seasonal allergic reactions,
- high body temperature,
- anxiety, etc.
Coming to this point, if your breathing complaints become really disturbing and persistent, to check some additional tests as follows:
- complete blood count with leukocytes differential ( to investigate possible anemia and inflammation),
- PCR and ESR (for inflammation/ infection),
- Chest X ray study (investigation of lung fields),
- Monitor your blood pressure and body temperature,
In case of persistent anxiety you should try to relax yourself by engaging in recreational activities (outdoor sports: walking, cycling, swimming, yoga, aerobics, etc.).
Hope you will find the above suggestions of some help.
In case you the cardiac ultrasound (echo) report is available to you, I would be willing to directly review it here for a second professional opinion. Could you upload it here?
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again,
Regarding your mild tricuspid regurgitation, I would recommend to not worry at all.
Trivial (mild) right heart valves regurgitations (tricuspid and pulmonary) are frequently encountered in normal healthy adults.
They are considered normal findings.
As I explained you above, mild left ventricular hypertrophy and mild left atrial dilation may be an expression of not properly controlled hypertension.
When not promptly controlled, hypertension may lead to more progressive changes (excessive left ventricular hypertrophy and left atrial dilation) with the consequence of left ventricular diastolic dysfunction. LV diastolic dysfunction, from its part, may be responsible for increased LV diastolic pressure and pulmonary artery pressure.
All the above scenario may be a hypothetical alternative for shortness of breathing (if diastolic dysfunction is concluded important in your echo exam).
Other potentially responsible alternatives for your shortness of breath may be:
- an acute pulmonary inflammation/infection,
- anemia,
- recently high blood pressure values,
- if you are diabetic, shortness of breathing may be an expression of cardiac ischemia,
- seasonal allergic reactions,
- high body temperature,
- anxiety, etc.
Coming to this point, if your breathing complaints become really disturbing and persistent, to check some additional tests as follows:
- complete blood count with leukocytes differential ( to investigate possible anemia and inflammation),
- PCR and ESR (for inflammation/ infection),
- Chest X ray study (investigation of lung fields),
- Monitor your blood pressure and body temperature,
In case of persistent anxiety you should try to relax yourself by engaging in recreational activities (outdoor sports: walking, cycling, swimming, yoga, aerobics, etc.).
Hope you will find the above suggestions of some help.
In case you the cardiac ultrasound (echo) report is available to you, I would be willing to directly review it here for a second professional opinion. Could you upload it here?
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I uploaded two files on the echocardiogram reports to this thread. I look forward to your opinion. Also, I forgot to mention 21 years ago I had radiation to the mediastinum to treat Non-Hodgkins Lymphoma. When my surgeon did my CABG x3 two years ago, he had to hook up the heart lung machine to my femoral artery by my groin because he said my aorta was soft and mushy (paper thin) and he couldn't manipulate it. Do you feel I could live a normal life with a thin aorta? I look forward to your opinion on all of this.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I carefully reviewed both your uploaded echo reports and I am glad to confirm that it is not revealed any diastolic dysfunction, also no increased systolic pulmonary artery pressure has been detected (PASP 30mmHg). Your cardiac valves seem to have a normal function.
So, regarding your mild shortness of breath, it can not be explained by any responsible cardiac issues.
Probably you should explore the test I mentioned at the beginning of our thread.
Sometimes, chest radiation may lead to several complications including mediastinal or pulmonary fibrosis. Pulmonary function tests(PFT) would be helpful in this regard.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I carefully reviewed both your uploaded echo reports and I am glad to confirm that it is not revealed any diastolic dysfunction, also no increased systolic pulmonary artery pressure has been detected (PASP 30mmHg). Your cardiac valves seem to have a normal function.
So, regarding your mild shortness of breath, it can not be explained by any responsible cardiac issues.
Probably you should explore the test I mentioned at the beginning of our thread.
Sometimes, chest radiation may lead to several complications including mediastinal or pulmonary fibrosis. Pulmonary function tests(PFT) would be helpful in this regard.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My final question to you. Doing to surgery my surgeon found my aorta to be soft and mushy. (Paper thin) He told my family that when he opened my chest he could only work in a space 4 cm. He said that the vein going to my brain was fibrotic from the shrunken tumor of my lymphoma 21 years ago. He said he wasn't able to stretch it so he could open my chest further. He also mentioned that when he connected my graphs he had to connect them to the base of my heart. He said my aorta was untouchable. He told my family after the surgery that I would be high risk for future surgeries. My question to you is can I live a normal life with A thin Aorta? Also does it affect my long-term prognosis due to the fact he had to connect my graphs to the base of my heart instead of my Aorta? Basically I like to know if these graphs last just as Long as a normal cabbage surgery would? These are my basic fears and anxieties. Please answer these questions as best as you can for me. In the future if I had to have another surgery in my chest for whatever reason do you think they would still be able to do surgery for me? Since I have all these little complications. I do look forward to your answers. Thank you very much !
Brief Answer:
I would explain:
Detailed Answer:
Hi,
I passed carefully through your concerns. I would confirm that chest radiation is well known for similar tissue changes (mediastinal and pulmonary fibrosis, pericardial thickening/ constrictive pericarditis, cardiomyopathy, etc.).
But, coming to your concrete question, I would explain that you shouldn’t worry about your aorta characteristics.
As long as your aorta dimensions are within normal ranges and the integrity of aortic walls is preserved (no aneurysms/ dissection), then there is nothing to worry about.
You just need to periodically check by means of cardiac ultrasound (echo) aorta dimensions and overall cardiac and aorta structure for assuring that no potential changes occur.
From the other hand, also CABG (bypass) intervention is performed through an opened chest procedure and the healing process leads to fibrosis.
So, in certain individuals with increased mediastinal fibrosis burden like you are (because of previous chest radiation and the performed CABG), a new (repeated) CABG (bypass) would pose some additional procedural difficulties, as it is more challenging to operate through a previously fibrotic tissue.
Nevertheless, I would explain that a re-do (repeated CABG) represents a more difficult strategy almost in every individual and not rarely the best alternative to follow when a new coronary revascularization is necessary after CABG, remain percutaneous angioplasty with stents implantation.
The doctor has chosen the best applicable graft implantation technique in you specific situation.
This does not mean that your long-term prognosis will be adversely affected.
Even if you may need a repeated surgery, though it may represent a bit challenging alternative, it is still safely possible in experienced surgeon hands.
So don’t worry about this issue!
Hope I have relieved some of your fears and anxieties!
Wishing you all the best!
Regards,
Dr. iliri
I would explain:
Detailed Answer:
Hi,
I passed carefully through your concerns. I would confirm that chest radiation is well known for similar tissue changes (mediastinal and pulmonary fibrosis, pericardial thickening/ constrictive pericarditis, cardiomyopathy, etc.).
But, coming to your concrete question, I would explain that you shouldn’t worry about your aorta characteristics.
As long as your aorta dimensions are within normal ranges and the integrity of aortic walls is preserved (no aneurysms/ dissection), then there is nothing to worry about.
You just need to periodically check by means of cardiac ultrasound (echo) aorta dimensions and overall cardiac and aorta structure for assuring that no potential changes occur.
From the other hand, also CABG (bypass) intervention is performed through an opened chest procedure and the healing process leads to fibrosis.
So, in certain individuals with increased mediastinal fibrosis burden like you are (because of previous chest radiation and the performed CABG), a new (repeated) CABG (bypass) would pose some additional procedural difficulties, as it is more challenging to operate through a previously fibrotic tissue.
Nevertheless, I would explain that a re-do (repeated CABG) represents a more difficult strategy almost in every individual and not rarely the best alternative to follow when a new coronary revascularization is necessary after CABG, remain percutaneous angioplasty with stents implantation.
The doctor has chosen the best applicable graft implantation technique in you specific situation.
This does not mean that your long-term prognosis will be adversely affected.
Even if you may need a repeated surgery, though it may represent a bit challenging alternative, it is still safely possible in experienced surgeon hands.
So don’t worry about this issue!
Hope I have relieved some of your fears and anxieties!
Wishing you all the best!
Regards,
Dr. iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
