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What Does My MRI Heart Scan Report Indicate?
Question: I'm age 61 and I'm an elite marathon runner having run 84 marathons including 24 XXXXXXX marathons. However in 2007 I received a heart pacemaker and just had it replaced with a Medtronic heart pacemaker and I'm running much better and faster however they decided to do MRI heart scan in April 2017 to check for fibrous but found zero fibrous however the scan showed severe tricuspid regurgitation with my right ventricle being 5.1 cm. So they then did ECHO one month later in May 2017 but my right ventricle was only 3.7 cm which is good but my heart doctor in XXXXXXX Minnesota is only relying on the MRI heart scan and wants to do major open heart surgery to remove the heart pacemaker lead wire which they think is causing the problem and put the wire somewhere else in the heart and then they want to put ring around my heart valve to prevent leakage and hopefully my right ventricle will reduce in size. I'm resisting because I'm running better plus open heart surgery is risky and I believe I will never be an elite marathon runner again and I may never run again. There's got to be other options but my heart doctor said there are none because I'm not a candidate for catheter surgery. I just don't know what to do and because I don't want open heart surgery their saying lets use the"wait and see approach". I think they think that in time I will decline and then come forward with wanting to do open heart surgery. Their saying if I don't do open heart surgery to repair my heart valve that I will die prematurely. However I'm not declining currently and I'm running faster so I just can't see doing severe open heart surgery. There's got to be other options out there somewhere in the USA. If you can help let me know.
XXXXXXX
XXXXXXX
Brief Answer:
Kindly Upload the reports of MRI and ECHO
Detailed Answer:
Hello XXXXXXX
I have gone through the medical case history of yours provided by you and i can very well understand your concerns. Am Dr Bhanu and am a cardiology practitioner.
XXXXXXX before we start with this discussion one hard fact which i know you already know, but still i want to remind you that Nothing Is Permanent And Nothing Stays New Forever thats the law of nature. If you keep this thing in mind then it becomes easy to adapt to situations and life becomes flexible and lot easier to live and stay happy, no matters what comes our way.
Developing Tricuspid Regurgitation of moderate degree is common after Pacemaker Implantation as a lead passes through the Tricuspid valve making it incompetent. Due to this regurgitation extra amount of blood enters the right ventricle due to which it dilates to accommodate this extra amount of blood entering which makes the valve more incompetent and this vicious cycle keeps on happening worsening the condition over time.
Reports of MRI are more reliable than that of an echocardiography and if thats showing dilated RV (51 cm) with severe regurgitation then this is a matter of concern.
Even if you are not having any trouble right now thats because initially our body compensates to some extent but after thats it gives away leading to sudden deterioration (probably over a period of 6 months). In that scenario then also you wont be able to participate in a marathon or even your daily activities will get hampered. But if you take the advice of your treating doctor then there are chances that after recovery from surgery you will become fit to participate in small runs initially.
As of now there is no other treatment option apart from surgery to repair the problem.
So in my opinion you should take the advise of your treating doctor.
I hope this information will help you take a right decision. If you have any other doubts you can ask me back.
Kind Regards
DR Bhanu Partap
Kindly Upload the reports of MRI and ECHO
Detailed Answer:
Hello XXXXXXX
I have gone through the medical case history of yours provided by you and i can very well understand your concerns. Am Dr Bhanu and am a cardiology practitioner.
XXXXXXX before we start with this discussion one hard fact which i know you already know, but still i want to remind you that Nothing Is Permanent And Nothing Stays New Forever thats the law of nature. If you keep this thing in mind then it becomes easy to adapt to situations and life becomes flexible and lot easier to live and stay happy, no matters what comes our way.
Developing Tricuspid Regurgitation of moderate degree is common after Pacemaker Implantation as a lead passes through the Tricuspid valve making it incompetent. Due to this regurgitation extra amount of blood enters the right ventricle due to which it dilates to accommodate this extra amount of blood entering which makes the valve more incompetent and this vicious cycle keeps on happening worsening the condition over time.
Reports of MRI are more reliable than that of an echocardiography and if thats showing dilated RV (51 cm) with severe regurgitation then this is a matter of concern.
Even if you are not having any trouble right now thats because initially our body compensates to some extent but after thats it gives away leading to sudden deterioration (probably over a period of 6 months). In that scenario then also you wont be able to participate in a marathon or even your daily activities will get hampered. But if you take the advice of your treating doctor then there are chances that after recovery from surgery you will become fit to participate in small runs initially.
As of now there is no other treatment option apart from surgery to repair the problem.
So in my opinion you should take the advise of your treating doctor.
I hope this information will help you take a right decision. If you have any other doubts you can ask me back.
Kind Regards
DR Bhanu Partap
Above answer was peer-reviewed by :
Dr. Kampana
This is not just a sudden problem regarding just the last 6 months. I had a XXXXXXX Scientific heart pacemaker put in the year 2007 but it got infected and I almost died. I then got a Biotronik heart pacemaker at the XXXXXXX Clinic in 2008 and had that until December 2016 when the batteries ended so I replaced it with the Medtronic heart pacemaker which is much better for marathon runners. The XXXXXXX Clinic had done ECHO heart scans from 2008 to 2010 reflecting moderate tricuspid regurgitation but they didn't worry about it. It was in 2010 that I really complained a lot with terrible breathing and bad performances from 2010 to 2016 because many days the Biotronik heart pacemaker would not work at all giving me only 120 heart rates which made it impossible to run fast and caused a lot of pain being in anaerobic mode. However I never had any ECHO heart scans done during 2010 to 2016 to confirm right ventricle size. The Biotronik heart pacemaker was a terrible heart pacemaker so I was glad to finally get it replaced with the Medtronic heart pacemaker in December 2016. So my guess is I have probably have had severe tricuspid since maybe 2010 which is 7 years considering all the pain I was in but I still ran marathons in the top 20% of my age group but it just wasn't like top 5% before I ever got heart pacemakers. Now after having the Medtronic pacemaker in me for 4 months I get a MRI heart scan to check for fibrous but find out about severe tricuspid regurgitation. My running has gradually been improving in speed since December increasing 12 seconds per average mile but now just in the month of May I have increased my speed another 11 seconds which is a total of 23 second improvement or 4.8% improvement. I run on accurate measured courses so I know my actual mileage and times for every run which I record and log in my book. So my thinking is my heart is gradually adjusting to my new Medtronic heart pacemaker which is reflected in the lower size right ventricle of 3.7 cm with ECHO heart scan in month of May which is 1 month later after MRI heart scan in April. So I'm not declining but I'm improving so why would I want to have my sternum cut down the middle for open heart surgery which is severe and there are risks I could die. Plus I just know I will never be able to run effective again after that so why should I do it ? So I have probably been dealing with large right ventricle size for at least 7 years but I have still run effective and I'm now improving with much better breathing and faster running. So explain that. Could I really have severe tricuspid regurgitation now ? Their just assuming that I do because the size of my right ventricle is 5.1 cm from MRI heart scan but they haven't verified blood regurgitation going backwards from right ventricle to right atrium. My ECHO heart scan from month of May shows only mild tricuspid regurgitation with 3.7 cm which correlates with my much improved running just in the month of May. So again something doesn't add up here and that's why I'm resisting such severe open heart surgery which will destroy my life as a marathon runner for-ever and my quality of life for not being able to run anymore plus the risk of dying. So again something is wrong with all this and I need explanation and better options. Having said all this would you if you were me still do severe open heart surgery ?
XXXXXXX
XXXXXXX
Brief Answer:
Hello Again
Detailed Answer:
First of all thanks for elaborating the information in detail. Reduction in the right ventricle size from 5.1 cm in MRI to 3.7 cm on ECHO over just a period of one month is quite significant.
Also the latest ECHO finding clinically co-relates with your improved physical activity levels.
Its advisable that you should undergo one more ECHO from some different center just to cross check the last ECHO results and if they came out to be similar then it confirms your improvement after change in pacemaker.
In that case there is NO NEED TO UNDERGO SURGERY because your RV size has come back within normal limits and your Tricuspid valve leakage/regurgitation also has reduced.
If possible kindly upload your MRI and ECHO reports for me to review from your dashboard.
Kind Regards
Dr Bhanu Partap
Hello Again
Detailed Answer:
First of all thanks for elaborating the information in detail. Reduction in the right ventricle size from 5.1 cm in MRI to 3.7 cm on ECHO over just a period of one month is quite significant.
Also the latest ECHO finding clinically co-relates with your improved physical activity levels.
Its advisable that you should undergo one more ECHO from some different center just to cross check the last ECHO results and if they came out to be similar then it confirms your improvement after change in pacemaker.
In that case there is NO NEED TO UNDERGO SURGERY because your RV size has come back within normal limits and your Tricuspid valve leakage/regurgitation also has reduced.
If possible kindly upload your MRI and ECHO reports for me to review from your dashboard.
Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by :
Dr. Kampana
See uploaded PDF reports on MRI scan done 4-11-17 and ECHO scan done 5-15-17.
XXXXXXX
XXXXXXX
Brief Answer:
Gone through the reports
Detailed Answer:
In the MRI report the Tricuspid annulus measurement is 5.1 cm which is beyond doubt dilated.
But in ECHOCARDIOGRAPHY report they have written it as mildly dilated with normal RV function but in dimensions column they have measured the RV maximum dimension in diastole in 4 chamber view to be 3.7 cm which is within normal limits which is bit of a mismatch. Your TV incompetency is not much in the current echo report and also your LV function is fairly alright.
And most importantly your clinical condition is better than before according to you.
So Considering all these facts in nutshell you can safely go with wait and watch plan taking all your prescribed medicines regularly.
After 3 months you can get Echo repeated to assess the progress over time. If hopefully things improve then you can continue with medical treatment safely enjoying your marathons the way you want.
I wish you good health.
Regards
Dr Bhanu partap
Gone through the reports
Detailed Answer:
In the MRI report the Tricuspid annulus measurement is 5.1 cm which is beyond doubt dilated.
But in ECHOCARDIOGRAPHY report they have written it as mildly dilated with normal RV function but in dimensions column they have measured the RV maximum dimension in diastole in 4 chamber view to be 3.7 cm which is within normal limits which is bit of a mismatch. Your TV incompetency is not much in the current echo report and also your LV function is fairly alright.
And most importantly your clinical condition is better than before according to you.
So Considering all these facts in nutshell you can safely go with wait and watch plan taking all your prescribed medicines regularly.
After 3 months you can get Echo repeated to assess the progress over time. If hopefully things improve then you can continue with medical treatment safely enjoying your marathons the way you want.
I wish you good health.
Regards
Dr Bhanu partap
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dr XXXXXXX XXXXXXXX
I told my heart doctors regarding what you said specifically about re-testing with another ECHO heart scan but they don't agree and won't do it. I truly believe what your saying that a 1.4 cm is a significant difference from my 4-11-17 MRI heart scan showing right ventricle size at 5.1 cm and my 5-15-17 ECHO heart scan showing right ventricle size at 3.7 cm. That 1.4 cm size reduction definitely correlates with my much improved running but my heart doctors are ignoring that.
It appears my heart doctors don't want to do another ECHO scan because it will probably reflect the same 3.7 cm size which they don't care about anyway and are only relying on the 5.1 cm size on MRI.
Considering how expensive those medical testing devices are they got to be pretty accurate. So my question is can MRI heart scans and ECHO heart scans really be that different regarding accuracy in size ? I can understand a little difference between MRI and ECHO but 1.4 cm just seems too much. I need to get this understood.
Dr. XXXXXXX XXXXXX,
This is a follow-up to my previous message. Let's assume that both my MRI & ECHO were done on same dates. If both are really accurate medical devices then my right ventricle on 4-11-17 for both tests should be 5.1 cm and on 5-15-17 they should both be 3.7 cm. If this is not correct then it means both medical devices are measuring things totally different from each other which makes no sense at all to me on why there used for testing.
XXXXXXX
XXXXXXX
I told my heart doctors regarding what you said specifically about re-testing with another ECHO heart scan but they don't agree and won't do it. I truly believe what your saying that a 1.4 cm is a significant difference from my 4-11-17 MRI heart scan showing right ventricle size at 5.1 cm and my 5-15-17 ECHO heart scan showing right ventricle size at 3.7 cm. That 1.4 cm size reduction definitely correlates with my much improved running but my heart doctors are ignoring that.
It appears my heart doctors don't want to do another ECHO scan because it will probably reflect the same 3.7 cm size which they don't care about anyway and are only relying on the 5.1 cm size on MRI.
Considering how expensive those medical testing devices are they got to be pretty accurate. So my question is can MRI heart scans and ECHO heart scans really be that different regarding accuracy in size ? I can understand a little difference between MRI and ECHO but 1.4 cm just seems too much. I need to get this understood.
Dr. XXXXXXX XXXXXX,
This is a follow-up to my previous message. Let's assume that both my MRI & ECHO were done on same dates. If both are really accurate medical devices then my right ventricle on 4-11-17 for both tests should be 5.1 cm and on 5-15-17 they should both be 3.7 cm. If this is not correct then it means both medical devices are measuring things totally different from each other which makes no sense at all to me on why there used for testing.
XXXXXXX
XXXXXXX
Brief Answer:
Hello Again
Detailed Answer:
Dear Sir
Here am not trying to convey you that the medical devices are inaccurate or there is no point in doing these tests, what am trying to convey is that, am not saying that this much significant improvement is impossible it is possible and if this has happened we should confirm it by repeating either an ECHOCARDIOGRAPHY or an MRI as that's the only way.
The reason why I said to repeat it from a different center is to nullify the operator dependent bias which can happen if you undergo these tests in the same center probably by the same operator.
I understand medical treatment is highly expensive in your country but there is no other way to confirm. Why the doctors are reluctant in repeating a test I can't say much on that.
Why don't you try consulting some other cardiologist and specifically asking for an echo to confirm things and bring your mind at ease. As it's the only way I can think as of now if your regular doctor don't want another test.
Kind regards
Dr Bhanu partap
Hello Again
Detailed Answer:
Dear Sir
Here am not trying to convey you that the medical devices are inaccurate or there is no point in doing these tests, what am trying to convey is that, am not saying that this much significant improvement is impossible it is possible and if this has happened we should confirm it by repeating either an ECHOCARDIOGRAPHY or an MRI as that's the only way.
The reason why I said to repeat it from a different center is to nullify the operator dependent bias which can happen if you undergo these tests in the same center probably by the same operator.
I understand medical treatment is highly expensive in your country but there is no other way to confirm. Why the doctors are reluctant in repeating a test I can't say much on that.
Why don't you try consulting some other cardiologist and specifically asking for an echo to confirm things and bring your mind at ease. As it's the only way I can think as of now if your regular doctor don't want another test.
Kind regards
Dr Bhanu partap
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Above answer was peer-reviewed by :
Dr. Remy Koshy
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