Question: I'm experiencing increasing breathing difficulty and disequilibrium, starting about six years ago and recently exacerbated. I underwent a heart catheterization two weeks ago. The attending cardiologist recommended VATR, but my regular cardiologist - who's a Director of the same group, graded my aortic valve stenosis as "mild to serious", but suggested that I might need VATR in "two or three years". I'm very concerned.

Thank you. The cardiologist almost certainly did say "moderate" rather than "mild". I didn't receive a copy of either the echocardiogram nor heart catheterization results. The follow-up visit occurred two weeks after the diagnostic procedures, and the cardiologist spent only a few minutes with me, where he reviewed those results on a computer screen. Frankly, he seemed mostly unconcerned, but my breathing difficulty and disequilibrium are very close to keeping me housebound. Aside from your very welcome input, do you think a second opinion from a local cardiologist would be wise? I'm not comfortable with "See you in six months, when we'll do another echocardiogram." (By the way, I own a pulse oximeter, and my normal resting oxygen saturation is typically around 85%, although I can raise it to 95% with deep breathing.)

Further to our pervious discussions, ​about 6 years ago I experienced an "incident" where I went to bed feeling fine, but awoke the next morning with severe disequilibrium. MRI, ENT and neurological tests showed nothing unusual. No firm diagnosis. During the ensuing 6 years, the disequilibrium either abated somewhat or I adjusted to it. But two weeks ago, I had a very similar experience. Suspecting stroke, I hospitalized myself for testing. Clinical tests for stroke were negative. That is when cardiological tests were performed, showing "moderate to mild" aortic valve stenosis. I have, by the way, been diagnosed with COPD, which I understand sometimes demonstrates similar symptoms (shortness of breath, poor balance due to oxygen insufficiency). Neither my cardiologist nor my pulmonologist seem particularly "interested", which is why I'm contacting you for advice.

Thank you, Doctor Makode. "Presyncope" is a term that is new to me, but in retrospect, I was in fact tested for that during my recent hospital stay. The drop in blood pressure during testing, from lying down to sitting to standing was considered to be well within normal (non-symptomatic) ranges, thus presumably eliminating presyncope. In fact, although feeling somewhat dizzy when - say, walking my dog for a short distance - I do feel as though I could faint, I never have done so. That feeling may be illusory rather than a genuine danger. Consequently, I'm inclined to accept my cardiologist's diagnosis to "let it go" for at least another six months. Your suggestions have been very helpful, have put my mind at ease, and I thank you.

Regards