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Suggest Treatment For Mildly Enlarged Left Atrium Along With Mitral Regurgitation
Question: could having a mildly enlarged left atrium along with mitral, pulmonic and tricuspid regurgitation cause pulmonary hypertension?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I would like to explain that from all your above prescribed echo information, the main factor that could lead to pulmonary hypertension is a clinically important (moderate - severe) mitral regurgitation.
An important mitral regurgitation, if not treated properly could lead to increased retrograde pressure in the left atrium, pulmonary venous-capillary system and consequently to the main pulmonary artery and right ventricle.
All this abnormally retrograde pressure increase could lead to left atrial enlargement, pulmonic regurgitation, tricuspid regurgitation.
This is the consequent pathological chain that cause pulmonary hypertension, measured by investigating tricuspid regurgitation for maximal pressure gradient through tricuspid valve, utilizing Doppler echo techniques.
But, from the other side, mild and trivial mitral, pulmonic and tricuspid regurgitations may be found otherwise in normal healthy individuals without pulmonary hypertension.
So, a necessary clue leading to pulmonary hypertension would be an important mitral regurgitation. All the other echo findings would be considered only consequences of that, or separated non-related findings.
If you could upload your cardiac ultrasound report, I would give a more direct opinion.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I would like to explain that from all your above prescribed echo information, the main factor that could lead to pulmonary hypertension is a clinically important (moderate - severe) mitral regurgitation.
An important mitral regurgitation, if not treated properly could lead to increased retrograde pressure in the left atrium, pulmonary venous-capillary system and consequently to the main pulmonary artery and right ventricle.
All this abnormally retrograde pressure increase could lead to left atrial enlargement, pulmonic regurgitation, tricuspid regurgitation.
This is the consequent pathological chain that cause pulmonary hypertension, measured by investigating tricuspid regurgitation for maximal pressure gradient through tricuspid valve, utilizing Doppler echo techniques.
But, from the other side, mild and trivial mitral, pulmonic and tricuspid regurgitations may be found otherwise in normal healthy individuals without pulmonary hypertension.
So, a necessary clue leading to pulmonary hypertension would be an important mitral regurgitation. All the other echo findings would be considered only consequences of that, or separated non-related findings.
If you could upload your cardiac ultrasound report, I would give a more direct opinion.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Findings
Technical Comments:
The study quality is fair.
Left Ventricle:
The left ventricular chamber size, wall thickness and systolic
function are within normal limits. There are no wall motion
abnormalities observed. Ejection fraction is normal. The visually
estimated ejection fraction is 60%.
Left Atrium:
The left atrium is mildly enlarged.
Right Ventricle:
The right ventricular cavity size is normal. The right ventricle wall
thickness is normal. The right ventricular global systolic function is
normal.
Right Atrium:
The right atrial cavity size is normal.
Aortic Valve:
The aortic valve is trileaflet. There is no evidence of aortic
regurgitation. There is no evidence of aortic stenosis.
Mitral Valve:
The mitral valve leaflets do not appear thickened. There is a trace of
mitral regurgitation. Normal left ventricular diastolic filling is
observed.
Tricuspid Valve:
The tricuspid valve leaflets are normal. There is a trace tricuspid
regurgitation. The right ventricular systolic pressure is estimated to
be 20-25 mmHg. There is no evidence for elevated right ventricular
systolic pressure.
Pulmonic Valve:
The pulmonic valve is not well visualized. There is a trace pulmonic
regurgitation.
Pericardium:
There is no pericardial effusion.
Aorta:
There is no dilatation of the aortic root.
Pulmonary Artery:
The main pulmonary artery appears normal.
Venous:
The inferior vena cava appears normal in size. There is a greater than
50% respiratory change in the inferior vena cava dimension.
Impressions:
The left ventricular chamber size, wall thickness and systolic function
are within normal limits. There are no wall motion abnormalities
observed. Ejection fraction is normal.
The visually estimated ejection fraction is 60%.
Normal left ventricular diastolic filling is observed.
There is no evidence for elevated right ventricular systolic pressure.
Measurements
Chambers 2D/MM
Name Value Normal Range
RVIDd 2.4 cm none
IVSd 0.9 cm (0.6 - 1)
LVIDd 4.6 cm (3.9 - 5.9)
LVIDd Index 2.5 cm/m2 (2.2 - 3.2)
LVIDs 3.3 cm (2 - 3.8)
LVIDs Index 1.8 cm/m2 none
LVPWd 0.9 cm (0.6 - 1)
Ao Root Diam 3.1 cm none
Ao Root Diam Index 1.7 cm/m2 none
Volumes/Mass
Name Value Normal Range
LA Vol bp (MOD) 62 ml none
LA Vol bp (MOD) Index 33.9 ml/m2 none
EF bp (MOD) 77.1 % (55 - 65)
Aortic Valve
Name Value Normal Range
AV Pk Vel 1.2 m/sec none
AV Pk Grad 5.9 mmHg none
Diastolic/Systolic Function Doppler
Name Value Normal Range
E Vel 1.1 m/sec none
MV Decel Time 247 msec (160 - 240)
A Vel 0.6 m/sec none
E/A 2.0 ratio (1.2 - 1.4)
Sep E to E Prime ratio 9 ratio none
Tricuspid Valve
Name Value Normal Range
TR Pk Vel 2 m/sec none
RVSP 25 mmHg none
Technical Comments:
The study quality is fair.
Left Ventricle:
The left ventricular chamber size, wall thickness and systolic
function are within normal limits. There are no wall motion
abnormalities observed. Ejection fraction is normal. The visually
estimated ejection fraction is 60%.
Left Atrium:
The left atrium is mildly enlarged.
Right Ventricle:
The right ventricular cavity size is normal. The right ventricle wall
thickness is normal. The right ventricular global systolic function is
normal.
Right Atrium:
The right atrial cavity size is normal.
Aortic Valve:
The aortic valve is trileaflet. There is no evidence of aortic
regurgitation. There is no evidence of aortic stenosis.
Mitral Valve:
The mitral valve leaflets do not appear thickened. There is a trace of
mitral regurgitation. Normal left ventricular diastolic filling is
observed.
Tricuspid Valve:
The tricuspid valve leaflets are normal. There is a trace tricuspid
regurgitation. The right ventricular systolic pressure is estimated to
be 20-25 mmHg. There is no evidence for elevated right ventricular
systolic pressure.
Pulmonic Valve:
The pulmonic valve is not well visualized. There is a trace pulmonic
regurgitation.
Pericardium:
There is no pericardial effusion.
Aorta:
There is no dilatation of the aortic root.
Pulmonary Artery:
The main pulmonary artery appears normal.
Venous:
The inferior vena cava appears normal in size. There is a greater than
50% respiratory change in the inferior vena cava dimension.
Impressions:
The left ventricular chamber size, wall thickness and systolic function
are within normal limits. There are no wall motion abnormalities
observed. Ejection fraction is normal.
The visually estimated ejection fraction is 60%.
Normal left ventricular diastolic filling is observed.
There is no evidence for elevated right ventricular systolic pressure.
Measurements
Chambers 2D/MM
Name Value Normal Range
RVIDd 2.4 cm none
IVSd 0.9 cm (0.6 - 1)
LVIDd 4.6 cm (3.9 - 5.9)
LVIDd Index 2.5 cm/m2 (2.2 - 3.2)
LVIDs 3.3 cm (2 - 3.8)
LVIDs Index 1.8 cm/m2 none
LVPWd 0.9 cm (0.6 - 1)
Ao Root Diam 3.1 cm none
Ao Root Diam Index 1.7 cm/m2 none
Volumes/Mass
Name Value Normal Range
LA Vol bp (MOD) 62 ml none
LA Vol bp (MOD) Index 33.9 ml/m2 none
EF bp (MOD) 77.1 % (55 - 65)
Aortic Valve
Name Value Normal Range
AV Pk Vel 1.2 m/sec none
AV Pk Grad 5.9 mmHg none
Diastolic/Systolic Function Doppler
Name Value Normal Range
E Vel 1.1 m/sec none
MV Decel Time 247 msec (160 - 240)
A Vel 0.6 m/sec none
E/A 2.0 ratio (1.2 - 1.4)
Sep E to E Prime ratio 9 ratio none
Tricuspid Valve
Name Value Normal Range
TR Pk Vel 2 m/sec none
RVSP 25 mmHg none
Brief Answer:
Nothing to worry about!
Detailed Answer:
Hi again!
I am glad to confirm you that, after reviewing your cardiac ultrasound report, it could be concluded that, besides a mild left atrial enlargement, all the other echo parameters are within normal values.
There is no important valvular dysfunction (regurgitations), and no pulmonary hypertension. Everything normal!
So just relax!
Nothing to worry about!
Wish you a good health!
Regards,
Dr. Iliri
Nothing to worry about!
Detailed Answer:
Hi again!
I am glad to confirm you that, after reviewing your cardiac ultrasound report, it could be concluded that, besides a mild left atrial enlargement, all the other echo parameters are within normal values.
There is no important valvular dysfunction (regurgitations), and no pulmonary hypertension. Everything normal!
So just relax!
Nothing to worry about!
Wish you a good health!
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
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