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What are the assessments done for a post-valve thrombolysis patient?

Q: I am thankful to your portal for prompt clarification to my queries. It was indeed of great help when recently your panel doctor suggested that I should consult a cardiologist immediately. I have yet another question to which I am sure I would get suitable advice. I am a AVR + VSD + Post-valve thrombolysis patient. On hearing a strange murmur I was opined by your panel doctor that I consult a cardialogist. I went for a check up on 19th. Nov. and was asked to go for an echocardiography. While the doctor felt the PHV movement was ok, he said I should wait till PG is read which turned out to be higher with max PG being 79 & mean being 46. The doctor then advised me to get admitted for thrombolysis. Since I was asymptomatic I decided to get the check done elsewhere and the next day at a different hospital the result was 86 and 56. Other common reading was 1-2/4 AR; good LV & RV function; LVEF of 66 & 55. However, I was advised not to panic as I was asymptomatic and was recommended Cardace 2.5 mg. I was also advised to go for TEE. On 26th I underwent TEE and the results were totally changed. The results being - normally functioning leaflets, no AR, no thrombus or vegetation, no RWMA, LVEF 55%, no atheroma in aortic arch. Since my surgery I have always had 1/4 AR which i was told was normal for such surgeries. Please let me know your views on this. How can there be such a turnaround? I hv been asked to stop Digoxin 0.25 mg daily and take Cardace 2.5 mg. My BP is normal (120/80). Please advise as to how one should proceed. I have been advised to see the cardiologist after a month.

A:Assessment by one of the places obviously is incorrect. It is always good and desirable to have assessment done by the cardiologist who was following you before and after surgery and serial echos are very useful. TE echo is a very reliable investigation. Your having no symptoms makes the possiblity of a malfunction less likely. I hope you are meticulously taking the anticoagulants. A repeat echo at one month is a good idea in view of the discrepancy. It is also good to consult the surgeon who had operated on you since he would be in a good position to guide you regarding the maximum permissible gradient for the size of valve used on you.

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