The greatest adverse effect of modern medical science is the notorious phenomenon of amplifying medical trivia .We rarely realise how much of anxiety this causes to our patients. We can’t complain either, as many of the medical professionals make a living out this.
For cardiologists and echocardiologists , there is often an issue in reporting some of their findings .Doppler is a great tool , especially the color Doppler which can pickup even few clusters of RBCs that leak into atria every time the AV valves closes. Ideally this has to be labeled as physiological MR or TR .If the arotic root is obliquely aligned with it’s leaflets one may even get a physiological AR .
While it is better to ignore these lesions , some call it as Trivial MR / TR/AR .
This can be detected up to 40 % of individuals.
What does trivial regurgitation mean to a doctor ?
It means nothing . Few may use it as a weapon to advice further visits to their clinic and do serial meaningless follow up scans .The irony is some of these patients enjoy this . . . and it becomes a different matter altogether.
What does it mean to the patient?
Anxiety for the majority , for the modern net educated public. No issue , for the ignorant and the take it easy men ! We have seen number of patients getting cardiac symptoms after reporting the physiological MR or TR.
So, should we report physiological events in routine echocardiogrpahy?
We need not . But we do it often .Why ?
There are few reasons for this phenomenon ( Which I believe are true , after observing as many echocardiography centers for more than few decades)
- Doctors and Imageologist are often self suspicious and worried about missing something and getting exposed among their peers and public. They do not want to miss any abnormality. So even a trival abnormality of negligible importance is also reported.
- In the prevailing Geo commercial medical world there are issues other than academic creeping in..
- Many get bored to report normal reports as they want to add spice to their report hence they fill it up all fancy terminologies . This sort of spice reporting adds self esteem the medical professionals .It makes some sense to report and reveal what they know to the non specialists.
- Finally, the present day high IQ patients also do not expect a bland ( normal ) report.They often relish some scribblings in their master health check reports. They tend to question the authenticity if we simply say everything is normal.
The following can be termed as Echo trivia in otherwise healthy individual
- Mild LVH
- Age related impaired relaxation of LV without LA enlargement.
- Mitral valve prolapse without MR
- Minimal pericardial effusion
- Patent foramen ovale without any shunting
When does a trivial lesions can be important ?
In a patient with established heart disease , a trivial valve leak could become important. For example in dilated cardiomyopathy, COPD, MVPS dilated aortic root etc .Here regular follow ups may be necessary.
Aortic and mitral valve degeneration with calcification in the elderly is now implicated in many of the unexplained strokes .Hence even though it is age related physiology it need to be given importance.
Can trivial regurgitant lesions be a risk for infective endocarditis.?
No one knows. Logic would imply a risk , as micro jets are the norm here . But the potential for it to cause a endothelial damage is negligible. Some sinister thinking cardiologists Many of the native valve endocarditis in otherwise normal hearts may be attributed to this physiological MR/TR .(Evidence less cardiology !)
Clinical use of physiological TR and MR ?
The physiological TR,MR jet helps us to estimate pulmonary arterial pressure and LA mean pressure. Systemic cuff pressure minus MR jet pressure give us LAP.TR jet plus RA pressure give an estimate of PA pressure .
