American College of Cardiology/American Heart Association 2006 Guidelines

[Arlyss]

The ACC/AHA have issued new guidelines this year for "the Management of Patients with Valvular Heart Disease".

I am pleased these guidelines include the latest understanding regarding bicuspid aortic valve and aortic aneurysm.

Quoting from section 3.3 of the guidelines:

"There is growing awareness that many patients with bicuspid aortic valves have disorders of vascular connective tissue, involving loss of elastic tissue (348,349), which may result in dilatation of the aortic root or ascending aorta even in the absence of hemodynamically significant AS or AR (350–353). Aortic root or ascending aortic dilatation can progress with time in this condition (354). These patients have a risk of aortic dissection that is related to the severity of dilatation (349,355–357). "

The publication of these guidelines should help those with bicuspid aortic valves in discussions with their doctors. I suggest printing a copy and sharing with your physician if he/she is not aware of the association between BAV and ascending aortic aneurysms.

Here is the link to the complete paper.
http://content.onlinejacc.org/cgi/content/full/48/3/e1?ct


Best wishes,
Arlyss

 

[Mary]

Arlyss,

Have you ever heard of any connection between BAVD and enlargment of the inferior vena cava?

 

[StretchL]

Thank You...

Thank You...

...for posting that link.

Score 1 for the Internet. (...and Arlyss!)

 

[Arlyss]

Guidelines for Valve Patients

Guidelines for Valve Patients

Yes, I was very glad to see these updated guidelines for valve patients come out. It is a comprehensive work of both before and after surgey - and it must have been a large effort to go through all the medical literature and publish this work.



Mary, I have not met anyone with that particular issue that is BAV.


Best wishes,
Arlyss

 

[hpuehler]

Thank you for the link!

 

[MrP]

Thanks Arlyss... I truly appreciate you providing this link. However, I didn't find any reference to brain aneurysms in BAV patients or guidelines for screening BAV family members. Did I overlook these? Will my cardiologist need to be convinced of the possibility of brain aneurysms related to BAV? Without complete guidelines, how does one justify costs associated with brain MRI to an insurance company? I also didn't find any mention of symptoms associated with ascending aortic aneuryms and guidelines for surgery when symptoms are present. How do we as patients provide feedback to this medical committee for updates to these guidelines?

 

[Arlyss]

Hi MrP,

These guidelines for valve patient care are new in 2006. The last version of these guidelines was done back, I believe, in 1998.

It is a great break through to have recognition of aortic aneurysm along with BAV. That is going to save lives, because generally no one was watching BAVs for aortic aneurysms in the chest.

However, there is still a great deal of work to do regarding the big picture of the body for those with BAVs. Dr. Wouter Schievink's papers pioneered brain aneurysm and BAV. Recently I was interested to see this paper also, which encourages investigating down in the chest when there is a brain aneurysm!
http://www.ncbi.nlm.nih.gov/entrez/...uids=16532727&query_hl=24&itool=pubmed_docsum

What can we do? Continue to provide credible information to our physicians, and insist on thoroughness, follow up, and openness of thought when someone is diagnosed with a BAV. Today knowledgeable physicians should be able to provide sufficient information to justify brain screening to insurance. There is a terrible consequence if insurance should deny the test and someone suffer brain injury or death because of it.


Best wishes,
Arlyss

PS

I have edited my original post above to indicate that these guidelines recognize the latest understanding of BAV and aortic aneurysm. There certainly is more to the BAV picture, but this is an important start.

 

[gijanet]

OH, look..........

OH, look..........

they at least partially acknowledge Katie's defects..........

"MR also develops commonly in children with primum atrioventricular septal defects. These defects are caused by a deficiency of the atrioventricular septum in the embryonic heart. There may be an isolated ostium primum atrial septal defect; ventricular septal defect in the inlet (posterior) septum; abnormalities of the mitral or tricuspid valve, including clefts; or some combination of the above. In a complete atrioventricular septal defect, there is a combination of a large primum atrial septal defect, a large inlet (posterior) ventricular septal defect, and a common atrioventricular valve that failed to develop into separate mitral and tricuspid valves. Repair of the defects in early childhood, with low mortality and morbidity, is now commonplace. The most common long-term sequela of surgery is MR, which can be mild, moderate, or severe......

Rarely, MV replacement with a mechanical or biological valve is necessary."

Say what? Yeah, right! Not too many revelations here for us.........sigh! But thank you for posting this anyway and keeping us up to date. Hope it helps some here.

Hugs. J.

 

[Phyllis]

Thanks so much for posting this, Arlyss. I hope Ross adds it to the Reference section. I immediately went to the section regarding echos, post surgery and the fact that patients with bioprosthetic valves may be considered for annual echos after the first 5 years in the absence of a change in clinical status. This is the course of action that Dick has chosen to follow with the agreement of his cardio and it relieves my mind to see it in black and white!