Aorta Measurements ???

[RunMartin]

Hi,
I have just got back from my visit to the Cardio. The left ventricle measurements were the same as they were six months ago BUT she said my arota measured about 5 to 5.5 cm. This was the first time this has been brought up. She said I would need to have a CT scan to verify this. She also said that when I have my valve replaced (not if I ...) I will need the aorta replacing as well.

Does anyone know what this measurement means in relation to having surgery??


Thanks

Martin

 

[Arlyss]

Regarding Your Aortic Aneurysm

Regarding Your Aortic Aneurysm

Hi Martin,

Did the cardiologist tell you your aortic valve is leaking, narrowed, or both? Did she say if your aortic valve is bicuspid (two leaflets instead of the normal three)? Bicuspid aortic valves are associated with aortic aneurysms. I will give you some links that will help explain aortic aneurysms in the chest.
http://www.cedars-sinai.edu/aorta
http://www.bicuspidfoundation.com

It is important that you be assessed by a center that specializes in aortic disease in the chest. The dimensions you give are in surgical range, and it is important that you get an accurate evaluation. You might also ask to have an MRI, rather than a CT of your aorta. An MRI does not expose you to x-rays! Cardiac MRAs are also available now in some centers, and this test gives a great view of the heart chambers and valves.

I hope some of this helps.

Best Wishes,
Arlyss

 

[RunMartin]

Hi Arlyss,
Thanks for your reply. I have a bicuspid arotic valve with moderate insufficieny (the insufficiency was not mentioned today so I presume it has remained the same).

In England we have a National Health Service. So unfortunatley I do not think I have a choice with what type of scan I have (similarly I do not have a choice as to when I have surgery).

Thanks

Martin

 

[Buzz Lanning]

Aorta

Aorta

Martin,

I was in the same boat as you; my aorta was increasing in size. At the time of surgery, my aorta was 5.0 cm. Recommendations for surgery is generally in the 5.5 cm range, mayber sooner; check with your cardiologist. Anyway, approximately 2 to 3 inches of my aorta was replaced with a Dacron graft during surgery to replace the aortic valve. Note: I'm not sure how the surgery is performed with a tissue valve, but with a mechanical valve, the Dacron graft is actually connected to the valve (referred to as a conduit).

In summary, the enlarged aorta could initiate your surgery, sooner, rather than later (instead of the valve / regurgitation / left ventricle enlargement). I also had a CT scan prior to surgery to verify there wasn't a thoracic aneurysm; which was negative.

 

[RunMartin]

What does the CT scan involve? Does it require a stay in hospital or will I be able to drive to the hospital, have the scan and drive home? The cardiologist said I could still run and swim etc which seems odd if the aorta is getting bigger. I did not seem to have any time to ask questions.

 

[Buzz Lanning]

CT Scan

CT Scan

The scan only took about 20 minutes. You lay-down inside a donut-type machine. The scan is done with & without contrast (a radioactive dye). You'll feel flushed during the injection, but that feeling dissipates rapidly. Yes, you can drive home.

Based on the results from my CT scan, the cardiologist allowed me to exercise with an enlarged aorta since there was no aneurysm present. However, it really didn't matter (for very long), just a few months later, I had surgery.

 

[RunMartin]

Thanks Buzz,
What is the difference between an aneurysm and an enlarged aorta? I hear both of them mentioned in posts but I assumed they were the same. Are there more complications replacing the aortic valve and part of the aorta as opposed to just the valve? i.e. is post op recovery more difficult and does it have any restrictions as to what you can do post op?

Sorry for all the questions but my head is racing a little bit at the moment.

Thanks

Martin

 

[Buzz Lanning]

Aorta

Aorta

Martin,

I'm not completely sure about the difference. I "believe" as the aorta uniformly increases in diameter, certain sections of the aorta can become weaker, causing the aorta to enlarge in this weaker section only; called an aneurysm (perhaps this phenomena is similar to a "bubble" forming on an inner tube). This can be observed during a CT scan or angiogram test. Since I'm not a expert on this subject, I'll defer to other valvereplacement.com members.

Next, replacing the aorta takes additional time during surgery, but probably has little effect on the recovery process.

Finally, I have no restrictions. The Dacron graft that replaced my aorta is just as strong has the original material (if not stronger).

The main issue is getting the aorta replaced or repaired before an aneurysm develops.

 

[Tom F.]

Well, for what its worth if your root or ascending aorta is at 5.0cm it seems to me that you already have an aneurysm. My ascending aorta was 4.8cm or so at the time of my surgery, and I was told to get it fixed soon, within 6 months. And during that time I was fairly restricted as to what I could do, otherwise I would face the possibility of rupture.

 

[ar bee]

i posted in another thread, that my cardio wants to push ahead with AVR since the aortic root has reached app 4cm (left ventricle size is stable over the past 18 month). He claims that it is better to do it early so that we only have to replace the valve!

well2u
ar bee

 

[RunMartin]

Hi,
Is it fairly common to have the aortic valve and root replaced??

 

[ar bee]

depends

depends

from what I read and my cardio says: if only the valve is stenotic/leaking then rather no, if the aorta has suffered (ie is dilated) then yes.

I take the view: leave as much as possible the way mother nature made it, but others differ for their own good reasons

well2u
ar bee

 

[bethanne]

my understanding is it depends what the cause of the bi-cuspid aortic valve is. I have a congenital bi-cuspid aortic valve. The way my cardiologist explained it to me is that the cells that did not form properly for the valve are the same cells forming the aorta. (short version of the explanation). Further research explains they are related by what is considered a connective tissue disorder. The pathology of the aorta is weaker (different protein structure) therefore prone to expand, etc.

An older theory (and may still apply to some scenarios) is that the blood flow coming from the valve at an angle due to the formation of the valve eventually leads to a weakened aorta.

The newer school of thought is to look at more than just the valve but to consider the whole picture (the aorta as well). Needless to say this is why I have changed to my current cardiologist becuase the previous one had not considered this element.

Last May my ascending aorta was at a 4.2. At St. Lukes the thought is surgery at 5cm. If you look at the Cedars Sinai website you will find they recommend surgery at 4.5. In summary, it is preferred to correct the valve and aortic root simultaneously to avoid a 2nd surgery. However, measurements would need to warrant timing for surgery for both.

Hope this helps....

 

[KathyH]

My aneurysm was 4.7 and I had mod- severe aortic reguritation. My surgeon said if I was tall he wouldn't be as worried about my aneurysm being that size, but I am 5ft 2in so he said that makes a difference. The Dr told me to have it done within 3 months. I know the surgery took alittle longer that just a valve, but, I was still able to have minimal invasive surgery. Good Luck.
Kathy H

 

[Gemma]

Hi Martin,
I was wondering how you were getting on.
I'm afraid I don't really know anything about aorta measurements or what the implications are of an enlarged aorta, although I do believe you can possibly get both mechanical and tissue valves with attached grafts .
I was just thinking about what you said re. not having time to ask all your questions. Would you be able to get in to see your GP (preferably BEFORE Christmas so you can get all your questions answered and not be worrying about it whilst carving the turkey ). He/she may well be able to answer some if not all of your questions. Jim found that after his GP picked up on his heart murmur, he did loads of research on the topic of bicuspid aortic valves, and is now very clued up. May be easier for you to do that than wait until you see your cardiologist again.
Best wishes,
Gemma.

 

[RunMartin]

Hi Martin,
I was wondering how you were getting on.
I'm afraid I don't really know anything about aorta measurements or what the implications are of an enlarged aorta, although I do believe you can possibly get both mechanical and tissue valves with attached grafts .
I was just thinking about what you said re. not having time to ask all your questions. Would you be able to get in to see your GP (preferably BEFORE Christmas so you can get all your questions answered and not be worrying about it whilst carving the turkey ). He/she may well be able to answer some if not all of your questions. Jim found that after his GP picked up on his heart murmur, he did loads of research on the topic of bicuspid aortic valves, and is now very clued up. May be easier for you to do that than wait until you see your cardiologist again.
Best wishes,
Gemma.

Hi Gemma,
Last time I talked to my GP about my heart problems he could not add much to what I already knew. The notes sent from the hospital to the GP did not reveal much except I had a bicuspid aortic valve with moderate regurgitation. I think what I am really trying to find out is whether it is unusual to have an aortic valve and part of the aorta replaced at the same time and whether there are any other restrictions regarding exercise post surgery compared to valve replacement only. If possible I would like to carry with my lifestyle which includes lots of running and swimming.

Over the last year I have been keeping an eye on Jims progress and it is good to hear he is doing well.

All the best

Martin