aortic root enlarged about 4 years after AVR

[Landon]

If anybody has any experience with or thoughts about the following situation, I would appreciate your comments:

I had an AVR in January 2002. In addition, I had an aneurysm of the non-coronary cusp of the sinus of Valsalva (in the area of the aortic root), so the doctor replaced with a graft the ascending aorta and the aneurysmal non-coronary cusp, but left intact the part of the aorta where the left and right coronary arteries emerge, putting the graft in there at a supracoronary area. Prior to the surgery, the aortic root had been measured at around 5.0 cm.

I just had a check and am told that my aortic root is measuring 4.6 cm, but the valve is doing great. My understanding is that the root normally should measure in the range of 3.5 cm and that, presumably (since there are no actual post-surgical measurements of the aortic root in the chart), after the surgery in January 2002, the root would have been normal size. The recommendation is to have another MRI in a year and see what the root is measuring.

Any thoughts?

 

[PJmomrunner]

Sorry about this development. I don't really have much to offer, but I thought I'd respond rather than let you continue to wonder when someone is going to respond .

If there are no post-surgical measurements of your root in the chart, I wonder if there was a post-surgical CT or echo done from which those measurements could still be made. It would be nice to know if your talking, "4.6cm, used to be 4.55cm" or "4.6cm, used to be 3.5cm." Failing that, I guess all you can do is monitor it closely. I might feel more comfortable with a first re-check at 6 months, followed with subsequent re-checks at a year, assuming the first check shows no progress over your initial 4.6cm.

 

[wpribyl]

I just had my 2nd recheck at 8 mo. I have a 4.7 anurism and it is the same size as before surgery. After surgery the surgeon said the vessel looked sound, so they left it. The cardio. said it will not go back down, but with the repaired valve, it should not get any worse, and to keep monitoring annually. I don't know if this is any help, just my 2 cents worth.

 

[Nan]

not exactly the same thing, but my aortic root was (and is) too small for my valve. they put in a dacron graft to enlarge it in order to be able to implant a size 17 St. Jude's aortic valve.

This has definitely caused problems as it still is not large enough. One of the potential solutions may be an aortic root replacement at some point in the future.

If they are following you closely, then that is somewhat re-assuring that it won't get out of hand unexpectedly.

I guess one of my questions to you (and you to them) is are you having any symptoms? Problems? etc. And if so, should they be monitoring even more closely?

Good Luck.

 

[Landon]

Thanks very much for your thoughts and comments. I am going to move up the next MRI to six months in order to see if there is any active progression going on here.

 

[Ambience]

Prior to and after my AVR my cardiologist can see a sub aortic bulge. He's measure it for the last few years and it's always been the same, both prior to and after surgery. I also had an aneurism fix in my aoritc root, but I'm not sure exactly what it is. Mostly because I was out on happy drugs when the doctor told me. All I know is that it involved kevlar.