Asc AO Has Increased .6cm in Last Year

[francie12]

I have been a member here since my son was 11, but have been offline for years because his situation has been, happily, stable. He is 22 now, and we have just come from the yearly echo, with an appointment in a week to see the new Adult Congenital Cardiologist. I wanted to check in here in the meantime to see if my worry is possibly not really warranted. The LvDD is now 5.7 with this new elite machine and technician, and has been 6.1 for the past few years, so that is good. But the Asc AO is suddenly up to 3.9 (was 3.3 for the last 10 yrs), a .6 increase, and this is what has me worried. He has moderate AO insufficiency. I know they compute risk using body mass index, and my son is 6'2", so perhaps that makes it all less concerning, but it is still a sudden increase. Any thoughts are much appreciated. We had virtually forgotten about this whole area, aside from yearly echos, for many years, but now I'm impatiently awaiting the appointment, a week away.

 

[skeptic49]

The sudden increase in the AO would set off alarms for me. I think your son will need to be carefully evaluated much more often - every six months I would think. Does he have a BAV? Aneurysms are not something to trifle with. I wish you both the very best in the new year.

 

[francie12]

Thanks so much for the response. Yes, I forgot to mention that there is a BAV at the bottom of all this. The concern is the sudden advance of the dilation after 10 yrs of stability. I wonder if there is a resource online where there this is addressed, what type of follow up is needed for what degree of increased dilation, etc. It is hard to wait for the appointment.

Happy New Year to you too, skeptic!

 

[tjay]

You mentioned new machine and technician, which is most probably the reason for any change (e.g. good for LvDD and worse for AO). Even with the same technician and machine, there is always slight variation, let alone with a change like this. Did you ask your cardio of this concern, and what did he say?

 

[AZ Don]

With a sudden change after 10 years of stability and mention of a new machine and technician, what comes to mind is that the margin of error in measuring an aortic aneurysm via echo cardiogram can be significant, especially with a change in equipment or technicians. Have the current and prior measurements been confirmed by CT or MRI? Those are much more accurate. FWIW, I remember well a post where someone's aneurysm grew suddenly by 0.5cm as measured by an echo, so they paid significant out of pocket costs for a CT (or MRI) only to find the aneurysm itself had not changed at all, the echo simply gave different results.

 

[Agian]

It sounds odd that it stayed the same between the ages 12 and 22. I would have thought his aorta would have grown with him. At 22 he's probably still growing and he's a big lad. If you're worried ask the cardiologist. Ask for another echo if you need peace of mind.

From one parent to another, I totally get it. I'm a neurotic wreck when it comes to the kids. I sense your anxiety.

 

[francie12]

This is very interesting, and true that we have indeed switched machines and technicians. He did have the old numbers confirmed by a cardiac MRI a few years ago. They tend to change slightly up and down, with a slight but steady upward trend, but they have never jumped up this much in one year. This time the LvDD went down .4cm, and the Asc AO went up .6cm so maybe it is just the discrepancies between machines/techs. If they prescribe another MRI at this point it would be reasuring, though.

The cardio appointment with the new Adult Congenital guy is in a week. I need to wait and see what he says, but yes, I am a nervous parent when it comes to medical issues and obviously jump all over this heart thing! I keep it to myself though. The patient himself just breezes through it all, and says he'll worry when it's time to worry.

I really appreciate this input, thank you! It is so helpful for me to come to appointments with some understanding in advance.

 

[francie12]

Update: We went to the appointment yesterday, and the new cardio does suspect that the increase in the Asc AO measure (.7 mm, rather than .6) could be due to the change in machine/tech. To be on the safe side they scheduled an appointment in 6 mons, as you guys thought would happen. Thanks again for the timely input!