Ascending Aortic Dilatation (& Dissection) Associated With Bicuspid Aortic Valve

[The Thief]

I just wrote the following blog post on the topic of Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve. I found some very useful resources that can help patient and doctor decide when to choose elective surgery under these conditions. In the post I include the article that explains how a simple calculation can be used to compare aortic (aneurysm) size vs. body size which apparently is an indicator. I also included a Relative Aortic Size calculator that I found on another website.

I plugged in my data and I am still under the criteria, though I am going in for surgery on Nov 25th, 2013. Better early than late.

Check it out here: http://robovalve.wordpress.com/2013/09/24/ascending-aortic-dilatation-associated-with-bicuspid-aortic-valve/

 

[skeptic49]

Thanks for your post. I found this on the site you linked to:

Approximately 60% of patients with normally functioning BAVs (at the time of diagnosis) have valves that continue to function normally throughout life (elderly patients up to 89 years of age have been documented to have perfectly functional BAV valves).

This I did not know. Some people in the waiting room may be there for a long time...maybe even permanently!

 

[epstns]

At one point I remember a statistic being posted that something like only 25% of BAV patients eventually need surgery. Could be I'm "mis-remembering" it or could be a wrong stat on either part, but I do know that not all BAV patients require replacement. That's TWO things I've won in life -- the 1969 draft lottery (drew #136 out of 365, would have been drafted in May if I hadn't enlisted), and the valve lottery. With a record like that, I don't get too many offers of backing for trips to Las Vegas. . .

 

[Agian]

Skeptic, I suspect our valves probably don't classify as 'normally functioning' with all that calcium. It would be great if I'm wrong.

 

[pellicle]

That's TWO things I've won in life -- the 1969 draft lottery (drew #136 out of 365, would have been drafted in May if I hadn't enlisted), and the valve lottery.

well I dunno ... you seem to have got the consolation prize on both of them .. you are here writing after all and from what I gather have all fingers and toes too. {USA: 58,220 dead; 303,644 wounded}

so, when we goin to Vegas? ;-)

 

[The Thief]

Well in in So Cal, 3 hours from Vegas... Gimmie the time and day and i'll meet y'all there!

 

[skeptic49]

Yea, good point, Aqian! If you have, say, moderate stenosis plus some regurgitation, is that a "normally functioning" BAV? Do all BAVs eventually become stenotic? Or, do some 89 year olds have clean BAVs with no calcification? We need clarification on that one.

 

[AZ Don]

Re. when to have surgery. Frankly I don't fully agree with the criteria. The way I looked at it was the risk of complications from the aneurysm, vs. the risks from the surgery. The thing is, once the aneurysm reaches a certain size (around 4.7cm I think), it tends to keep growing. So surgery is almost certain and so is the accompanying risk. The only question then is what is the risk in waiting for surgery. Figure 11 in the article here: http://content.onlinejacc.org/article.aspx?articleid=1140497 (click on pdf at the right to see the whole article) shows that for an anuerysm from 4.0 to 4.9cm, the risk of rupture, dissection, or death is over 5% per year. So assume that the risk of significant complications from surgery is 5%. Then if you have surgery right away your risk of complications are 5%. If you wait a year your odds of no complications are (1-5%)*(1-5%) = 90.25%, so your odds of complications are 9.75%. If you wait 2 years your odds of no complications are (1-5%)*(1-5%)*(1-5%) = 85.74%, so your odds of complications are 14.26%.

So if an aneurysm has progressed to the point that surgery is virtually certain, then the longer you wait the higher your risks. Beyond 6cm (less with other conditions such as BAV) the risk grows significantly, but complications do occur at smaller levels. For those awaiting surgery for aneurysm, you should be aware that 2/3's of aortic dissections and ruptures in a Yale study were coincident with physical or emotional stress: http://www.valvereplacement.org/for...se-and-stress-with-Aortic-Aneurysm&highlight=.

I did this analysis while waiting to get my full results only to find that I was already beyond the surgical criteria already, so I had my surgery ASAP.

 

[AZ Don]

Re. Well functioning BAV's. I happen to have one. I never had symptoms and have exercised all my life. Prior to my surgery for aortic aneurysm my echo showed no aortic regurgitation or insufficiency. My surgeon thinks that there is a 50% chance that my valve will fail and I will require another surgery. (estimates from other sources are all over the place but generally less than my surgeon's estimate). His estimate for the life expectancy of my valve was comparable to that of a replacement tissue valve - 15 to 20 years. I was given the option to replace the valve but a well functioning valve is considered to be better than any replacement, so I figured if it ain't broke, don't fix it. If it does wear out in the future, I'll deal with it then. I have not seen any data or even theories on why some BAV's fail and others don't.

 

[Sunshine susan]

So Thief,I find your handle interesting.... Anyway, I had AVR with St Jude's in 1999. No problems until Echo in April of this year. After CT for verification, I have an aortic root dilation of 4.9. Have seen surgeon and will have another CT in Oct to help determine such increase not evident in past years. Has been a very stressful couple of years but won't bore you with details.... Just many opportunities for "flight or fight" episodes. I went to the body size sight and seems I should have taken the bullet a good while back as I am very small. Was there any electivity in your Nov surgery? I would like to just get it done if it needs to be done. That's what I did i in 1999..just do it. Don't like living like a walking time bomb... Any thoughts based on your experience?

 

[The Thief]

There was some electively, or else I would have had it sooner, like in september. I chose November out of convenience with work. I kinda wish it was done already though. I'm looking forward to be on the road to recovery.

 

[Sunshine susan]

I will be learning in November what I can expect. Good luck to you and keep us posted! My recovery first time was not a difficult process... Back to work in 6 weeks full time and not slowed down since in 1999! Will keep you in my thoughts and prayers!