BAV/AVR and Aortic Dissection - Is There A Link?

[Rush20]

I've been reading many internet based articles on Aortic Dissection due to the attention the condition received as a result of John Ritter's passing.

Although the web is a great resource (and great place to meet great people ) I find it difficult to believe everthing as, just in life, many conflicting arguments.

Anyway, has anyone on this board investigated the link of a Bicuspid Aortic Valve being a precursor to Aortic Dissection? Has anyone asked their cardios or surgeons? Similarly, has aortic valve replacement been linked? From what I remember in my crash course or "Heart 101" during the two weeks I went from diagnosis to surgery, the models and descriptions were not related. My next appointment with my cardio is in early March and I plan to ask him. My follow-up appointment with my surgeon was cancelled due to an emergency surgery he had to attend and I spoke with his assistant who provided generic information - nothing too specific to me or my condition.

All the press associated with John Ritter came after my surgery and to be quite honest, I wasn't very interested in hearing/reading about it due my own recovery and pain, plus I was really trying to stay positive. Only now do I feel compelled to learn more.

As always, your thoughts and feedback is appreciated.

 

[Ross]

Allen I don't really know if a bicuspid valve really has anything to do with it or not. I think that's more speculation then provable truth.

When mine ruptured, it did so just above the valve and it wrecked one of the leaflets. From what I read of the surgerical report, the surgeon used part of my pulmonary artery to repair the valve and then replace the dissection area with a synthetic graft. I continued on for 6 years before the valve finally went and it was replaced with a St. Jude Mechanical in July 2002.

While this doesn't exactly answer your question, perhaps you can use it as a case history?

 

[epstns]

I've read and been told by my cardio that those of us having bicuspid aortic valves "may" be at higher risk of aneurisms and dissection. As soon as the cardio read my first echo that stated "probable bicuspid valve" he ordered a set of chest x-rays to evaluate my aorta. The main condition prevalent among BAV patients is coarctation of the aorta (restriction or malformation of portions of the aorta) which may cause weaknesses that could lead to aneurisms.

The cardio also said that many times when they go in to replace a bicuspid aortic valve there is additional work needed to repair the aorta itself.

It pays to be observant.

 

[warnerd]

I have nothing to add that hasn't already been addressed in previous threads.
The John Ritter situation got me to doing some research basically asking the same question. "Does AVR replacement leave you at greater risk of dissection?"
After reading an article in Men's Health, discussing "regular" guys having dissection during weight lifting, really got me looking in to it. I couldn't find anything definitive. I scheduled an appointment with my cardio and told him what I was up to and my concerns. He told me that I was under no restrictions either in lifting or doing cardio work. He ordered a CT scan to make sure and help put me at ease. It came back fine. He did caution me that dissection is generally a catostrophic event and not chronic. That is my story. Others have stories that "contradict" this advice. I think that is why they call it medical practice. Dave

 

[DickV]

I?ve had both and asked my surgeon this very question some years ago. His comment was that there is a correlation but there are varying opinions. One opinion is that it may be genetic wherein some have a gene that causes both problems or effects one that triggers the other. I honestly do not think they know for sure but I do feel that in many one precipitates the other. IMHO..

 

[LKC]

There is an interesting article in the August 2002 issue of Circulation magazine (which you can access at www.Circulationaha.org) entitled "Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve," that concludes (among other things), "BAV malformations are inherited, particularly in males, and . . . the BAV is a disease of the entire aortic root and has a propensity for both valvular and aortic complications, often requiring surgery . . . ."

 

[Susan BAV]

Allen -

Being a female born with a bicuspid, my experience is a little more rare, however, I did quite a bit of reading on bicuspids before my surgery and, yes, as others have confirmed here, there can be a form of disease throughout the aorta. One form can be a coaractation, which I had repaired in my late teens, and even the aorta itself can be thin, weak, diseased. Catastrophic failure from dissection is not a nice thought. My cardio told me a couple of weeks ago that there are no restrictions for me now, such as how much weight I can lift (I don't lift weights but I do like to rearrange my furniture, etc.). I'm not sure I buy it though; I'm going to be more cautious than his recommendation. I've read other posts from ones with valve replacement and they have a 50 lb. restriction. The surgeon had a pathology done on a piece of my aorta that he removed during my surgery and he said it came back healthy but a "little thin." Like Ross, this may not answer your questions but maybe it's a little more information that might help. Best wishes, ~Susan

 

[Rush20]

Thank you for all your comments and suggestions. I will ask my cardio at me next appointment and plan to perform some more research.

I led a very active lifestyle prior to my surgery and although I'm starting to get back into my "old life", I'm being very cautious with my weight lifting exercises and I do not plan to max out anytime in the near future. I also subscribe to Mens Health Magazine and read the article mentioned earlier. Scared the *$&@*! out of me! However, it was also documented that there have been more exercise related tragedies as a result of aeorbic exercise (marathons, etc.) than weight lifting related.