BAV, CTD & scans

[Davidr]

I have just seen my cardiologist...interesting meeting...

Bear in mind that this is a government hospital, so we weigh clinical practice with costs...

I asked about risk factors for Connective Tissue Disieses and bicuspid aortic valves.

First question - is the fact that I had a BAV an additional risk factor which should indicate a higher INR? - nope! You no longer have a BAV, since it was replaced (can't argue with that logic)

Second question - high association between BAV and Aortic Aneurysm, what tests should we do to rile it out? - you had an echo a month ago to check function of valve, etc...this also looks at the aorta, and no indications of problems...will repeat approx every 2 years...aortic aneurysms don't develop overnight, and so there should be little risk, if any!

Third question - what about an MRI, to be sure. (I found this interesting) MRI is contra-indicated with a mechanical valve! Can be done, but not ideal...CAT scan is better!! Not indicated at all if echo is clear! No need to worry!

Fourth question - what about cerebral Aneurysm? - answer - good point!!! Hadn't thought of that!!! Let's do either an MRI or a Contrast CAT scan...MRI is contra indicated, but CAT is fine!!

I am in the queue for a CAT scan of my head to rule out this problem...

I'd be interested in others opinions of this!

David

 

[skeptic49]

Hi David,

I'm pre-op, but my surgeon did order a CT Scan of the chest to evaluate the entire aorta. It was reassuring to learn that, while I do have an enlarged ascending aorta, my arch and descending aorta is normal. I don't know your age, but if your echo indicates no enlargement of the aorta, I would probably hold off on a chest CT scan until later to minimize radiation exposure. I do think it is a good idea to get a brain scan since you are BAV.

Best wishes,

Jim

 

[Lily]

David, somewhere I think I read a study that indicated a lower INR target was preferable for some patients with known bicuspid-related connective tissue issues.

Anyone else remember that? Or please correct me if I'm wrong.

 

[Lionheart]

David,
The first three questions seemed like good questions with reasonable answers, but I'm confused by the 4th question. Maybe I've missed some of your other posts that describe an issue, but do you have symptoms or indications of cerebral aneurysms? Or are you trying to do a preliminary check to make sure that you are not at risk for these? As far as I know CAT or MRI scans are not Standard procedures for BAV patients. I have BAV and no one has mentioned that I need to check for cerebral aneurysms. Am I missing something?
Thanks
John

 

[Lynlw]

David,
The first three questions seemed like good questions with reasonable answers, but I'm confused by the 4th question. Maybe I've missed some of your other posts that describe an issue, but do you have symptoms or indications of cerebral aneurysms? Or are you trying to do a preliminary check to make sure that you are not at risk for these? As far as I know CAT or MRI scans are not Standard procedures for BAV patients. I have BAV and no one has mentioned that I need to check for cerebral aneurysms. Am I missing something?
Thanks
John

John, there have been a couple threads about BAV and brain annuerysm lately, here is one of them http://www.valvereplacement.org/for...26-Relationship-of-BAV-and-Cerebral-Aneurysms

David
As for Mechanical valves and MRIs. I haven't heard mechanical valves are contra-indicated w/ MRI. You should get a valve id card and it says that the valves are MRI compatable and usually says what machine setting should be. Here is a pdf about St. Jude valve and MRIs http://health.sjm.com/heart-valve-answers/daily-life/~/media/SJM
Health/HVA/PDF/Checklist_Questions%20PDFs/MRI_Safety_Information_2.ashx

 

[Lionheart]

Thanks Lyn

 

[jake]

Evaluation and my trips to the hospital

Evaluation and my trips to the hospital

Howdy all:

Great information so I figured I would toss my two cents worth in. When I was diagnosed it was initially done because of a heart cath that revealed the aortic aneurism. They send me immediately for a surface echo which only confirmed the aneurism, and also found the bi-cusped valve. The surface echo showed the aneurism to be a little over 5 cm smaller than the following CT scan which I was sent for after the echo. Now, let’s take it one step further! One hospital used a 2 dimensional view of the aorta on the CT and evaluated 4.6 cm. 6 months later, I returned to have another image taken and was complaining about the radiation exposure associated with a CT every 6 months so they decided to give me an MRI with gadolinium. This showed the aorta at 4.2 cm. Either my aorta shrank or more likely the different imaging accounted for the different size estimation. This forced them to have to compare geographic futures of the aorta for comparison.

Fast forward to a one year CT with 3 dimensional software enhancement and now it was a benefited 5.0 cm. I also had a follow up TEE (Trans-esophageal Echo) and that said 4.6 cm on the aorta. At this point, I am having symptomology (pain in chest, back, shoulders, etc) so now its go time.

What does it all mean? You will get different imaging size if you different imaging systems. You CT scans from 2 different hospitals and they will be different. You can have 5 different radiologists read the CT and get several size estimates. Different images + different radiologists = different results. The bottom line is that if you have an aneurism that is over 4.5 cm on ANY image, you should be concerned. If you have a Bicuspid aortic valve, your risk factor goes up significantly. If you overweight, a smoker, a drug user, or very physically active or you have a job that requires lifting more than 50 lbs, your risk factor for dissection goes up exponentially.

Let’s take a step back and add also that many countries with socialized or governmentally controlled health care and a lot of private insurance companies DO have criteria on when an aorta can be replaced if they are going to pay for it. I don’t know if this is true or not but I was told that in Italy, their government health care stipulates that a person less than 5cm (non bicuspid) and 4.8cm with bicuspid is not eligible for surgery. Again, I don’t know that for sure, but here in the USA, I know for a fact some insurance companies will put you through the ringer to get an aorta replaced at less than 5 cm unless a surgeon strongly recommends it.

I hope my experiences will be of benefit to you and best wishes for whatever happens.

 

[normofthenorth]

The article at http://content.onlinejacc.org/cgi/content/abstract/55/3/186 may be helpful. Jake's "You will get different imaging size if you different imaging systems." sounds about right.

In other arenas (mostly my 93-or-94-year-old Dad's spine), I've been shocked at how Just Plain Wrong the results of MRI scans (and interpretation) can be. In Dad's case, he had the worst (and almost only) backache of his life, so eventually they sent him for an MRI. It showed a massive "shadow", which seemed to be a bone infection of the spine. They put him on huge IV doses of Penicillin to treat it, while debating whether or not to send him for emergency back surgery. A month later, they did another MRI, which showed that the infection had spread and grown. The debate for surgery intensified. One more month later, the third MRI essentially "proved" that the pro-surgery alarmists were right, and that surgery was Dad's only hope -- except by then Dad's back pain was improving, and he soon checked himself out of the hospital. He never had another backache, or another MRI (or surgery), until he died peacefully at 98.

One of Ontario's most famous back specialists, known popularly as "The Back Doctor" (and the author of a book by that name) said on a radio interview I heard, that you should send your worst enemy for an MRI of the spine, because it will very likely show a "false positive" -- as it repeatedly and very seriously did with my Dad. Maybe it's different with Aortas, but I'm going to stay MRI-skeptical until they win back my trust.