BAV related to aneurysms?

[jax3172]

I've been doing some interesting research (in and of itself scary) that says that there is a statistical relationship between BAV and less than perfect arteries. It seems that the aortic valve and the arteries come from the same early "crest" cells, and that BAV and ascending aortic aneurysms may come from the same defect as opposed to the former causing the latter. I am learning so much - maybe too much!!! A little knowledge can be dangerous. It seems that people with BAV have a higher incidence of aneurysms in areas other than the aorta.

So my question is this: do any of you know if there is a test to determine if you had rheumatic fever as a child (antibody test or something) or if your valve is bad due to a genetic defect in which case you might want to be on blood pressure and or blood thinners meds even if you get a tissue valve? Or is that a really stupid question because if you need a valve job, then who cares how you got there?

 

[karlaosh]

Definitely NOT a stupid question, although I don't know the answer.

My bicuspid aortic valve was detected when I was a baby. Apparently I had a pretty loud murmur very early on by my pediatrician. I lived near Mayo Clinic, where their pediatric cardiologists confirmed bicuspid aortic valve disease.

 

[PJmomrunner]

Hi Jax.

Absolutely NOT dumb questions. What have you been reading?

Your suggestion that BAV people be on blood pressure meds makes sense to me, given what I've read about BAV aortic tissue. I'm not sure what the benefit to blood thinners would be?

Wouldn't it be great to have a bunch of CT surgeons and/or cardiologist monitor this forum?

 

[savysmommy]

I have both a BAV and an ascending aortic anerysum. They must be related... Just found out a few months back.. but have known about a "murmur" forever. I have low blood preasure, always have.

 

[windsurfer]

Would impact tests

Would impact tests

Excellent question. It would impact tests being given if cardiologists believed in the close association. I've been getting echos since 1998 for aortic stenosis and never has any cardiologist suggested I even get a test to see if I have an aneurysm and therefore change the pre AVR medications and perhaps timing of surgery given the higher risk from such.

Bobco

 

[epstns]

If your cardio does not react to the relationship between BAV and possible aneurisms, I would look for another cardio. My first cardio never even identified my BAV, instead writing my stenosis off to age. Hah! I was only in my mid 50's at the time. For numerous reasons, I fired the first cardio. The second had an echo done, detected the "probable" BAV, then ordered a full set of X-Rays to view the aorta for possible complications. Fortunately none detected so far, but at least I know he's watching.

 

[PJmomrunner]

The association between BAV's and aortic aneurysms IS well documented. (These are just a few papers. I searched PubMed for "bicuspid dilated aorta" or "BAV aneurysm"

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=12970255&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=9631276&query_hl=5

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=12694773&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/...&dopt=Abstract&list_uids=12694773&query_hl=12

http://www.ncbi.nlm.nih.gov/entrez/...&dopt=Abstract&list_uids=15791031&query_hl=14

http://www.ncbi.nlm.nih.gov/entrez/...&dopt=Abstract&list_uids=15541263&query_hl=17

And there IS evidence of aneurysms elsewhere in BAV people, but this is all I found:

http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=7570751&query_hl=1

 

[jax3172]

BAV related to aneurysms?

Great responses - thankx all.

For you AVR "veterans": have any of your surgeons suggested that your ascending aortic aneurysms (for those of you who had one in addition to your valve problems) were related to your genetic BAV condition? I'll see if I can dig out the study showing the correlation between AVR patients and other unrelated aneurysms in both them and family members.

By the way, anyone know of a test to confirm that a person had rheumatic fever at one time?

 

[tobagotwo]

You can check in the VR References Forum for more information on BAV syndromes as well.

You do not develop BAV: it's congenital. You can have BAV and get Rheumatic Fever, but Rheumatic Fever or other heart-damaging viruses and bacteria (endocarditis) will not give you BAV.

Best wishes,

 

[mmarshall]

not sure about the rheumatic fever issue but the bicuspid is related...or at least in my case. my bav was detected when i was a week old and my latest cardio broke it down to me. i had two "murmurs" related to my aorta. the valve was bicuspid and the aorta was not fully developed which caused the regurgitation....which then causes the aneurysm over time. i was put on lisinopril earlier this year...yea i kinda put it off on seeing my cardio the last 6 years. i was put on that to take some pressure off of my heart working over time....left ventricle was severly enlarged and aortic root was at 4.5 now have a tissue valve and i am only on 81mg of asprin and 20mg lisinopril daily...i go see my cardio this thursday and they may be taking me off of the lisinopril so just daily asprin.

 

[jax3172]

was the rheumatic fever a red herring?

was the rheumatic fever a red herring?

Tobago gave me some real food for thought. Was I born with BAV or did the rheumatic fever ding the valve and make it bicuspid. His clear response was that I was most likely born that way and rheumatic fever ("BAV is genetic...") does not turn a perfectly good valve into a BAV. This is very enlightening, to say the least.

Now I am wondering if I ever really had Rheumatic Fever (RF), and if so, what harm did it do to my heart that wasn't already done by the genetic BAV condition? I will ask my surgeon next week if there is some sort of test to see if I ever had RF, and if so, should I get it.

So one of the original discussion points still remains: Are surgeons (or cardios for that matter) acknowledging a correlation between BAV and arteries that are more prone to aneurysms (arteries in general, not just aortas)? If so, what medications or checkups or life style changes are being suggested?

Gee, I feel like I'm in grad school!

 

[Ashley]

How do you know?

How do you know?

Hello all,
Just finished reading the thread -- interesting! I have a few questions. I have a BAV - congenital. I have read a lot of stuff that relates to BAVs and aneurysms, but I don't fully understand what the relationship is. And when you say that people with BAVs have a higher risk of developing other aneurysms, does this only relate to the heart, or your whole system? So far as I know, I have never been detected to have an aneurysm associated with my aortic valve. Is this something they can only see when they open you up? Would a cath, chest xray and multiple echos identify it? Can it develop later, and if so, why would it develop? I have only ever been told that I have aortic stenosis (.8). My cardiologist has never made mention of other complications - but is this something that I should ask about? Is it possible that my only complication would be severe stenosis? Is the potential risk of developing an aneurysm a reason to think about surgery?
Thanks so much - and sorry for all the questions. So curious now!!!

 

[jax3172]

BAV and aneurysms

BAV and aneurysms

Ashley,

I just posted this on another thread but it deals with your question:

I found the following article that suggests that there is a correlation between less than perfect arterial tissue, in general, and BAV:

http://stroke.ahajournals.org/cgi/content/full/26/10/1935#R43

I quote: "...The familial occurrence of spontaneous arterial dissections and BAV suggests a common developmental defect. The aortic valvular cusps and the arterial media of the aortic arch and its branches are derived from neural crest cells, suggesting that a neural crest defect may be the underlying abnormality in these families."

Very interesting!

I guess the point in the journal article is that individuals with BAV and families of those individuals are more prone to "other" types of aneurysms. This is interesting stuff. In response to Rachel, I can't believe that any cardiac surgeon would even think about replacing an AV without "replacing the timing belt while he was in there" - doing something to the aorta itself.

But the bigger question remains: are we folks just more susceptible to aneurysms because of our genetic condition, and if so, what checkups, meds, or life style changes should be considered, regardless of surgery? And are the cardio surgeons and/or cardios all up on this???

 

[jax3172]

Racel's 2nd operation and same old question

Racel's 2nd operation and same old question

Racel,

I'm curious. At the time of the first surgery, did the surgeon not see the ascending aortic aneurysm or did it balloon after the first surgery? Also, why did your first VR go bad? I have to ask an obvious question: did you use a different surgeon the second time?

I would love to see the other part of this thread explored that concerns susceptibility to aneurysms (in general) for BAV patients, and what you all are hearing from doctors on this, including meds, life style, frequency and type of periodic diagnostic tests, etc.

 

[coryp]

not sure about the rheumatic fever issue but the bicuspid is related...or at least in my case. my bav was detected when i was a week old and my latest cardio broke it down to me. i had two "murmurs" related to my aorta. the valve was bicuspid and the aorta was not fully developed which caused the regurgitation....which then causes the aneurysm over time. i was put on lisinopril earlier this year...yea i kinda put it off on seeing my cardio the last 6 years. i was put on that to take some pressure off of my heart working over time....left ventricle was severly enlarged and aortic root was at 4.5 now have a tissue valve and i am only on 81mg of asprin and 20mg lisinopril daily...i go see my cardio this thursday and they may be taking me off of the lisinopril so just daily asprin.

What has your blood pressure been like sine the surgery? I am taking 80 mg diovan (1 time daily) to keep it at 105 or lower.

My dr. feels that this is most important for the tissue.

 

[Mary]

I think that there is confusion about bicuspid arotic valve and BAV syndrome.
I copied the following from one of PapaHappyStar's posts that appeared about a month ago. Burair says,


I am not an expert, I can try to put down my understanding of research into bicuspid valves I have picked up and read since I've been diagnosed with aortic valve stenosis due to a congenitally bicuspid valve.

Two of the causes of congenital bicuspid aortic valves are:

-- a glitch in early embryonic development leading to a fusion/malformation of the aortic valve leaflets

-- a genetic problem usually involving a tissue disorder that makes the aortic tissue 'stretchy' and different from normal tissue

There maybe more -- but most papers seem to suggest these are the main possibilities for a bicuspid valve.

What complicates things is there is no agreement that the presence of an aortic aneurysm necessarily means you have the 'stretchy' tissue abnormality. The aneurysm may be due to the creation of a high speed 'jet' of blood from the blocked valve striking the sides of the aorta. There is some indication that an ascending aortic aneurysm due to possible tissue problems is present more often in people with aortic valve leakage ( regurgitation ), but there is no real way of identifying causes on a case by case basis, maybe they will come up with a clear genetic signature for a genetic bicuspid valve soon and be able to test for it. I havent heard of anything so far...

I hope this helps the discussion.
Mary

 

[mmarshall]

when i saw my surgeon last friday it was 96...and that was in the surgeon's office...lol i have been having some pretty cool head rushes when i get up since about a week after the surgery so that is why they are thinking that i will either be taken off the lisinopril or have it lowered to 10mg....plus i think my cardio wanted to keep my bp in the same range...100 to 110...but that was before surgery. i will find out for sure this thursday. i have not seen my cardio since surgery so this thursday will be the first checkup with him. but that is all that i am taking now...asprin and lisinopril. i was taking protonix for 3 weeks but finished that last friday....also took 400mg of advil for 1 week for anti-inflamatory but that was finished a while back.

 

[Ashley]

I think that there is confusion about bicuspid arotic valve and BAV syndrome.

Thanks Mary,
I think you are right - I am definitely confused. The info from Burair however has cleared that up a bit for me. I don't think I have BAV syndrome, but rather a bicuspic aortic valve. Although even about that I am not sure. The info is helpful though, thank you. I am learning so much every day!

 

[kmc]

I have BAV and ascending aortic aneursym with surgery scheduled for July 7. I have been to two cardiologists and 3 surgeons until I settled on the one to do the surgery and the one to take care of me afterwards. My understanding, though I may be wrong, is that a BAV does not in itself cause the aneurysm but it is a good indication that you have a connective tissue disease that makes the wall of your aorta supceptible to an aneurysm. Not every one with a BAV gets an aneursym. Nor does evey BAV person have connective tissue disease. The odds are just increased. We lucky ones born with a BAV must be more vigilant with ourselves and our families because it is hereditary. An echocardiogram is the best way to detect aneurysms, once found CTs and MRIs are done. Kevin

 

[windsurfer]

another cause of "BAV"

another cause of "BAV"

Great discussion. My dad had "BAV" and and AVR at 74 about 2 years after I was diagnosed with BAV. But the surgeon said his was a fused trileaflet. Later another cardiologist thought my echo looked like a fused trileaflet. It is my understanding that the fusing is caused by some damage to the surface layer and the normal healing process causes calcification or fusing of the leaflets. That also may be the reason why some "BAV" are not congenital e.g RF, or fen-fen diet drug or perhaps inflammation where the base of the leaflets rub when inflammed (think of the donut hole shrinking when it becomes inflammed and the bases of the leaflets rubbing due to the tighter fit),,...

However, I think it is difficult to distinguish between congenital BAV and subsequently environmentally induced fusing just by an echo when caught at a late stage. Perhaps only after surgery do they really know.

But just the same, if the jet stream of the stenosis can weaken the aorta when your peak gradient exceeds a certain level - in my case over 70 mmhg then it seems we should be managing our blood pressure as a preventative effort and go to surgery sooner than is often recommended. I'm on no BP medications. One of my cardiologists feels I should avoid surgery until symptoms appear - perhaps a year or so from now despite the latest echo showing 0.7 cm2 and 70mmhg peak. I'm talking to surgeons now regardless of his recommendations.

Bobco