BAV w/ 5.1cm dilated aorta + new finding - Atrial Septal Defect ..anyone had similar?

[Cliffk17]

Hi everyone!
Wondering if anyone may has come across this situation that has now presented itself in my case? I am particularly wondering if this new finding will prompt surgery to take place sooner than later?

A bit of history:

2013
- Initial diagnosis of bicuspid aortic valve (BAV) and dilated ascending aorta 5.1cm (51mm)

2015
- aortic root dilated to 5.1cm (51mm), ascending aorta moderately dilated to 4.6cm (46mm) and aortic arch 3.5cm (35mm) ....unchanged from testing in 2014 and 2013
- Only trace regurgitation ....same as in 2014 and 2013
- Left ventricular ejection fraction rates "low/normal" ....2015 52% ...2014 and 2013 showed between 55-59%
- aortic valve showing mild sclerosis and no stenosis ....unchanged from previous years

In my most recent tests, as of the last couple weeks, the above 2015 results came back which I was pleased about being that there had been essentially no change in my aorta dilation. In Canada, recommended size for replacement is 5.5cm (55mm) unless there are other significant symptoms to accompany the dilatation.

The concerning part for me is that these recent tests now have uncovered an additional CHD (congenital heart defect). I have an apparent Atrial Septal Defect (ASD), also referred to as a "shunt". It is running from left to right. So oxygenated blood from the left atria is flowing through this hole into the right atria.

Other observations:
- Right ventricle is dilated. Apparently the basal portion is 4.4cm and the mid section is 6cm. I have no idea what is normal for comparison?
- Right atria is mildly dilated, left atria is normal in size
- Mild mitral valve sclerosis with trace regurgitation
- Tricuspid valve normal with no regurgitation

I have been lucky so far with avoiding surgery relating to my BAV and dilated aorta issue. I am wondering if anyone has come across something similar and whether this second finding will now prompt surgery to take place?

I have further testing upcoming, Cardiac MRI, transesophegal echo and Ejection Fraction testing to further determine the severity of the ASD.

Thank you for your time and feedback in advance. Just really trying to get a handle on how these latest findings may or may not affect my situation!!

 

[Bonbet]

CliffK17: I haven't been around here very long, haven't had my surgery yet for my severe BAV stenosis, so I'm no expert. I do have "patent foramen ovale" or PFO which just means that a hole between chambers (in this case atria) did not close at birth - as it is supposed to. It is the most common congential heart defect and in many cases it remains asymptomatic (depending on it's size and the amount of mixing occurring between oxygenated and unoxegenated blood.) Mine was discovered incidentally on my first or second echocardiogram. The surgeon says it is not significant but he will look at when he's in there to see if it is worth repairing. Also, my son, now 39, was born with ASD and had OHS at age 4 to fix it. And guess what? They no longer do that surgery as OHS, it is now repaired via a trans arterial procedure - typically femoral.
My son's mother-in-law had hers repaired a few years ago, without OHS! They can usually determine via your echo the amount of shunting and if is significant or not. So, the testing should give you some more info. But it is probably pretty low on the list of things to worry about. Good luck, Bonbet

 

[AZ Don]

I was diagnosed in 2013 with a (well functioning) BAV and 5.0 ascending aorta and 5.0 aortic root. In the US, at the time, the criteria for surgery was 5.0 so I had a valve sparing aneurysm repair shortly after diagnosis. The US guidelines have since been updated to 5.5. I can't tell you how your other conditions may affect your situation, though I think it is likely that surgery is inevitable and more issues can only move up the date. You mention that you were lucky to avoid surgery. Certainly OHS is not something that you want to rush into, but there are worse things and it was a relief to have my aneurysm repaired.

 

[cldlhd]

I was diagnosed in 2013 with a (well functioning) BAV and 5.0 ascending aorta and 5.0 aortic root. In the US, at the time, the criteria for surgery was 5.0 so I had a valve sparing aneurysm repair shortly after diagnosis. The US guidelines have since been updated to 5.5. I can't tell you how your other conditions may affect your situation, though I think it is likely that surgery is inevitable and more issues can only move up the date. You mention that you were lucky to avoid surgery. Certainly OHS is not something that you want to rush into, but there are worse things and it was a relief to have my aneurysm repaired.

I agree when I had my aneurysm replaced this yr it was supposedly 4.7 to 4.8cm but was more like 5 and the surgical report said the "aortic wall was thin" so I'm happy I had it done.