Bicuspid Aortic Valve and possible future aortic dilatation

[BionicBuddy]

Hi again. Does anyone have any data on the possible development of aneurysm/dilation in someone with BAV with severe asymptomatic stenosis needing repeat surgery for this problem alone?

Hubby is leaning toward mechanical because one and done is very appealing, but one and done may not be one and done, because as the cardio said to us, you can't change DNA. What does the science say about this likelihood of happening despite SAVR? (cardio said that SAVR or no SAVR would not make any difference in the development of possible future aneurysm/dilation)

We saw the cardiologist yesterday and we are preparing for surgery in the next 3 - 4 months after the coronary angiogram is done and to eventually meet the surgeon and discuss options. It's definitely sobering after watching and waiting for 22 years. But it's also sobering laying my head on his chest and listening to that incredibly loud systolic murmur that increases at late peak systole.

I just wanted to say, that I've read so many of your stories on this site. You are all heroes with great tenacity. I have so much admiration for all of you and thank you for sharing your wisdom, knowledge, experience and stories.

(Yesterday's report: aorta sinus 36 mm, aorta sinuses index 19 mm/m2, prox asc aorta 37 mm, Prosc asc aorta index 20 mm/m2 and normal is < or = to 19; I'm going to dig up his results from 20 years ago to see if it's stable or has been on the incline)

 

[Lucker]

Hello, thanks for your kind words. The statistics are all over the place, but with these dimensions at 60+ YO the aneurysm is rather unlikely, AFAIK.

 

[tom in MO]

Anyone can get an aneurysm in many places. People with BAV have a heightened risk, however I was told "don't worry be happy your BAV is fixed."

I do some isometric exercises (Charles Atlas ones) and the cardiac nurse said to always breath, don't hold my breath when exerting during exercise. She said this was due to my slightly higher risk of a aneurysm due to the connective tissue defects in BAV people.

 

[Dano64]

I don't have the data handy, but I did read some of those studies last year linking BAV with future ascending aneurysms, because that is what happened to me. My cardiologist did not warn me about that at all, so it surprised me. I think it is worth researching somewhat when making a decision. Best wishes on a successful future surgery!

 

[Lucker]

Anyone can get an aneurysm in many places. People with BAV have a heightened risk, however I was told "don't worry be happy your BAV is fixed."

That's true, Debakey himself had a dissecting aneurysm at 90+ and he most certainly hadn't BAV. But again, the dimensions now look reassuring.

 

[Lynn]

I had an annual follow up with my cardiologist last week and ask him this very question. My aortic root is in the normal range for my age and has not progressed in size for several years. He said, based on my age (60) if I was going to develop and aneurysm there would likely be some signs of it by now. He said, while it’s still possible, he thinks it’s very unlikely at this point. Also said that though aneurysms often occur in people with BAV, not everyone gets them-you either do or you don’t. His words; stating the obvious But I get his point. This jives with what my surgeon said two years ago prior to surgery. Incidentally, my aortic root measure .2 smaller on my last echo than it did prior to surgery. Likely just a difference in how it was measured, but good news all the same.

 

[BionicBuddy]

He said, while it’s still possible, he thinks it’s very unlikely at this point. Also said that though aneurysms often occur in people with BAV, not everyone gets them-you either do or you don’t. His words; stating the obvious But I get his point. This jives with what my surgeon said two years ago prior to surgery. Incidentally, my aortic root measure .2 smaller on my last echo than it did prior to surgery. Likely just a difference in how it was measured, but good news all the same.

You make a good point.

The following is only my observation of BAVers on this forum. Those who needed re-ops due to aneurysms appear to have been younger (less than 50). I haven't seen any over 60 who needed a re-op for aneurysm with an intact valve at that age. Maybe there are?

Our cardio said that the risk for aneurysm/dilatation in BAVers is high. We didn't ask what "high" meant, nor in what age bracket, etc., but we will surely be asking him again as well as the surgeon.

Chuck wrote a great post here:

https://www.valvereplacement.org/th...ic-aneurysm-from-dr-birdi.889078/#post-924310
With older people they seem to give a little more leeway with dilatation and the lack of need for surgical repair even when measurements head north.

I understand your "good news". With very severe AS at present, hubby's last echo showed a 0.1 cm improvement. Very likely only just procedural discrepancy, but psychologically, every little bit helps!

 

[Superman]

We didn't ask what "high" meant, nor in what age bracket, etc., but we will surely be asking him again as well as the surgeon.

Thing is, it can be 10x higher than the general population and still be rather small odds statistically.

I was 17 when I had my valve replaced and 36 when I had my aneurysm repaired. I’m 50 now. But I don’t feel a day over 49. Just for reference.

 

[Lucker]

Our cardio said that the risk for aneurysm/dilatation in BAVers is high. We didn't ask what "high" meant, nor in what age bracket, etc., but we will surely be asking him again as well as the surgeon.

This "high" means a lot higher than with a tricuspid valve, but still less than 50%.

 

[Lucker]

With very severe AS at present, hubby's last echo showed a 0.1 cm improvement. Very likely only just procedural discrepancy, but psychologically, every little bit helps!

It almost never shrinks, but a lesser occasional measurment speaks for a probable stability, which is great.