Bicuspid Aortic Valve & Aortic Disease

[Arlys]

I was so glad to find this website and hope that sharing my husband's experience may help others, particularly those with bicuspid valves. My husband had AVR surgery in 1990. He was very ill prior to surgery, but recovered well with his new Hall-Medtronic valve. We were told he was "fixed", and it seemed to be true until an echo 11 years later revealed an ascending aortic aneurysm. We were shocked, having no idea there was a risk of any problems with the aorta itself.
It is described in the medical literature. There is a risk of aortic dissection or rupture associated with bicuspid aortic valves. The August issue of the AHA journal Circulation has an excellent paper from the U of Toronto describing all aspects of this very well. The paper is fully available on the web at
http://circ.ahajournals.org/cgi/content/full/106/8/900?eaf
My husband's story is located on the aneurysm support group at
www.westga.edu/~wmaples/velebir_arlys.html
This may not seem like good news, but for those who know they have/had a bicuspid valve, once this is understood the aorta can be monitored proactively and surgery planned if necessary. I encourage you to take the Circulation article and discuss it with your doctor. It is important to be treated by those who understand and specialize in aortic disease. I suggest a major medical center which also has expertise in the Marfan's Syndrome, since the problem with the aortic tissue is similar.
The rupture of an aneurysm is deadly. I am one of the fortunate ones to still have my husband. Aortic disease is dangerous, but there is more hope and help today than ever before. I look forward to hearing from others, and welcome all emails and comments. Arlys

 

[srwieland]

Thanks Arlys.

Now I understand better why my surgeon wanted to replace my entire ascending aorta and root, even though there was only moderate root dilation.

 

[Arlys]

Hi Steve,
You were very fortunate to have a surgeon who fully understood your condition. If the surgeon had left the aorta, probably the best thing that might have happened would have been another complex surgery, and the worst would be aortic dissection, which many do not survive. In fact, the paper is not published yet, but there is a study where they recommend replacing the ascending aorta when the bicuspid valve is replaced, even if the aorta is not enlarged, because this is safer than the risk of aortic dissection or the risks of a second surgery.
Hope you are doing well. Arlys

 

[John Cochran]

Arlys,
Thanks so much for posting the American Heart Association clinician update. I just read the whole thing, and I was really stunned (my background is biomedical engineering). I had a bicuspid aortic valve, and had a replacement with a SynerGraft valve, root and conduit. I am right now considering myself very lucky. The research presented argues strongly against the Ross Procedure for those with bicuspid aortic valves, since the pulmonary valve may be predisposed to dilation.

The research also would indicate that those who have received mechanical valves to replace a bicuspid valve need to be continually monitored for aortic root problems and possible aortic dissections. For those who don't read the whole thing, the underlying premise is that bicuspid aortic valves are related to other possible aortic problems; the vavle is the symptom of a disease, not just a physical anomaly.

I sent this article to the surgeons with whom I regularly correspond...it will be interesting to hear their responses.

Thanks again, and best wishes for your husband.

--John