Cleveland Clinic BAV/Aneurysm Surgery Forumla

[skeptic49]

I've been trying to find this formula for a while now.

An aorta that is enlarged and forming an aneurysm can be repaired, but at Cleveland Clinic we more often replace the damaged section with a section of plastic tubing that is sewn into position. The timing for repair of an aortic aneurysm is critical. When the valve is faulty and the aorta has enlarged to greater than 4.5 cm, we repair the aorta at the same time we repair or replace the valve. If the aorta has enlarged but the valve is still good, the optimal time to repair the aorta varies. At Cleveland Clinic, we have developed a special mathematical formula we use to determine this, based on the patient’s height and weight and the size of the aorta - surgery is usually recommended when the aortic cross sectional area in square centimeters, divided by the patient's height in meters is more than 10.

Source: http://my.clevelandclinic.org/heart/disorders/bicuspid_aortic_valve_disease.aspx

If I understand this correctly and my calculations are correct, here are two examples:

I am 6'5" tall, which is 1.96 meters. Currently my ascending aorta is at 4.5 cm diameter, which calculates to a cross sectional area of 15.9 cm2. 15.9 divided by 1.96 = 8.1 which is less than 10, not time yet for surgery.

If and when my ascending aorta reaches 5.0 cm in diameter it will then have a cross sectional area of 19.6 cm2. 19.6 divided by 1.96 = 10, which is the recommended trip point for surgery on my aorta.

I'm a taller than average person. Based on a person that is, say 5'10 inches tall, the calculations are different. A person that height will have a calculated formula factor of 8.9 when her aneurysm is at 4.5, still not yet time for surgery. However, when her aneuysm reaches 4.7 cm, her formula factor rises to 9.8, and when the aneurysm is 4.8 cm across, her forumla factor is then 10.2, and surgery would be recommended according to the Cleveland Clinic formula.

Interesting stuff.

Jim

 

[Ross]

Interesting yes. Thing is, I no longer trust formulas when it comes to aneurysms. Those deadly suckers have a mind of their own. They can stay the same size for years or suddenly enlarge and blow with no warning.

 

[Maryka]

I agree with Ross!

 

[rtblount]

Cleveland Clinic formula

Cleveland Clinic formula

I've been trying to find this formula for a while now.


Source: http://my.clevelandclinic.org/heart/disorders/bicuspid_aortic_valve_disease.aspx

If I understand this correctly and my calculations are correct, here are two examples:

I am 6'5" tall, which is 1.96 meters. Currently my ascending aorta is at 4.5 cm diameter, which calculates to a cross sectional area of 15.9 cm2. 15.9 divided by 1.96 = 8.1 which is less than 10, not time yet for surgery.

If and when my ascending aorta reaches 5.0 cm in diameter it will then have a cross sectional area of 19.6 cm2. 19.6 divided by 1.96 = 10, which is the recommended trip point for surgery on my aorta.

I'm a taller than average person. Based on a person that is, say 5'10 inches tall, the calculations are different. A person that height will have a calculated formula factor of 8.9 when her aneurysm is at 4.5, still not yet time for surgery. However, when her aneuysm reaches 4.7 cm, her formula factor rises to 9.8, and when the aneurysm is 4.8 cm across, her forumla factor is then 10.2, and surgery would be recommended according to the Cleveland Clinic formula.

Interesting stuff.

Jim

How do you calculate the cross sectional area? I am 5'5" tall(or short) and my ascending aortic aneurysm is 5.3cm. Is more info needed?

 

[Lynlw]

How do you calculate the cross sectional area? I am 5'5" tall(or short) and my ascending aortic aneurysm is 5.3cm. Is more info needed?

Without even looking at the formula, almost every surgeon would recomend surgery when the Aorta reaches 5, no matter how tall or short they are.

 

[Lynlw]

It is all so interesting and often amazes me just how much the doctors have to learn about each little part of the heart to make their decisions about when is the best time to operate based on benefit /risk (Not to mention how all the other organs can be affected)
Not that exact formula, but that is often the kind of things they have to do to decide when children/teens need surgery. Since they are growing and all different sizes, their bodies and all the internal organs size can change quite a bit in just a year, but the part they are watcching even tho it is a "larger" measurement, compared to the rest of the heart it can be pretty much the same.
So there isn't a certain number (like a 5 for Aorta in adults) cut off point that they can go by. Since your heart is roughly the size of your fist, and I was told when Justin had his surgery at 18 months, his heart was about the size of a walnut, something that sounds like it is very small by the measurement, could be huge compared to the rest of his heart. Then since different children are such different builds even at the same age, you can have a pretty tiny 5 year old or a pretty tall one, they have to figure out all kinds of forumulas to figure out when is the "right" time to operate. It would make sense that an annuerysm that is large in someone 5 foot, compared to the rest of their Aorta or heart, would be different in a person that is 6 foot tall.

 

[skeptic49]

How do you calculate the cross sectional area? I am 5'5" tall(or short) and my ascending aortic aneurysm is 5.3cm. Is more info needed?

Pi x radius squared....a 5.3cm circle has a radius of 2.65 cm so the cross sectional area would be 22.1 cm2 divided by your height in meters (1.65) = 13.4...which is way over the value of 10 surgery tripping point.

Jim

 

[rtblount]

Cleveland Clinic Aneurysm Surgery Formula

Cleveland Clinic Aneurysm Surgery Formula

Pi x radius squared....a 5.3cm circle has a radius of 2.65 cm so the cross sectional area would be 22.1 cm2 divided by your height in meters (1.65) = 13.4...which is way over the value of 10 surgery tripping point.

Jim

Thank you for the reply. By way of further info I had my bicuspid aortic valve replaced in 1997 with a St. Jude mechanical valve which has performed perfectly. About 4 years ago my cardio discovered that I had a 5.2cm ascending aortic aneurysm and he has been monitoring it every year since. Basically it hasn't changed in size in 4 years. His recommendation has been not to do surgery until or if it reaches at least 5.5cm. He regularly tells me that the surgery is something I do not want to have if it can be avoided. I just turned 72 years old last Friday and I am worried about waiting. The cardio seems to think that the aneurysm will not grow since the bicuspid valve has been replaced. I don't know what to think.

 

[Ross]

Thank you for the reply. By way of further info I had my bicuspid aortic valve replaced in 1997 with a St. Jude mechanical valve which has performed perfectly. About 4 years ago my cardio discovered that I had a 5.2cm ascending aortic aneurysm and he has been monitoring it every year since. Basically it hasn't changed in size in 4 years. His recommendation has been not to do surgery until or if it reaches at least 5.5cm. He regularly tells me that the surgery is something I do not want to have if it can be avoided. I just turned 72 years old last Friday and I am worried about waiting. The cardio seems to think that the aneurysm will not grow since the bicuspid valve has been replaced. I don't know what to think.

After having mine rupture, I certainly know how you feel about waiting. I have another now in my abdomen that were watching and if you think I'm not petrified after what all I've been through, well...................

 

[DavesMom]

Interesting thread, though I'm a math idiot and couldn't figure this out if I tried. I'm only 4'10", 85 lbs. and my ascending aortic aneurysm is 4.4. Anyone care to figure it out? : )

I am surprised at the comment about the aneurysm not growing if the bicuspid valve has been replaced. My valve was replaced and I had one aneurysm repaired in '99 and now I have another one. It hasn't changed in the three years since it was discovered but I can't imagine it won't change sometime in the future. Interesting.

 

[kpearse]

To me waiting is well, hard. I have a CT scan every six months. Sometimes It's on my mind, other times not. My aortic root is 4.3 and my ascending aortic aneurysm is 3.9. They say wait until that number 5. Sucks. Just saying....

 

[Duffey]

If you're someone who smokes, they usually lower the size recommendation. I think they drop it down to 4.5
Ross, before yours dissected, were you a heavy smoker?

 

[Ross]

At that time, I smoked, but wouldn't say heavily, not that it matters. When you could smoke at work, you'd be lucky to have 4 puffs out of a full cigarette.

 

[DavesMom]

Let me see if I got this straight. Remember, I'm a math idiot.

My ascending aortic aneurysm is 4.4, which works out to a cross sectional area of 15.20. My height (4"10") in meters is 1.47. 15.20 divided by 1.47 = 10.34.

Am I right?

I have a yearly CAT scan (well, last year I had a MRI/MRA), and have been told that the aneurysm is "stable," so I've tried not to be concerned. However, I'm taking this to my next cardio appointment because I don't think she has ever taken my size into account and - at least according to this - it may be a factor.

I trust Cleveland Clinic but you hate to base everything on these formulas because as we know these things have a mind of their own. They can blow early (as Ross found out) or they can go years without changing or causing a problem. So who knows?

Trust me, after two OHS I'm not looking for another one but as Ross said, it's hard not to be petrified just knowing it's there!

Have to tell you guys I got a big laugh, though. When I googled "What is 4"10" in meters?" one of the answers was "short." Yeah, I know. I know.

 

[rtblount]

After more than a year since you did this calculation for me I am preparing to get a surgical assessment from the Cleveland Clinic. I will let you know how it comes out.

 

[RobThatsMe]

Interesting yes. Thing is, I no longer trust formulas when it comes to aneurysms. Those deadly suckers have a mind of their own. They can stay the same size for years or suddenly enlarge and blow with no warning.

Yuppers.. My doctor told me this years ago. Dissections and aneuryms can stay the same size, dorment for years, then WHAM!
They are not predictable. IMHO, If you have one and it has grown to a point that the doctors are wanting you to have checkups every 6 months, that's the first warning sign. Use some time to get as healthy as "Safely" possible, and then take action and get it fixed while you are strong enough to take on the surgery. There is a reason that aneurysms and dissections are known as the silent killers.

Here is a very recent article on this topic.

http://abcnews.go.com/Health/HeartH...-spur-early-treatment-saved/story?id=14511569

Rob

 

[Lynlw]

Yuppers.. My doctor told me this years ago. Dissections and aneuryms can stay the same size, dorment for years, then WHAM!
They are not predictable. IMHO, If you have one and it has grown to a point that the doctors are wanting you to have checkups every 6 months, that's the first warning sign. Use some time to get as healthy as "Safely" possible, and then take action and get it fixed while you are strong enough to take on the surgery. There is a reason that aneurysms and dissections are known as the silent killers.

Here is a very recent article on this topic.

http://abcnews.go.com/Health/HeartH...-spur-early-treatment-saved/story?id=14511569

Rob

Rob, thanks for the link, My Mom had surgery for her AAA so i'm always interested in hearing word getting out about them. I went to the ORg (mainly because i wanted to find out about the cool suspenders to be honest ) they were talking about and there is a link for free screenings for AAA http://www.findtheaaanswers.org/get-screened/aaa-screening-locations-amp-events/ You have to check often since they add events.

altho these are just for abdominal, it certainly couldnt hurt to get checked, especially if you have other annuerysms or in your family.

 

[rtblount]

After 6 years of having an ascending aortic aneurysm measuring during various ct scans at 5.2 or5.3cm I am now scheduled for surgery at the Cleveland Clinic on January 23, 2012. Dr Lars Svenssen will do the surgery. The formula referred to relating the area of the aneurysm to height was significant in deciding it is time to operate since I am only 5'5" tall(or short). will try to give a report after recovery.

 

[nanc107]

When to replace aorta - calculations

When to replace aorta - calculations

I was told I needed a new BAV but they were not going to address my root at this time. That concerns me since I don't want two surgeries. What is the best way of assessing the root? They have not done a CT scans yet on this only MRI/MRA without contrast.

I don't get how to do the Cleveland calculation I see on this website. Can someone calculate for me?
I am 57, 5' 3", 115#, ascending aorta is 3.7 cm, valve area 0.9 cm2 per surgeon. Can someone do the Cleveland calculation and let me know the results? Doesn't the valve area mean severe stenosis?

I am concerned no one is assessing any aneurysms around aorta. I have had a Brain MRI and it shows chronic ischemia. The neurologist said it was due to my bad valve. Has anyone been told this and what tests do they do to tell if the ischemia is from the heart?

I know lots of medical questions. Can't get into Mayo until Feb. 23, waiting is driving me crazy. I would appreciate hearing from any of you that have had experience with these things.

Thank you.

 

[Mom2izzy]

I get 6.7 (cross sectional area of 10.75 divided by height in meters, 1.6m).