CT Results in - Opinions Requested on 4.4 cm aortic root

[ron]

Hello Everyone,

I have a bicuspid with severe stenosis (0.8 cm). I am symptomatic.

Just got my CT results in, and the cardiologist says my aortic root is 4.4 cm. He says that this is a "grey area" regarding surgery. Will they fix it on spot, or will they leave it and monitor it?

What do you guys think? I have heard something about the Bentall procedure and the Tuck procedure. I don't know much about either.

Today I am bummed out....

 

[ken taylor]

Well my arotic valve area is o.88 two months ago ascending artery 4.4 only symptoms are tired easy, and daily nap, with that said im having surgery next week in Houston, I pushed for the surgery, for me no use in playing the waiting game, I want my life to move forward, not deterate! good luck.

 

[ron]

Well my arotic valve area is o.88 two months ago ascending artery 4.4 only symptoms are tired easy, and daily nap, with that said im having surgery next week in Houston, I pushed for the surgery, for me no use in playing the waiting game, I want my life to move forward, not deterate! good luck.

Thanks Ken,

I made a mistake - no symptoms right now.

So you are going to replace the valve and the ascending artery? have you spoke to surgeons? What are they recommending?

 

[Bina]

Just a few weeks before OHS my valve was measured at .8 cm and during the pre-op cath I was told that the root
was somewhat dilated but I never asked for the figure. Anyway, surgeon wanted to evaluate the root in surgery
and I woke up with a new valve and original root.
Sometimes the root will have too much damaged tissue and must be replaced, other times it has dilated
due to excess pressure from the stenotic valve.

 

[ken taylor]

I meet with the surgon next week wed. may 25th surgery the next morning, After what ive learned and because This will be my 2nd OHS, I would hope he replaces the acending arotic, Do not want a 3rd a few years out from now . By the way, The cardiologist would have waited until I showed severe symptoms. I said I felt worse than I do and told them do it now or I will go shoping for surgery now some where else. I think if we have no symptioms , because of insurance or there libility they waite for symptoms. Im sure if I had not told them I have symptoms I would still be on hold. Hope this helps.

 

[ron]

Just a few weeks before OHS my valve was measured at .8 cm and during the pre-op cath I was told that the root
was somewhat dilated but I never asked for the figure. Anyway, surgeon wanted to evaluate the root in surgery
and I woke up with a new valve and original root.
Hello Bina,

Thanks for your input...

Sometimes the root will have too much damaged tissue and must be replaced, other times it has dilated
due to excess pressure from the stenotic valve.

I am not sure if my aortic root is damaged or just dilated from stenotic valve pressure.

At this moment, I feel that I would prefer to fix the root now rather than have to come back later...

 

[ron]

I meet with the surgon next week wed. may 25th surgery the next morning, After what ive learned and because This will be my 2nd OHS, I would hope he replaces the acending arotic, Do not want a 3rd a few years out from now . By the way, The cardiologist would have waited until I showed severe symptoms. I said I felt worse than I do and told them do it now or I will go shoping for surgery now some where else. I think if we have no symptioms , because of insurance or there libility they waite for symptoms. Im sure if I had not told them I have symptoms I would still be on hold. Hope this helps.

Hello Ken,

I agree with you. I want to get this surgery over with. Looks like we are in the same boat....

 

[jklump]

My valve was .8 also and I was only slightly sypmtomatic when I had it replaced 3/4/11. The CT showed my asending aorta was 4.6. Surgeon said no sense doing it twice so , I now have a dacron graft. 11 weeks post surgery today......... feeling great!

 

[ron]

My valve was .8 also and I was only slightly sypmtomatic when I had it replaced 3/4/11. The CT showed my asending aorta was 4.6. Surgeon said no sense doing it twice so , I now have a dacron graft. 11 weeks post surgery today......... feeling great!

Thanks for your input.

Now I am hoping that they do both at the same time. I don't want to sit in the waiting room on this thing if they choose to leave it alone.

 

[bdryer]

Hi Ron

I want to get my two cents in also. As an Aircraft tech I'm all about preventative maintenance and being proactive. Get your root and AV valve replaced together. Another reason is that you can get an AV valve with the ascending aorta attached. This eliminates a heap of extra work/stitching for the surgeon.

Know that because I required a graft of the ascending aorta [not the root] along with an AV implant, my surgeon recommended I go mechanical. To me it made no difference as I was going mechanical regardless. Some manufactures are producing both mechanical and biological valves with the ascending aorta attached. Hence what ever your choice of valve composition you can find an AV with the ascending aorta attached.

My AV was replaced when I was at .5cm2 and the ascending aorta aneurism was 4.6 cm at age 55. I've got a 23mm On-X implanted. At two months post op, I'm feeling great! I wish I would have had the valve replaced years ago! Don't be bummed, your going to get a fix. Concentrate on what is going to be implanted. Hell we all wish we did not have to go this but we did and it ain't that bad. Good luck and let us know what type of valve you are leaning towards. Us VR folks like to debate the pros's and cons of valve composition. Got to run, my warfarin fix is calling me!

 

[ron]

Hi Ron

Know that because I required a graft of the ascending aorta [not the root] along with an AV implant, my surgeon recommended I go mechanical. To me it made no difference as I was going mechanical regardless. Some manufactures are producing both mechanical and biological valves with the ascending aorta attached. Hence what ever your choice of valve composition you can find an AV with the ascending aorta attached.
QUOTE]

Hello Bdryer,

Thanks for your reply! Your response has made me feel better about what I am facing here. I agree with your sentiment here. I prefer to chop the head off of this snake before it grows and bites me more.

So you have one piece then? I don't know what a 23 mm On-X is, but I am assuming that is a mechanical valve that extends upward to substitute for the aorta that is being replaced...

 

[bdryer]

Hey Ron

Good news, you are are a teacher and know how to do research! This will be invaluable for your up and coming AV and aorta root replacement.

All right, lets answer your questions. First off, I did not have the root replaced. The aneurism was above the root. IE it was further down stream of the root. The surgeon had to remove a section of the aorta above the root and below the aorta arch. He accomplished a graft with synthetic material. Thus my aortic valve was replaced as a separate task from the graft of the ascending aorta. Your procedure will encompass the replacement of the aorta root which attaches to the aorta valve as a singular procedure. Know that associated cardiac arteries attach to the root. The surgeon will have to reattach the associated cardiac arteries to the root.

What is a 23 mm On-X? On-X is the valve MFG, just like St Judes or Carbomedics are valve MFG's. 23mm is the area of the valve. A normal human valve opening is about 2.5 cm2. Lets move the decimal of the 23mm On-X and bingo, the area is 2.3 cm2. Mechanical valve areas are in odd numbers. Starting around 15 mm up to about 27 mm. The surgeons want to implant as large a valve as possible without damaging the annulus of the heart or injuring the adjacent nerves. The larger the opening of the annulus the > blood flow to the body.

I chose the On-X AV valve for several personal reasons. I also went mechanical to avoid a reoperation. In turn I elected a life time of anticoagulation therapy. I am going to encourage you to GOOGLE the various valve MFG's web sites both mechanical and biological. This way you will familiarize yourself both pictorially and literally with what's available. You can also use the VR.ORG search in the "valve selection" forum and read the discussions. After a little research, valve choice and aorta root replacement will make more sense and you will better understand what we may offer or debate. Come back and fire your questions at us. In a couple of hours you will develop a good familiarization with the choices.

The On-X site has a great section on the, "Surgeons Discussions of the On-X Heart Valve". You will actually listen to the surgeons discussion. It is very interesting and enlightening.

Ok Ron, theirs your home work. Their is no pass or fail, but you take away only what you put into it. We'll see back here very soon I'm sure!

 

[ron]

Hey Ron

Good news, you are are a teacher and know how to do research! This will be invaluable for your up and coming AV and aorta root replacement.

All right, lets answer your questions. First off, I did not have the root replaced. The aneurism was above the root. IE it was further down stream of the root. The surgeon had to remove a section of the aorta above the root and below the aorta arch. He accomplished a graft with synthetic material. Thus my aortic valve was replaced as a separate task from the graft of the ascending aorta. Your procedure will encompass the replacement of the aorta root which attaches to the aorta valve as a singular procedure. Know that associated cardiac arteries attach to the root. The surgeon will have to reattach the associated cardiac arteries to the root.

What is a 23 mm On-X? On-X is the valve MFG, just like St Judes or Carbomedics are valve MFG's. 23mm is the area of the valve. A normal human valve opening is about 2.5 cm2. Lets move the decimal of the 23mm On-X and bingo, the area is 2.3 cm2. Mechanical valve areas are in odd numbers. Starting around 15 mm up to about 27 mm. The surgeons want to implant as large a valve as possible without damaging the annulus of the heart or injuring the adjacent nerves. The larger the opening of the annulus the > blood flow to the body.

I chose the On-X AV valve for several personal reasons. I also went mechanical to avoid a reoperation. In turn I elected a life time of anticoagulation therapy. I am going to encourage you to GOOGLE the various valve MFG's web sites both mechanical and biological. This way you will familiarize yourself both pictorially and literally with what's available. You can also use the VR.ORG search in the "valve selection" forum and read the discussions. After a little research, valve choice and aorta root replacement will make more sense and you will better understand what we may offer or debate. Come back and fire your questions at us. In a couple of hours you will develop a good familiarization with the choices.

The On-X site has a great section on the, "Surgeons Discussions of the On-X Heart Valve". You will actually listen to the surgeons discussion. It is very interesting and enlightening.

Ok Ron, theirs your home work. Their is no pass or fail, but you take away only what you put into it. We'll see back here very soon I'm sure!

Thanks for the info. Much appreciated. Reattaching the coronary arteries sounds troublesome. I guess I have to have faith that a good surgeon can pull this off

I understand 23mm now. That applies to width as I see you explain it. I will definately review my options here, and get several surgeon opinions.

I have a question though...

How do they make the decision to repair the aoritc root, as opposed to replacing it? My cardiologist said that at 4.4 cm, I am in the "grey area."

Might they try to spare it somehow? If so, how would they do that?

 

[bdryer]

Good day Ron

I can only make the assumption that the decision regarding replacement, repair or electing to monitor is dependent on the surgeon and what data/stats are used for this determination. I'm certain you could interview X number of surgeons and find varying opinions. I would go with a surgeon who sides with what procedure YOU would like.

I can not comment personally on the aortic root sparing surgery.

Lets hope that other VR members with aortic root problems post their experience.

Ron, how old are you? Your age makes a huge difference in choosing the composition of a heart valve. IE MHV or biological.

 

[Duff Man]

I also have a 4.4cm aortic root. I can tell you for certain that IF i were having AVR due to stenosis today, I would absolutely without a doubt have the aneurysm resected while they're in there. That's just me though. The more savvy aortic surgeons seem to be more aggressive about when to resect the dilated aorta while already there.

 

[ron]

I also have a 4.4cm aortic root. I can tell you for certain that IF i were having AVR due to stenosis today, I would absolutely without a doubt have the aneurysm resected while they're in there. That's just me though. The more savvy aortic surgeons seem to be more aggressive about when to resect the dilated aorta while already there.

Hello Duff,

Thanks for the reply.

When you say, "have the anuerysm resected" do you mean have the aortic root replaced? I believe this is the Bentall Procedure, correct?

 

[Duff Man]

Yes, I meant the Bentall procedure when i said "have the aneurysm resected".

I've talked to more than a few surgeons about my aneurysm, and none of them feel it's necessary to go in at 4.3 or 4.4cm for JUST the aneurysm, but I did get the impression that they would want to operate if I also had moderate to severe stenosis as an indication for surgery already. I just happen to have mild stenosis, so they won't operate until the magic 5.0cm.

To be honest, I would be weary of a surgeon that didn't want to do the bentall's procedure at my diameter if surgery on the valve is already indicated for aortic stenosis. Of course I'm not your doctor and I'm not A doctor and this is just my layman opinion... but that's my impression.

By the way, being bummed about an aortic aneurysm is 100% completely normal. I found out about mine when I was 24 and I'm 28 now. The chances of one having a problem acutely at 4.4 cm aren't all that high, but it's still something that should be taken in to account if they're already cracking you open. Multiple surgeries are undesirable for most people

 

[ALCapshaw2]

Ron -

Given that you have BAV and an Ascending Aortic Aneurysm, THE Most Important thing for you to do at this point is to interview Surgeons and select one with LOTS of Experience dealing with those issues. Such surgeons are most likely to be found at the Major Heart Hospitals. The closest ones to you would probably be Stanford in SF and UCLA. Others of possible interest are the Cleveland Clinic, Mayo Clinic (MN), and the Texas Heart Institute (Houston).

Remember, it is the Surgeon who will ultimately decide how to address your aneurysm and not your Cardiologist (or any Cardiologist).

'AL Capshaw'

 

[ron]

Yes, I meant the Bentall procedure when i said "have the aneurysm resected".

I've talked to a more than a few surgeons about my aneurysm, and none of them feel it's necessary to go in at 4.3 or 4.4cm for JUST the aneurysm, but I did get the impression that they would want to operate if I also had moderate to severe stenosis as an indication for surgery already. I just happen to have mild stenosis, so they won't operate until the magic 5.0cm.

To be honest, I would be weary of a surgeon that didn't want to do the bentall's procedure at my diameter if surgery on the valve is already indicated for aortic stenosis. Of course I'm not your doctor and I'm not A doctor and this is just my layman opinion... but that's my impression.

By the way, being bummed about an aortic aneurysm is 100% completely normal. I found out about mine when I was 24 and I'm 28 now. The chances of one having a problem acutely at 4.4 cm aren't all that high, but it's still something that should be taken in to account if they're already cracking you open. Multiple surgeries are undesirable for most people

Hello Duff,

Thank you for clarifying. I just wanted to doublecheck that.

Good to know that I am not alone infeeling this way. I am not given to depression easily, and I am a very upbeat and positive person. Wehile I am not depressed right now, I am not jumping for joy either. Actually, I feel like I am in limbo. But I have to live my life no matter what. I don't want to stop making plans and living my dreams.

Thanks for the input, man.

 

[ron]

Ron -

Given that you have BAV and an Ascending Aortic Aneurysm, THE Most Important thing for you to do at this point is to interview Surgeons and select one with LOTS of Experience dealing with those issues. Such surgeons are most likely to be found at the Major Heart Hospitals. The closest ones to you would probably be Stanford in SF and UCLA. Others of possible interest are the Cleveland Clinic, Mayo Clinic (MN), and the Texas Heart Institute (Houston).

Remember, it is the Surgeon who will ultimately decide how to address your aneurysm and not your Cardiologist (or any Cardiologist).

'AL Capshaw'

Al,

thanks for the info. I have an appt. at UCLA on thursday, and I will know more about my options then. I am going for a seond opinion to the Cleveland Clinic and a 3rd out at U of Penn.