Dilated Aorta...

[robojerry]

Hi everyone,
Hope you're all well or well on your way to getting there!
I've not posted on here for a long time but I know that over the past decade or so this place has been of great comfort and a font of information regarding all things valvey, and is always my first port of call if I have any worries, concerns or intrigues.
So I had AVR for a bicuspid valve 9 years ago at the age of 23. I went for a check-up today (apparently it was my first in 3 years!), and the valve is looking fine but the doctor did mention that my aorta (not the root but the bit past it, if that makes sense) was dilated at 4.1cm. Now this was the first I've heard of it so I'm a bit lost. They said that when I had an MRI 2.3 years ago that the aorta was at 4.1cm at that point so there has been no change over that time. He didn't seem overly concerned and we scheduled an appointment for 12 months time. I asked if it was a matter of "when rather than if" it would get worse and he said that it was "an if, with a but", in that it won't necessarily get worse but there's a higher chance that it will simply because of my medical history.
Does it all just simply mean that I've got a non-progressive dilated aorta? And the worry is that because its already 4.1cm, if it does begin to dilate further it will become an aneurysm much more quickly?
I asked lots of questions but you always think of more important ones on the way home, and the key question here is that could it have been at 4.1cm or thereabouts before the operation and hasn't progressed all that much over the 10 years post-op?
I know that no definative answers can be given because its all a bit vague but any info or advice would be greatly appreciated.
Thanks!

 

[pellicle]

Hey robojerry

I had my valve replaced at about 28 with a homograft and about 20 years later the aorta dilation drive a reoperation.

The only way to know what's going on is to keep monitoring yearly (which may well mean an MRI to get a better reading), and take it as it comes.

It could well be that it settles in and stays ok for some years.

What sort of activity levels do you have?

PS I see from your bio that you are on warfarin, I infer from that the valve is a mechanical? If that's the case I understand better why you may not be anticipating another surgery.

All I can suggest is that if you do weight lifting with weights like half your body weight or so you may want to revise that down. It may make a difference (but that's conjecture on my part)

Best Wishes

​​​​

 

[AZ Don]

Does it all just simply mean that I've got a non-progressive dilated aorta? And the worry is that because its already 4.1cm, if it does begin to dilate further it will become an aneurysm much more quickly?
I asked lots of questions but you always think of more important ones on the way home, and the key question here is that could it have been at 4.1cm or thereabouts before the operation and hasn't progressed all that much over the 10 years post-op?

Only the future will tell whether your dilated aorta progresses or not and at what rate. While MRI's are pretty accurate, Echo's can easily be off by a couple mm, depending mostly on the technician and person reading the echo. In general aortic aneurysms tend to grow 1 or 2mm per year, but that can vary widely. I expect that dilated aorta's can grow slower or not at all. I think the dividing line between dilated and aneurysm is around 4.5cm. Although some of the criteria regarding aneurysms ignores body size, there are also Dr's and measurements that account for body size, so a 4.1 aorta could be more of a concern to a smaller than average person then it would be to a larger than average person. As far as the higher chance of it progressing, that's because something like 20% (I think, offhand) of people with BAV develop aortic aneurysms. This is much higher than the general population.

The reference to avoiding heavy weights above has to with the increase in blood pressure associated with heavy lifting, which puts more stress on an aortic aneurysm. In general, for those with an aortic aneurysm, very strenuous exercise is not recommended, especially heavy weight lifting. But moderate aerobics are recommended and lighter weight lifting can be fine. And this is for people with an aneurysm. The restrictions would be less to none at all for a dilated aorta. Bottom line, if you do a lot of very strenuous exercise that is a subject to bring up with your Dr.

 

[Warrick]

I'm sure I've read somewhere that the chance of aneurysm with BAVD is 50% - 65% greater than normal , mine was 4.1 cm last echo so who knows, bit like a garden hose I reckon, one day it's fine and next it's expanded (days stretched out years though bit longer than the average garden hose if you buy the cheap ones)