Is an aneurysm common for people with a bicuspid valve?

[Critter]

I have had an aneurysm since diagnosis and I have been taking increased dose of metoprolol and started Losartan, an arb agent which has been shown to be effective in keeping the aneurysm from growing. Has a proposed effect of keeping the connective tissue from rupturing by inhibiting an enzyme. Size of mine still remains at 4.3 cm.

 

[Jeff Lebowski]

I have had an aneurysm since diagnosis and I have been taking increased dose of metoprolol and started Losartan, an arb agent which has been shown to be effective in keeping the aneurysm from growing. Has a proposed effect of keeping the connective tissue from rupturing by inhibiting an enzyme. Size of mine still remains at 4.3 cm.

My aortic root aneurysm was 4.1 cm during aortic valve replacement surgery. The surgeon did not intervene in the aneurysm, I console myself that cardiovascular surgeons know better.

 

[Critter]

Surgeon told me and I have read that 4.5 is where you get it done. Judgement call at time of repair. I have a ct aortic angiogram every couple of years. Echo’s are inconsistent even in the hands of experienced sonographers. The angio looks at the interior dimension of the wall of your aortic arch. Important to visualize the intima of the vessel. Take losartan and up your beta blocker to as much as I can tolerate. Seems to be working running 3 miles several times a week. Here is a study that points to folks who have Marfan’s syndrome https://pubmed.ncbi.nlm.nih.gov/16601194/. These people have high incidence of aortic rupture and that is why I thought about talking to my cardiotron about it and he brought the same study up and we started me on 25mg. Few months ago I upped it to 50mg. I do not have history of hypertension, btw. This is for prevention of having my chest cracked open again.
Tony

 

[Jeff Lebowski]

Surgeon told me and I have read that 4.5 is where you get it done.

This is a very relative issue. Some surgeons talk about a limit of 5 cm or even 5.5 cm for aortic aneurysm surgery.

 

[Dano64]

I had BAV, first replacement 2001. Feb 2022 had ascending aortic aneurysm replaced and had my homograft valve replaced at the same time even though it wouldn't have needed replacement but for the aneurysm, which was at 5.1 I believe. My surgeon monitored me over 3 plus years until the aneurysm grew to 5.1. It is a big surgery, but at the right facility, they know how to fix this. Doing well now 2.5 years later. All the best to you!

 

[Critter]

Jeff, maybe the difference lies if you already have the hood open on car do you fix both? If someone is found at 4.5cm as outpatient then waiting to 5 is warranted. YMMV

 

[Critter]

Found indications for repair in UpToDate

condition Aneurysm diameter*
Sporadic (not associated with disease below)
Ascending ≥5.5 cm
>5.0 cm (ACOE and low operative risk)
Isolated arch aneurysm ≥5.5 cm
Marfan syndrome (MFS), familial thoracic aortic aneurysm/dissection (FTAAD), others¶
Without risk factorsΔ◊ ≥5.0 cm
With risk factorsΔ◊ ≥4.5 cm
Loeys-Dietz syndrome (LDS)
Without risk factorsΔ◊ ≥4.5 cm
With risk factorsΔ◊ ≥4.0 cm
Bicuspid aortic valve (BAV)
Without risk factorsΔ◊ ≥5.5 cm
>5.0 cm (ACOE and low operative risk)
With risk factorsΔ◊ ≥5.0 cm
Concomitant aortic valve surgery ≥4.5 cm

 

[Jeff Lebowski]

Jeff, maybe the difference lies if you already have the hood open on car do you fix both? If someone is found at 4.5cm as outpatient then waiting to 5 is warranted. YMMV

You are right at this point, but do not forget that there is also the possibility that your existing aortic aneurysm may not progress after mechanical aortic valve replacement surgery. No one can predict that. As in my case, my aneurysm was 4.1 cm when my valve was replaced. I thought like you and asked my surgeon why you did not intervene in my aneurysm during the same operation.
His answer to me was as follows: "During the operation, I saw that your aorta was a little thin and I decided to leave it as it is"
To be honest, I could not say anything against this explanation, after all, this is his speciality.
However, I think we should also take into account that every intervention in your body can bring different risks. For example, in abdominal aortic aneurysms, sometimes the grafts can slip from where they are located.

 

[Critter]

Absolutely, less is better if you can do it. I am glad I have my native vessel and how it will respond to normal physiologic stresses. Replace that segment and you lose some neurological connections that can affect your ability to respond in heart rate, vaso constriction/dilation, etc..