living with an aortic aneurysm

[jjay32]

The possability of aortic arch replacement is there, here is the ct chest angiogram findings:

There is dilatation of the ascending thoracic aorta. 3 cm above the aortic valve the aorta measures 4.65 cm in greatest transverse diameter. 5 cm above the aortic valve the aorta measures 4.4cm. There is mild ectasia of the innominate artery. The left common carotid and subclavian arteries are normal in appearance. At the level of the mid transverse portion of the arch the aorta is of normal caliber. The descending thoracic aorta is normal. There is no evidence of dissection or intramural hematoma.

I am not sure if the mild dialiation of the innominate artery is going to be a long term problem or not. I guess we will see with the next set of pictures!

 

[ctyguy]

Virtually everyone I have met that had a bicuspid aortic valve with stenosis (self included) needed a valve replacement. The only valve repairs that I am familiar with were due to regurgitation. The primary reason for this I think is calcification. I know my surgeon who is top shelf at Cleveland Clinic didn't even hesitate when I asked that question. He said that based on my valve opening (.9 cm) he was certain that there was not only calcification but that it was significant. He could also see it in the CT scan evidently. When my procedure was performed he told me that the calcification was even worse that he thought and that I was very fortunate because my valve was in bad shape.

 

[thenewmarket]

O.k., o.k.......my husband is one of those 130 AV REPAIRS done at Cleveland Clinic. Yes, it is humbling, frightening, and encouraging all rolled in on an emotional level. I would have to pull his records to give you all the numbers, etc. but prior to surgery we did not think a repair was possible. We had opted for a tissue valve for BAV but got a repair instead. Once in surgery, it was determined my husband's tissue was "very viable". It was possible to remove the small amount of calcification that was present and proceed with the repair. We are now eight months post surgery, and his latest echo was fantastic!

Will this repair last any longer than a tissue? God in His infinite wisdom is the only one who truly knows the answer to that question. We are confident in our situation that this was best for us, and we choose to live each day to the fullest with very grateful attitudes! We want to be that BAV repair that just has to be done one time. If not, we will accept what comes our way!

 

[MrP]

Jerome,
Seems to me you will require replacement of your ascending aorta up to the the innominate artery to avoid another possible surgery down the road (semi-beveled technique where a portion or tongue of Dacron extends into the bottom part of the arch), and therefore, deep hypothermia circulatory arrest will be necessary during resection of your aneurysm. The bypass machine is turned off during this critical period. An experienced aortic surgeon will be able to reduce the time during which the bypass machine is turned off. This is the surgery that I required, and Dr. Coselli in Houston was able to reduce this critical window to just 14 minutes. He is amazing and one of the top three aortic surgeons in the world with an excellent track record. On the west coast, Dr. Miller at Stanford is an excellent aortic surgeon. You may have a very good local surgeon available as well. Ask the local surgeon questions about DHCA and their track record in this area. If a total arch replacement is required, there's increased risk of paraplegia. So, you want to ask questions about criteria your surgeon will use to determine if this necessary or not.

All my best,
MrP

 

[Susan BAV]

Another member here (Harleygirl) fairly recently received a repair for her bicuspid when her aneurysm was repaired (with a graft) but I don't recall whether her valve was in a stenosed or regurgitating state.

 

[csutherland]

I haven't been on for a few days and this thread is new to me. After reading it all, it scares me to death that you still aren't on BP meds! Jerry had AVR 6 yrs ago, then 3 yrs ago a 5.3 ascending aortic aneurysm was detected. He is not BAV. They did a 3-mo checkup for the 1st two times, then 6-mo, and now it's yearly. It has not grown at all. He's on 4 different BP meds. They want to keep it at 110/70. I would think that given your BAV that BP control would be even more critical. Your BP is way too high.

 

[jjay32]

Had my appointment with my GP today. blood pressure at the office was 110/80 right arm. that was down from 127/82 last visit. At work I have been using one of the pharmacy machines on left arm. Those readings are in the 140/82 average. So could be different arm or calibration of the machine? I think I will get a home unit that I than can calibrate with the doctors office. I have made a great effort in trying to eat healthier and it seems to be paying off-- I am down 10 Lbs! Now I must keep it up! I will be going to have a consult with a surgeon on June 9, to see what he says my game plan should be. He is with the group I was looking at so they are the experienced surgeons for Spokane. I did get a copy of my echo, lots of stuff to figure out what it means! It showed:

Left atrium--mildly enlarged

right atrium--normal

mitral valve--trace mitral regurgitation. No stenosis, no prolapse, minimal anterior and posterior MAC. Thickening at the attachment of the anterior leaflet

tricuspid valve--trace regurgitation, no stenosis, no prolapse, mild pulmonary hypertension.

Inferior vena cave-- dilated (>=5o% collapse/16-20 mmHg)

Aortic valve--mild aortic insufficiency, mild stenosis, bicuspid valve

Pulmonic valve--trace regurgitation, no stenosis

Aorta-- dilated sinus of valsalva, dilated ascending aorta.
(left heart measurements -sinus of valsalva 4.3cm, mid-ascending 4.8cm) [ct scan showed mid ascending at 4.65cm]

Some of the measurements of the aortic valve itself:

pl velocity 2.2 m/sec
peak gradient 19mmHg
mean gradient 7 mmHg
Transvalvular TVI 57cm
valve area 1.9 cm2
valve area index 0.9cm2/m2

Final interpretation:

1. normal left ventricular size and systolic function. Mild concentric hypertrophy.
2. Mild diastolic dysfunction
3. normal right ventricular systolic function, with borderline increased size.
4. left atrium: mildly dilated
5. right atrium: normal
6. Valves:
Mitral valve: thickened anterior leaflet- appears to be due to the aortic regurgitation jet.
Aortic valve: bicuspid, moderately sclerotic, mild stenosis
Tricuspid valve: mild regurgitation
Pulmonic valve: normal structure with no significant regurgitation
7. Pulmonary pressure is moderately elevated
8. Normal appearing pericardium
9. Moderately dilated ascending aorta.

any insight on what this all means let me know! I have learned alot from reading posts, and I do thank you all for your help in how to get informed and in control of your own health.

 

[67walkon]

Your valve size is pretty good. I was doing 50+ mile bike rides when mine was down to 1.0cm.

I think AHA reccomends aneurism repair at 5.0.

The surgery isn't nearly as frightening as you might think. 10 months after surgery, I feel perfectly normal.

Watch your BP, monitor the aneurism and make your own informed decision.

 

[Duff Man]

You're getting close to needing the aorta replaced but it sounds like your valves are decent.

Everything about my aortic valve says moderate.. It's better to see "trace" or "mild".

 

[ALCapshaw2]

Since you have a dilated Aorta, I recommend asking any Surgeon you interview how much experience they have with Surgery of the Aorta (including Root, Ascending Aorta, and Aortic Arch). This is NOT run-of-the-mill Heart Surgery, and is best left to the Experts in the Field.

Any Cardiologist / Surgeon worth his salt will want to monitor the diameter of your Aorta (at multiple points) on a frequent basis (at least every 6 months) to look for progresssion. At 4.8, you are approaching the range of recommendation for replacement / repair surgery. Note that not all aneurisms wait until the magic 5.0 cm to disect or rupture. Our moderator, Ross, had an aortic disection at 4.8 cm. You do NOT want to go there!

'AL Capshaw'

 

[jjay32]

The surgeon consult is on June 9, and thanks to this forum and great group of supporters, I feel that I have enough knowledge to ask the right questions. I want the BP addressed and estimation of when surgery is appropriate in my case.

 

[Mike C]

You may want to ask for losatran.

its a blood pressure mediciation but als has shown some positive resutls in marfan mice with anearyusms.

its approved for blood pressure and it just may make your aorta a little more stable.

mike