Pseudo Aneurysm

[Bill Hall]

Hi All - I was hoping someone had some information on this subject. I recently had my echo which revealed something. So, they had me do a CT scan which showed an aneurysm on my aorta. They thought that it was along the souture lines where my aortic valve was replaced back in 2001. I have read many postings, but I never heard about this pseudo-aneurysm. I am seeing a surgeon tomorrow. If anyone has information about this, I would certainly appreciate it.

 

[Susan BAV]

There's a member here, I think it's Rachel Howell maybe, and false aneurysm is in her signature. I don't know anything about it but maybe you could look for her posts and/or PM her. She posts pretty often so I think she'll probably see your question though. What do the doctors tell you that you need to do?

(edit - I looked her up: Rachel_Howell and her repair of a "false" aneurysm was in 2004.)

 

[Arlyss]

Pseudoaneurysm

Pseudoaneurysm

The wall of the aorta is made up of 3 layers. With a true aneurysm, all three layers are intact and the wall is bulging.

A false or pseudoaneurysm is where the layers have been disrupted by something - one or more layers are just not there anymore. You can imagine that this is even more delicate than a "regular" aneurysm - there is less tissue in place to hold together.

The link below gives a general overview of the aorta, and there is a paragraph about pseudoaneurysm under "Aneurysm Types". It mentions that "These aneurysms are more unpredictable, with a higher tendency to rupture at smaller sizes."

http://www.cedars-sinai.edu/3866.html

There are a number of references in the medical literature. Here is one from the Mayo Clinic

http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=16798195

I hope you can be referred to "extra specialized" aortic surgical expertise for this. Perhaps Rachel will chime in on this thread. If she had not gone to Dr. Coselli, or one of the few other surgeons with very specialized skill in this country, she would not be here today.

I am so sorry you have this and give you my very best wishes as you seek the help you need,
Arlyss

 

[LUVMyBirman]

Our long lost friend Bill! Hope you are doing well.

Would suspect that most tests could give a false positive. Have had it happen....not in the regard of the aorta. Other heart measurements. I would find out which test would be appropriate to give you a close to definitive measurement.

Good luck and keep us posted!

 

[Bradley White]

Hi Bill,

Arlyss gave a good description of a 'pseduo' or 'false' aneurysm. As she stated they have a high tendency for dissection and are thus treated very agressively in most instances. I believe they are most often found in patients who have had an AVR with a homograft and also somehwhat common in those who have a bioprosthetic valve. A few instances have been reported in mechanical valve recipients and in a few people who have not had an avr.

I am glad you are meeting with a surgeon, let us know how it goes.

Brad

 

[Bill Hall]

Thanks for the replies. I was in LA on a business trip when I originally heard this news. Then, I was scheduled for vacation time on the Outer Banks, NC, where I am now (coming home today). Since it seemed important, I delayed my departure and scheduled an appointment with this surgeon. He didn't show up after 3 hours, so I left and will reschedule. Since I handcarried the CD with the CT scan, I don't exactly know what he would be able to tell me. I think it is better to let him have time to look at the CT scan and then he can tell me something meaningful. My valve (aortic homograft) is 6 years old and I wondered if it was a good time to have it replaced (if they recommend surgery). They would have me already open. I don't know much about the failure mechanisms of these homografts, so if anyone has information, that would be greatly appreciated.

 

[LUVMyBirman]

I may be way off base....but ould the hemograph be causing the pressure on the aorta? i.e. maybe it is time to have the valve replaced? Did they access your valve?

 

[Bradley White]

Hi Bill,
The pseudo aneurysm is most likely occuring in the homograft tissue that was implanted. These pseudo aneurysms tend to occur much more commonly in homograft tissue then in one's own natural tissue, likely due to some sort of degradation that occcurs between the death of the donor and the time of implant into the recipient. Assuming that the pseudo aneurysm is occuring in the homograft tissue they will likely have to replace the valve and remove all of the homograft tissue. Simple repair of these aneurysms in homograft tissue does not often occur.

In the first few years after homograft implantation failure is most often caused by an acute immune reaction or a pseudo aneurysm. As time progresses, these causes of failure take a bake seat to structural deterioration as they main cause for explantation. This structural failure is thought to be caused on low level immune attacks on the valve over its life span that cause calcification and most often regurgitation in the homograft.

I imagine they might want to give you mechanical valve due to this complication. Good luck. Let us know how it goes.

Brad

 

[Arlyss]

Hi Bill,

What was your original aortic valve like - was it bicuspid or some variation of leaflet malformation?

You want to get some very clear answers about what is going on in your body - is your aorta abnormal also? It is all about the connective tissue that makes up your valves and blood vessels. From your profile, you had issues with both your mitral and aortic valves. Did anyone give you an underlying reason for problems with both valves?

If you have delicate connective tissue, I do hope you have the resources to find the most skilled aortic surgical hands, that have done this type of redo operation in the past. In the mean time, keep your blood pressure controlled and no heavy lifting - to keep pressure/stress off the false aneurysm.

Wishing you the best,
Arlyss