Questions about my condition and future surgery

[JCC]

Greetings,

I am new to the forums. I have found them very helpful to me. It is comforting to hear your stories and experiences. Here is my situation and questions:

I was born with a BAV. I have always known that someday I will need a replacement. Last year at my yearly Echo my cardiologist told me my valve will last me another 5 years at least. I am currently 41 years old. A month ago I went in for this years echo and the story changed. My valve is still the same but now they see an ascending aortic aneurysm, measured at 4.8 in the echo. So they ordered a CT scan to get an exact measurement. I had the CT scan this past Wednesday and it shows the aneurysm at 5.2. So now I am looking at surgery as soon as I am ready. Maybe even this month. There is also a third issue that I have not seen mentioned in any forum. The aneurysm has also started in the first of the three arteries that comes off the arch of the aorta. So the surgeons want to do three steps in my surgery. First is to replace the valve, second is to replace the part of the aorta with the aneurysm. The third is to detach the three arteries and re-attach them to the new section of aorta that they are putting in. They want to do step three to avoid future complications and future OHS.

The first two steps of VR and Aorta replacement seem to be very common. I see many people in these forums who have had them both done. The third step is the most concerning to me.

So my questions are: Has anyone had an aneurysm affect their arteries that come off the aorta? Has anyone had them removed and attached to the new section of their aorta? All three seem like a lot to do all at once. Would it be best to do all three steps at this point?
Any info and advice is greatly appreciated.

Thank You

JCC

 

[Mentu]

JCC, welcome to VR. It not uncommon for those of us with valve problems to have multiple issues. I can only tell you what my surgeon said "One surgery is better than two and it is better to operate before it is an emergency." If you trust your surgeon, you already know what you are going to do. If you do not trust your surgeon's advise then you should be seeking another opinion. Let us know how things are going with you.

Larry

 

[Jason]

I had the first two issues that you have, which is what led to my surgery as well. My valve was still in the 'good' range on it's way to 'bad', but the aneurysm developed quickly and forced the surgery. I did not have any issues in the arch or the arteries, though, so don't have any experience there for you. My guess is that the doc is looking at how quickly your aneurysm developed in the aorta and is thinking that it would be best to address all three issues at once. If it were me, I would personally agree, as I wouldn't want to risk having to have another surgery so soon after. That being said, I have no medical basis for my gut feeling, and I agree that if you are unsure, a second opinion cannot hurt. LEt us know what you find out or decide.

 

[mainframe]

JCC, sounds like a Bentall procedure. Several folks including me (#2) have had that procedure. Make sure your surgeon has lots of experience.

 

[scott.eitman]

I have to guess that many of us have had this done, but may have never asked for that much detail. For me, I have to assume the process for installing a homograft involves all three steps. I have yet to have any discussions with that surgeon.

 

[JCC]

I meet with the Vascular surgeon this afternoon. He is the one that will perform step #3. Hopefully he will put me at ease a bit and answer all my questions.

 

[kfay]

It certainly sounds like it is time for surgery, as others have said, it's better to do it before it is an emergent situation. The most important thing at this point is making sure you have a very good surgeon who has done many of these. You don't want a cardiac surgeon who does mostly CABG with only a few valve surgeries a year. I would most likely seek out a second opinion from another surgeon just to make sure you are in the best hands.

 

[Sarah_Louise]

Welcome to the boards
Good luck for this afternoon, hope you get your questions answered, and your mind put at ease & a bit more of a plan
Love Sarah xxxxx

 

[dhudson]

Wow you got alot on your plate all of sudden. Best wishes and good luck, I will pray for you.

 

[JCC]

Yes, it has been a lot to take in. Very overwhelming but I know it has to be done. I should have a set surgery date within a few days.

 

[TheGymGuy]

Similar situation here. For 30 some years monitoring BAV, and all the sudden this year - surprise you have an ascending aortic aneurysm of 4.8cm or about so. For about 10 years I knew that the valve was in a condition where this would be coming, the great news is that it's all fixed now, I am 3 weeks post up and things are moving in the right direction.

Best advice most people would give you, me included, is to find a surgeon that is very experienced with Aortic work. What my cardiologist said to me once was that any surgeon can install your valve and do it well, but it takes a specialist to work on your aorta. I bypassed a larger hospital and surgeons that do several hundred surgeries a year, and I opted in for a local hospital that is smaller and is not as well known. However, my surgeon's main area of expertise was aortic repair. I trusted that he would be able to look at the aneurysm and test everything and make a decision as to what needs to be replaced and how so that we do not have to revisit it later.

Also, try to interview your anesthesiologist and pick their brain as much as you can.

 

[kschul]

Hello JCC,

I had a valve sparing aortic root replacement. I had a tricuspid valve, but had an aneurysm. It is common when you have this type of procedure that they take off your coronary arteries with what is called coronary buttons and replace them back onto your new Decron graft. I did not have an aneurysm in these arteries, but you may be having the same type of procedure done.

 

[Superman]

Mine may have been similar. I had two of the three arteries that came off the aorta that actually came off at the same spot in what looked like a 'Y' shape, only picture a short, fat base. Pretty sure they were detached and sewn on to my graft. I have a final check up with my surgeon in May, I'll have to get a refresher on what they did.

It is broken down into three steps to explain what they are doing, but there really would be zero benefit and actually more harm cracking you open three times to do each step individually. Think of it like an oil change. You wouldn't make three trips to the mechanic to have them change the oil, change the oil filter, and change the air filter. You just take care of everything that needs work while they're in there digging around.

 

[Jason]

I don't think JCC is talking about the coronaries, which is what a Bentall procedure will replace and is quite common. My understanding is that he is talking about the innominate or brachiocephalic artery (I had to look it up)which is the first artery that takes off of the arch. This feeds the right carotid and the right subclavian. I have a co-worker who has an aneurysm developing at this point, but haven't personally heard of anyone that was having an aneurysm develop at the root and further up the arch, at the same time.

 

[Superman]

I don't think JCC is talking about the coronaries, which is what a Bentall procedure will replace and is quite common. My understanding is that he is talking about the innominate or brachiocephalic artery (I had to look it up)which is the first artery that takes off of the arch.

Not sure if this was a reply to mine, but that's what I was referring to as well. The right carotid and right subclavian take off from the aorta as one, then branch out. On mine, the left carotid and left subclavian took off the same way, only with a wider base. So instead of the three arteries coming off the top, I only had two. I know he had to attach them to the graft, I just can't recall if he attached the left base, or if he cut the base out as well and attached the individual carotid and subclavian arteries in a more conventional fashion.

 

[JCC]

Thanks everyone for sharing! It's great to know I am not alone.

Superman, yes that is exactly what I have. They will be attaching a second graft that looks like a pair of pants to the new section aorta graft, then they will attach the first two arteries to the smaller graft. Then the third artery they will bypass/reconnect in another area of my chest. The vascular surgeon who will be doing the above steps did a good job of explaining and set me at ease a bit. He says he does this type of work all the time, my situation of having all three steps done at the same time is not so common but the technique and work they are doing is very common.

The two surgeons are available next week. I may go in as early as Monday. They want to do an angiogram on Monday, keep me in the hospital and have the surgery on tuesday. This is all happening so fast...but I don't see any reason to wait any longer. I am getting past being terrified and am starting to feel confident about the surgery.

 

[escargome]

Best Wishes to you JCC. You are right. It sure is happening fast, but better to get everything taken care of and start your new lease on life. Take Care:biggrin2:

 

[njean]

Keep thinking positive thoughts!

Wishing you the best of luck! Godspeed!

 

[Sarah_Louise]

Good luck for monday
Love Sarah xxx

 

[Boston Tiger]

Best wishes as you get ready to head in, JCC. It's great that they caught things in time and that you'll be looking at a simple (but also complex) fix for your problem. It is amazing what heart surgeons can do nowadays!