Questions for surgeons on 5.0 cm ascending aorta?

[afraidofsurgery]

I recently saw a new cardiologist, as my beloved cardiologist who saw me through a pregnancy and valve replacement retired. She wanted more information on whether my valve was bi-cuspid, and I informed her I was told after surgery it was a 'bicuspid with a poorly formed 3rd leaflet'. She informed me bicuspid valves are often accompanied by a dilated aorta with high risks of dissection, which I wasn't really aware of. So I agreed to a MRI thinking this was to check a box on her 'to do' list since my aorta was not dilated at surgery (10 yrs ago) and I have had no problems since surgery. To my shock, my ascending aorta is at 5.0 cm. So now I"m going to see a surgeon (and perhaps get a 2nd opinion) for their 'wait and watch' or 'repair' recommendation.

What questions should I ask? On my list are to understand what the repair would entail, what the outcome statistics are, and what the potential complications of this being a second surgery might be. Any others?

As I'm in the beginning phases of researching this whole topic, your input is appreciated.
Apologies I have not participated in this site since right after my surgery, this is an amazing group and helped me tremendously before my AVR surgery.

Patty

 

[pellicle]

Hi

... She informed me bicuspid valves are often accompanied by a dilated aorta with high risks of dissection, which I wasn't really aware of. So I agreed to a MRI thinking this was to check a box on her 'to do' list since my aorta was not dilated at surgery (10 yrs ago) and I have had no problems since surgery. To my shock, my ascending aorta is at 5.0 cm.

yep, she's right and the data suggests it ... I didn't know about it for my first two surgeries, but my 3rd was hastened by the discovery of an aneurysm (I was 48 at the time)

So now I"m going to see a surgeon (and perhaps get a 2nd opinion) for their 'wait and watch' or 'repair' recommendation.

I'm guessing, but I expect that they'll slate you in for another scan in 3 months, because they don't have enough data to know if its changing fast or not ... so I expect you'll need to just wait (calmly) till then.

What questions should I ask? On my list are to understand what the repair would entail, what the outcome statistics are, and what the potential complications of this being a second surgery might be. Any others?

FIrstly I'd say wait till you have more data. Then as to repair it will depend on where it is, but it may also involve a valve replacement too. That's not as bad as it sounds because the repair is essentially 90% of what one does for a VR, so why not just slot in a new valve too (and simplify sugery with a pre-attached valve & aortic riser).

Second sugeries bring a minor increase in the same risks you underwent with your first, because modern medical imaging has gone leaps and bounds since your first one (2005?) and they can assess and plan more easily to find stuff normally lurking underneath scar tissue (like nerves).

I'd just wait and see what they find (in the next scan) before getting fired up planning what may not happen quite yet.

Best Wishes

 

[afraidofsurgery]

My follow up scan is in about a week. In the meantime, I am now on metroprolol and was just prescribed losartan (bp still 140/95 on metroprolol) and a baby aspirin in addition to my coumadin for the mechanical valve. I feel over-exposed to the medical care system!! It's interesting the difference between the cardiologist's approach (very attentive, concerned, etc.) and the surgeon's (Nah, no need to worry, we're just gonna collect more scans and see what's going on here...). I could write a book.

 

[DDT77]

metropolol? Enjoying the nightly motion picture features? Fantastically creative dreams abound?

I had similar attitudes between cardio and surgeon. Interesting case for the cardio, and 'this isn't urgent' from the surgeon. But when you are the waiting room (figuratively) stress abounds. I didn't know about aorta dilation likelyhood with BAV until cardio said 'you have an issue here'! Resulted in referral to surgeon within a week, and surgeon said you can schedule surgery for anytime in next six months, after that, risks go up.

 

[afraidofsurgery]

Hmm no crazy dreams with metroprolol, although my dreams tend to be vivid and memorable anyway. I do feel more relaxed and 'mellowed' though!
My follow up scan showed no change so I am staying in the waiting room. Having been here before (for valve replacement), I've learned to stay in the moment and not stress about what could be. Although it is weird to know that the aneurism 'lives' in my chest. It's a reminder to enjoy and appreciate the day, there you never know when things might change. And to keep my job as my health insurance comes with it

 

[vitdoc]

I had aortic valve repair 1977 and 1983. Stable until 6.5 cm ascending aortic aneurysm discovered 2006. I had a relatively new and inattentive cardiologist who missed the enlargement on prior echo cardiograms. Given the large size the recommendation was to have surgery. I had a new aorta plus valve put in together. Developed third degree heart block requiring a pacemaker. Now 2019 so far so good. Did have a mitral clip placed 2016 for decompensated mitral regurgitation. It worked perfectly.
Today I biked 38 miles age 70. So watch it closely but even at 5.0 you have an increased chance of dissection. Not sure of the statistics of dissection vs aortic size. Also 5 for a male is different for a female. Go to a experience place with a good volume for the aorta. Significantly more involved than just valve surgery. Your brain is cooled since there is a period of time of non circulation with aorta surgery. Shorter time the better.

 

[afraidofsurgery]

Thanks vitdoc - didn't realize the surgical issues, yikes. Am waiting to get a copy of my CT images to get consults with a few other high-volume places. Bike on!

 

[DachsieMom]

My understanding is with bicuspid, rupture can occur at lower diameters. I am tricuspid but only 4 ft 10 inches so my aorta was considered small for a normal sized person but big for me (can’t recall exactly, but it was high 3 or low 4). I have the st Jude aortic valve conduit, which is the valve with tube (graft) attached. I am now four years out and have no restrictions. Regarding questions, I havent had a second surgery (and don’t plan to!) but I would ask if they plan to use a valve with Dacron graft attached. It’s true that it is more complicated and I believe only performed at certain center, but they are one complete unit. I assume that lowers the risk of leaks, but I am not a doctor.

 

[pellicle]

...Significantly more involved than just valve surgery. Your brain is cooled since there is a period of time of non circulation with aorta surgery. Shorter time the better.

just wanted to add (for the benefit of others) that while some people have the standard anatomy:

...others may have a non standard anatomy (which also complicates things more resulting in lengthened surgeries as observed above)

mine was bovine