Ross Procedure failed then St. Jude Mechanical now (15 years later) Aortic Aneurysm

[deanmenta]

In 1999, when I was 32 years old, I had a Ross Procedure to remedy my bicuspid aortic valve.
Six months later the new aortic valve ruptured and I had another surgery that resulted in getting a St. Jude mechanical aortic valve.
15 years later, now I am 47 years old, I have just been diagnosed with a "Aortic Pseudoaneurysm".
I had a brief communication with my surgeon (Dr. Vaughn Starnes USC) who thinks I will need surgical repair.
I will be meeting with him soon to get his full opinion of my situation.

Just wondering if anyone out there has had any similar experiences.

Thanks

 

[pellicle]

Hi

not sure how similar it is, but I had to have my valve replaced (which was a homograft) due to an Aortic Aneurysm, and now have a kevlar stocking over a ATS mechanical. I'm not sure what the pseudo implies there.

I understand that aneurysms are somehow more likely in BAV patients and I have wondered if its due to the arterial wall being weaker congenitally or if somehow the cutting and joining it results in there being a weakening. I doubt anyone really knows the answers to that.

I wish I could offer you more .. but I'm not sure exactly what information you're asking for.

Best Wishes

 

[Arne]

Hi Dean,

Did they explain why it ruptured?

 

[deanmenta]

The surgeon who read my CT scan said she thinks the anuerysm is stable for now, but ordered a second scan to see if there is any changes after a few days. I just had the second scan done yesterday and I'm now waiting to hear from her about what she thinks. I will report back when I hear.

Would love to hear from others with aortic aneurysm experiences.

 

[deanmenta]

Btw, I did not have a rupture.

The report in the first scan said "out-pouching near the aortic graft measuring 2.5 x 1.1 x 1.1 possible pseudoaneurysm
or aneurysm"

 

[river-wear]

Dean, I think that question was in regard to your first "new" aortic valve that you said ruptured six months after your Ross Procedure.

You'll find that many folks here have had an aortic aneurysm repaired - sometimes by itself and others at the same time as a valve replacement. Do you have any specific questions or concerns? I didn't realize it until I just looked it up, but sometimes they can do the repair via catheter using a stent and graft.

 

[deanmenta]

Aha - I don't recall any explanation for the rupture that caused my ross to fail back in 1999. sorry.
One of the leaflets did tear for whatever reason.

So, I have a lot of questions regarding aneurysm repair, but was hoping that someone my have had been in a similar situation as I am in and could possibly offer any advice.

I just spoke with the surgeon who read my second scan.
The determination was that the bulge hadn't changed in the time between the 2 scans (5 days) and therefore she is recommending that I meet with Vaughn Starnes in 2 weeks (he is on vacation now) to get his opinion of what should be done. She did say - when I pressed her - that she would go ahead with surgery to repair the aorta but thinks is it safe to wait until I can consult with Starnes. Unfortunately, I am not very reassured by her advice. I am worried about rupture - she explained that since I have not shown any physical symptoms that she is not concerned. However, from what I can gather this condition rarely present symptoms until it is too late! I will be calling her back tomorrow to hopefully get a bit more clarity.

Any other information form you all would be greatly appreciated.

Thanks!

 

[deanmenta]

One quick question> does having a synthetic aorta require coumadin ?
this is if I end up having my mechanical worked on as well and somehow end up with a tissue valve.

 

[pellicle]

One quick question> does having a synthetic aorta require coumadin ?
this is if I end up having my mechanical worked on as well and somehow end up with a tissue valve.

If a tissue can take an aortic graft I think you may not need ongoing warfarin, but uncertain if A goes with B. Of course you may still require warfarin even with a tissue valve post surgery anyway ...

 

[deanmenta]

I'm thinking maybe I could be a candidate for TEVAR procedure, but that's just me speculating.
I'll be meeting with Vaughn Starnes tomorrow to get his assessment.

 

[deanmenta]

Dr. Starnes is reccomending I have surgery to fix my pseudo aneurysm.
I am scheduled for surgery in 2 weeks.
He is going to replace the ascending section of my aorta with a dacron graft.
I feel pretty confident that this is the right decision, although I am not looking forward to going through open heart surgery for the 3rd time after 15 years.
If anyone is interested I'll keep posting my progress here.

 

[river-wear]

I'm sorry you have to go through this again. Best wishes for a speedy recovery! Hopefully you will find it easier now, given that medicine has continued to improve.

 

[deanmenta]

Thank you!

 

[river-wear]

Dean, how is a "pseudo aneurysm" different from a "real" aneurysm? Did Dr. Starnes explain that?

 

[spartangator]

Sorry to hear about the situation but glad there is directive, effective action to make things better. Reading things on here and elsewhere, the Dacron repair seems to be a common one and work well (mine has, anyway ). We look forward to hearing about you being back on your feet.

 

[deanmenta]

@ river-wear - I didn't ask what the difference between a "pseudo aneurysm" from a "real" aneurysm, but I just emailed Starnes' assistant to see if that can be explained. I'll post when I find out.

@spartangator - Thank you!

 

[deanmenta]

Here is the info I received from Robert Sachs who works with Dr. Starnes:


Dean,
A pseudo aneurysm is like a bulge on the aorta.
Think of an inter tube of a tire that has a weak spot and a bubble forms thru the tube. That is what you have . a aneurysm is the entire aorta enlarging
If you goggle pseudo aneurysm and select Wikipedia encyclopedia it has a good picture but it is in the heart not the aorta
Bob

 

[river-wear]

Thanks, Dean. That looks more scary than a regular aneurysm... but I can see that maybe it isn't more dangerous.

In any case, good luck with your surgery. I hope you have an uneventful recovery!

 

[Rick]

Just read the thread...best of luck Dean! I've heard from many folks that USC is a good place for operations related to the aorta and have read over the years of folks that were successfully operated by Dr. Starnes

 

[deanmenta]

Thanks Rick !