workmonkey
Active member
Hello Everyone.
I wanted to get your stories on when you decided to have surgery for your ascending aortic aneurysm (or when you plan on it). There seems to be conflicting and evolving thoughts and data about how proactive to be.
I was diagnosed with a functional bicuspid aortic valve earlier this year (no stenosis, no regurgitation, no calcification, etc). My aortic root measured 4.4 cm. My stress test was good. My cardiologist told me we'd be "watchfully waiting" over the coming years with a MRI once every six months or so to monitor growth. While very surprised to hear I had heart defect, I was comforted knowing they could ultimately fix it, if/when the time came. With no symptoms, I went back to life as before.
As part of the "watching", I had an MRI two weeks ago (my first). It showed my ascending aorta measured 5.1 cm. My cardiologist recommend immediate surgery and sent me to a cardio-thoracic surgeon at NYU (I live in NYC). Shocked, I made an appointment and mentally tried to accept the concept of OHS.
Surprisingly, the surgeon (one of the top 100 according to magazines) was decidedly against surgery. He said my valve was perfectly functional for now, so why replace it? He said it isn't a guarantee that bicuspids will ultimately fail. He also said given my age (38 year old and asymptomatic) let's wait and monitor how the aneurysm develops. I'm on statins and beta-blockers to manage it in the meantime. He was very confident in his recommendation and called my cardiologist to report back.
I later talked to my cardiologist, who politely disagreed with the surgeon. He says 5.0 cm is the "new" cutoff (for years it seemed it was 5.5 cm .. It seems the increasing safety of this surgery moved it down).
My instinct is to follow the famous surgeon who has done hundreds if not thousands of valve replacements and aortic repairs. My cardiologist seems to be looking at absolute numbers, whereas my surgeon is looking at me as an individual. But that may just be wishful thinking.
It seems every case is different and it is hard to know the rules. Dr. Svennson at Cleveland Clinic seems to use 5.0, and according to his formula I should have surgery. But even he says, that's a general rule of thumb, not an absolute. I'm getting a second opinion from another experienced surgeon at NY Presbytarian in a few weeks.
I'm obviously prepared to have the surgery to prevent a rupture. However, if I'm not in immediate risk then I'd rather wait and see how this thing develops, confident in knowing I'm "diagnosed". It isn't so much a fear of surgery (which I have as I'm sure you all did) ... It is the practical notion that because valves wear out, and I'm 38, if I could buy some time, it'd help me in the long run. I also don't want to have OHS if my threat of an aneurysm is only 3% or so, which seems to be the data below 5.5 cm. Every different hospital and medical journal I read seems to have a different take on the proper time.
As a final question, does anyone have thoughts on Losartan (vs beta-blockers) to slow down the growth of the aneurysm? There seems to be a lot of buzz about it recently.
Your stories and criteria for decision-making would be helpful. Thanks in advance.
I wanted to get your stories on when you decided to have surgery for your ascending aortic aneurysm (or when you plan on it). There seems to be conflicting and evolving thoughts and data about how proactive to be.
I was diagnosed with a functional bicuspid aortic valve earlier this year (no stenosis, no regurgitation, no calcification, etc). My aortic root measured 4.4 cm. My stress test was good. My cardiologist told me we'd be "watchfully waiting" over the coming years with a MRI once every six months or so to monitor growth. While very surprised to hear I had heart defect, I was comforted knowing they could ultimately fix it, if/when the time came. With no symptoms, I went back to life as before.
As part of the "watching", I had an MRI two weeks ago (my first). It showed my ascending aorta measured 5.1 cm. My cardiologist recommend immediate surgery and sent me to a cardio-thoracic surgeon at NYU (I live in NYC). Shocked, I made an appointment and mentally tried to accept the concept of OHS.
Surprisingly, the surgeon (one of the top 100 according to magazines) was decidedly against surgery. He said my valve was perfectly functional for now, so why replace it? He said it isn't a guarantee that bicuspids will ultimately fail. He also said given my age (38 year old and asymptomatic) let's wait and monitor how the aneurysm develops. I'm on statins and beta-blockers to manage it in the meantime. He was very confident in his recommendation and called my cardiologist to report back.
I later talked to my cardiologist, who politely disagreed with the surgeon. He says 5.0 cm is the "new" cutoff (for years it seemed it was 5.5 cm .. It seems the increasing safety of this surgery moved it down).
My instinct is to follow the famous surgeon who has done hundreds if not thousands of valve replacements and aortic repairs. My cardiologist seems to be looking at absolute numbers, whereas my surgeon is looking at me as an individual. But that may just be wishful thinking.
It seems every case is different and it is hard to know the rules. Dr. Svennson at Cleveland Clinic seems to use 5.0, and according to his formula I should have surgery. But even he says, that's a general rule of thumb, not an absolute. I'm getting a second opinion from another experienced surgeon at NY Presbytarian in a few weeks.
I'm obviously prepared to have the surgery to prevent a rupture. However, if I'm not in immediate risk then I'd rather wait and see how this thing develops, confident in knowing I'm "diagnosed". It isn't so much a fear of surgery (which I have as I'm sure you all did) ... It is the practical notion that because valves wear out, and I'm 38, if I could buy some time, it'd help me in the long run. I also don't want to have OHS if my threat of an aneurysm is only 3% or so, which seems to be the data below 5.5 cm. Every different hospital and medical journal I read seems to have a different take on the proper time.
As a final question, does anyone have thoughts on Losartan (vs beta-blockers) to slow down the growth of the aneurysm? There seems to be a lot of buzz about it recently.
Your stories and criteria for decision-making would be helpful. Thanks in advance.
