Thoracic aorta dilation in an AVR veteran

[Guest]

I am a 74-year old male who learned much from this site back in 2001 when I was first diagnosed with aortic stenosis. I was operated on in September of that year (just before 9/11, in fact) and was given a bovine replacement valve.

The bovine valve has performed like a champ and, as we speak, is heading toward its16th anniversary in sterling shape. However, a new problem has popped up: dilation (or aneurysm) of the thoracic aorta: i.e., enlargement of the aorta just above the replacement valve. The aorta has grown from 2.5 cm to 4.4 cm in width since my previous echo-cardiogram in 2012. I also have begun to have some periodic elevated systolic pressure, so my cardiologist has put me on a mild dose of blood pressure control medication.

He points out that as the width of the aorta reaches the neighborhood of 5.0 cm (likely about a year away at present rates) it will likely be necessary to replace both a portion of the aorta and -- while they're at it -- the aortic valve itself. Moreover, this problem seems to be most pronounced among recipients of replacement aortic valves.

I am wondering if any of you have experience, direct or indirect, with this sort of situation -- and what advice of "lessons learned" you might share. Many thanks!

Peter E.

 

[epstns]

Peter - I have no direct experience with aortic dilation or aneurysms, but having a bovine aortic valve implanted as a result of having a bicuspid aortic valve, I have to ask if you, too, had a bicuspid aortic valve. The reason I ask is that there is a documented connection between aortic aneurysms and dissections, bicuspid aortic valves and connective tissue disorders among the cohort. If you had a bicuspid valve, it is possible that you may have such a connective tissue disorder, which may in turn be leading to your dilation.

BTW - My bovine aortic valve is just coming up on its 6th birthday, and yours at 15 years and still strong gives me hope that these newer valves will last as long as they projected they would.

 

[Duffey]

Hi Peter, and welcome back. I think I joined VR just about the time you became less active on the site. I can't offer anything in terms of your aorta enlargement, but I am very glad to read that your bovine valve is performing well after sixteen years of use. I have had a bovine valve since 2005, so your experience reassures me that I will get at least fifteen years of use from mine.
Your aorta seems to be enlarging at a fairly rapid pace. How often are you seeing the cardiologist? Was the original valve a bicuspid?
Best wishes, Mary

 

[Heart Of The Sunrise]

Peter when my BAV was discovered in October of 2012- my aorta was 4.4 cm...then just before surgery in March of 2013 it was 4.9 cm. On 3-18-13 I had the ON-X valve implanted with the attached aorta graft. My Coumadin dosage is 5.0 mg per day. My INR range is 1.8-2.2. I self test at home with the Coaguchek XS meter. Coumadin has not been a problem.