Thoracic aortic aneurysm

[Jimmyk]

After doing a lot of reading last night, I have a lot of questions for the surgeon who did my AVR last year , who I would want to operate on me again if need be.
After discovering a aortic aneurysm in me getting bigger, I’ve been trying to get info about the procedure to correct the problem.
I’m sure there are a lot of people on here who have been through this.
A couple of questions I’d like to ask,
what if I have to get this operated on, while I’m on Warfarin?
Is this operation as complicated as AVR surgery?
Will they have to open me up in the same area as the AVR surgery?
Is this a one time fix?
Any feedback would be greatly appreciated.

 

[user 16827]

I aint a doctor Jim just a guy in jeans and a T shirt but ;

I presume its a root aneurysm ? how far into the arch does it go ?

The warfarin i would expect you to be bridged ( as in taken down then up again )


All OHS is complicated but they are very good at it these days

I imagine it's just a redo like last time yes

My understanding of my aneurysm repair which is a dacron graft, is there are no guarantees
It was explained to me that if we get an aneurysm we are statistically more likely to develop one again compared to the masses
the graft is stitched into the aorta once the bulge is cut out, this joint site needs to heal so initially they will keep your blood pressure controlled
the place you may develop any future bulge is after the joint site, this will be monitored via scans probably for a few years to make sure it settles
in my case i had a CT every year for 3 years then another after a further 2 years

good luck jim
sending you my best wishes

 

[Jimmyk]

Thanks Leadville,
if you don’t mind me asking, have you been ok since you’re surgery? Did CT scans reveal any growth after surgery. Hope I’m not getting too personal by asking these questions. If I am, just disregard. Anyway, hope your feeling well now.

 

[Jimmyk]

I don’t understand the whole thing that much.
From what I do know. There is a note in my hospital records from last year, I believe it said an assending thoracic aortic aneurysm measuring 4.3 cm . This was discovered from a ct scan while in the hospital during AVR.
Last week I was discharged from a different hospital for a different issue.
A ct scan was done there also. When I got home, I started comparing the 2 sets of records. That’s where I discovered the growth of the aneurysm. is now 4.7 cm. That’s .4 cm growth in a year.
The whole thing is very scary, but after being through the AVR last year. It’s a little more bearable.
I know I’m already jumping the gun. A cardiologist hasn’t even looked at this yet.
But nevertheless it’s scary.

 

[user 16827]

ask away jim , that's why the forum is here,

my scans are all fine, prior to surgery and now to a lesser degree i exercise a lot
my heart had enlarged slightly and the Docs told me to take it easy regarding BP which i did and at 12 months
my heart size & thickness had remodeled to normal. i was bicuspid btw

i'm not sure what valve you have ? mine is a st judes , because of the leaky valve my pre opp resting HR was around 60 bpm
im now around 50 bpm which shows me it was working to compensate for the regurgitation
i find comfort in the lower rate

I was worried about another aneurysm but as time passes and your scans come back as normal this will give you peace.
Its a difficult & emotional time facing surgery, you are among people that have all been on the journey

i have always found that getting things out clears my head so with that in mind ; ask away

 

[user 16827]

bear in mind you will get different results from different scans and different Radiologists

the scans are not 100% so it doesn't necessarily mean it has actually grow that much in a year

there is a degree of interpretation

The fact that you have an ascending aortic aneurysm means you will be monitored & scanned

hopefully you may be years away from surgery

 

[Jimmyk]

Thanks again for your input,
the valve I have is a carbonmedics standard Aortic valve, A5-029.

 

[Paul1972]

Hi Jimmyk ,I can’t answer your question on warfarin as I had my two operations the other way around , they found my 8.2cm anurysam by chance so I had a Dacron graft with valve repair in sept 16 and then had to have the valve changed to merchanical in sept 17 due to leakage . As for the surgeries they were in my opinion pretty much the same recovery wise.I work in heavy construction work and was back working both times within 12 weeks with no real restrictions as long as I wasn’t over straining to much . So far all is good as regards ct scans etc and I’m gaining more confidence as the months go by . Regards Paul

 

[Jimmyk]

Good to hear Paul, I work in heavy construction myself.
I went back to work 4 months after the AVR surgery. It wasn’t the same, not sure if it was the medication side effects, but after hanging in there for 6 months, I was laid off. Haven’t been back yet. It’s actually 3 months now since I’ve worked.
I’m 53 and feel 73. Going to try concentrating on getting healthy again, I will try to get this aneurysm behind me,possibly get off of the Metoprolol medication.
Think I’m starting to ramble now.

 

[Paul1972]

Hi again Jimmy , you carry on rambling it’s good for us heart patients to hear about each other’s experiences and emotions so we can help each other and learn about what we all have faced through our tough times.I’m sure you will get back to feeling healthier again . Paul

 

[Jimmyk]

Thanks Paul,
I noticed on one of your comments.. you mentioned that you had an 8.2 cm aneurysm.
WOW.. good to hear your surgery was a success.
I’m thinking about 5 cm and becoming a ticking time bomb. I’m complicating this a little too much!

 

[pellicle]

Hi Jimmy
I see you've got some good answers above already, that's good (and keep that Bene Geserit Litany in mind..)

So with that in mind I'm not sure where your Aneurysm is ... for Thoracic Aortic Aneurysm isn't narrow enough to make a comment (without some assumptions).

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Assuming its not on the valve side of the arch, then as has been mentioned it can be patched.

So let me have a crack at a few of your questions:

A
After discovering a aortic aneurysm in me getting bigger, I’ve been trying to get info about the procedure to correct the problem.

well based on what you've said in an earlier post I suspect its still "monitor and see" ...

A couple of questions I’d like to ask,
what if I have to get this operated on, while I’m on Warfarin?

its simple, you go off warfarin, then go back on. Being on warfarin isn't like being on Oxygene (in that you'll die when its removed). There are plenty of people out there who just don't even bother taking it regularly and many have no issues

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818019/

these two guys lasted 27 and 37 years event free ... so its not like a Sci-Fi movie where you turn into a clot before our eyes and die. Its more like wearing a condom, you may not get them pregnant (or catch something) first time without one (but you may), none the less its best practice to use them if "running free" without a regular partner (who you trust).

It is emerging that we are now contemplating if we over "anticoagulation therapy" many patients, and while some facts are emerging and some studies are pointing to INR Target = 2 being sufficient for many modern bileaflet valvers, there is some caution in the area.

So my view is that without you being clearly "prone" to thrombosis events that being off warfarin for a week surrounding a medical procedure is a lower risk thing than being on AC therapy during the healing process.

I strongly recommend you read my thoughts and analysis of an article on this on my blog:
http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html

Is this operation as complicated as AVR surgery?
Will they have to open me up in the same area as the AVR surgery?
Is this a one time fix?

without knowing where exactly my feeling is "yes, its OHS" but it could be between the ribs (which I'm told is actually more painful in recovery despite all the folks horrorfied with the idea of cutting through bone (I can assue you my soft tissue injuries have hurt more and taken longer to heal.

It may indeed be a one time fix, but as you are discovering, when you find that one thing has gone wrong, it may lead to another different but related thing being found.

My strong advice is to stop worrying about this ... no *really* ... my wife used to worry about getting cavities in her teeth (which she had a few fillings for) but died of a cancer ... a friend of mine survived cancer treatment and was killed in a car crash.

The only certainty of life is death ... so knowing that why not just try to enjoy each day as it happens? Don't demand more than you'll get, and don't demand to know what happens tomorrow.

If you read through my (probably first post here) on post surgical feelings I went through some pretty dark times. So ******* dark that it was hard to even see that I may have had post surgical depression (I mean its hard to know which water molecule in that bucket was from your thimble right). It took me (I say that as if its past tense) 6 years to get past a lot of that **** but now (mostly) I enjoy my days and don't make out as if I'll live to 89 nor that I will stop planning as if I will.

Best Wishes

 

[Paul1972]

Hi Jimmy ,it’s hard for us not to let our minds wonder and over complicate things I know that from experience . Try and concentrate on getting healthy like you said .Pellicle has given you lots of great information and advise I hope that helps you. All the best Paul

 

[pellicle]

Hi Jimmy ,it’s hard for us not to let our minds wonder and over complicate things I know that from experience . Try and concentrate on getting healthy like you said .Pellicle has given you lots of great information and advise I hope that helps you. All the best Paul

Actually Paul I was going to say the same of your posts

Jimmyk something to read on "philosophy" which I wrote while in the midst of dealing with my own struggles

http://cjeastwd.blogspot.com/2015/09/denial-or-delusion.html

 

[Jimmyk]

Thanks so much. I was just reading another post about someone going through the same thing.
I was wondering are aortic aneurysms common with people who had value replacement?

 

[Warrick]

Thanks so much. I was just reading another post about someone going through the same thing.
I was wondering are aortic aneurysms common with people who had value replacement?

Hi Jimmy, I feel for you as I have had AVR with an aortic artery considered mildly dialated which was not resolved.

As I understand it (I'm not sure about other causes necessitating AVR) bicuspid aortic valve disease is a connective
tissue disorder which also causes the walls of the aortic artery to be weaker thus resulting in an aneurysm, I think it's roughly 2/3rds of all BAVD results in an aneurym, and the risk of aneurysm after AVR and no artery repair with a BAV is still around the 65% mark

(and increased risk of aneurysm in other arteries as well such as in the brain)

 

[Jimmyk]

I was walking 3 miles for exercise 2 or 3 days a week . The Appointment with the cardiologist is not for another 2 weeks.
After getting the news about the aneurysm, I’m not sure if it’s safe to go for my walk.
Actually, I’ve been isolating in the house for the last week or so.

 

[user 16827]

walking will get you out the house, you will benefit from blue light, increased serotonin, overall decreased blood pressure
and all the other great health benefits of walking,


stick with a moderate pace and if possible call at the coffee shop for a social coffee and watch the world go by before the return leg home,

hibernating is not good Jim

 

[mrfox]

I definitely would get out of the house and go back to walking as much as you can Jimmyk - in my understanding that's the absolute safest kind of exercise you could be doing and you're more likely to be harmed by isolating yourself than going out for regular walks.

 

[pellicle]

Jimmyk
I agree with ask the comments about walking. It's the best thing to do. Walking is what I was also told to do after surgery. The only thing you should do now is to avoid straining type lifting.

Shutting yourself in us about the worst most harmful thing you can do to yourself right now.

Also Warwick is bang on, the reasons which cause heart surgery are the predictor of the chances of needing more. If you had rheumatic fever that damaged the valve, leading to a surgery, then you many never need another. If you had bicuspid valve from birth (like me) the we see a likelihood for aneurysm.

Best wishes