What about the Aortic Size / Body Surface Calculation?

[cbdheartman]

I have read about the Aortic Size/Body Surface calculation. I saw it mentioned in this article (http://emedicine.medscape.com/article/424904-overview). Going by my height and weight 6'4'' roughly 195 lbs, my body surface is calulated at 2.19 m2. 4.9 cm/2.19 is only 2.24 on that and according to that article this translates into a low risk. "In addition, relative aortic size in relation to body surface area may be more important than absolute aortic size in predicting complications. Using the aortic size index of aneurysm size divided by body surface area, patients are stratified into 3 groups: less than 2.75 cm/m2 are at low risk (4%/y), 2.75-4.24 cm/m2 are moderate risk (8%/y), and greater than 4.24cm/m2 are high risk for rupture (20%/y)."

Any thoughts on using that sort of calculation vs. absolute size?

I will try to step away from the computer now!

 

[Gail in Ca]

Sometimes it's not about just size. Mine was at 6 when it was discovered. I waited 6 wks for surgery, and the surgeon said my aorta "fell apart" in his hands when he was trying to cut into it to place the dacron graft. Hence, the whole piece was taken out, not saved to wrap the dacron. I was very lucky it hadn't started dissecting.

 

[Lisa in Katy]

You have a good doctor. Talk to him about all of these things. The people here will give you their opinions, but it sounds like you need several experts to walk you through your questions and denial. If your doctor doesn't think you need surgery yet, ask him why. It could have something to do with the above calculation.

 

[Ross]

Hi it's me again! Point blank, ask those that are telling you not yet, if it were them owning this thing, if they'd wait. Watch the expression on their faces and read their eyes. Check for signs of lying if they don't say they'd do it now.

 

[bugchucker]

One tends to look up and to the left when lying according to a cop friend of mine.

 

[skeptic49]

I have read about the Aortic Size/Body Surface calculation. I saw it mentioned in this article (http://emedicine.medscape.com/article/424904-overview). Going by my height and weight 6'4'' roughly 195 lbs, my body surface is calulated at 2.19 m2. 4.9 cm/2.19 is only 2.24 on that and according to that article this translates into a low risk.
Any thoughts on using that sort of calculation vs. absolute size?

I will try to step away from the computer now!

I think that this particular formula is seriously f****d up. You will be long dead if you wait to have this formula tell you that it's time to have surgery for your aneurysm.

Jim

 

[ALCapshaw2]

Where is the factor for BAV and Weak Connective Tissue in that formula?

 

[skeptic49]

Using the aortic size index of aneurysm size divided by body surface area, patients are stratified into 3 groups: less than 2.75 cm/m2 are at low risk (4%/y), 2.75-4.24 cm/m2 are moderate risk (8%/y), and greater than 4.24cm/m2 are high risk for rupture (20%/y).

Note that this formula specifies risk for rupture only, not dissection.

For me, I'm 6'5" and 235 lbs with a corresponding body surface area of 2.41 cm2, so if I used this formula with my ascending aorta presently at 4.3 cm I am only at "low risk" for rupture. Maybe.

But using this formula my aneurysm would have to grow to 6.7 cm to get to the "moderate" risk category, and an incredible 10.3 cm to get me into the "high" risk category! Are they kidding?

So this is really not a useful formula. And even if it was useful, what they consider "low" risk (4 percent a year chance of rupture) is a risk factor that is at least DOUBLE that of surgery mortality rates at most major heart hospitals. And as Al points out, where is the factor for BAV and CTD? And where is the factor for accompanying aortic stenosis? And where is the factor for sex of the patient?

Jim

 

[RvUsa]

OH boy this should be a good one for me!!!

Lets see, my surface area is 3.487 m2 and my aneurysm is 5.4cm. so that is 5.4/3.487= 1.5486 cm/m2 so that puts me way low in the low risk... LOL

So for me to be in the moderate I would need to be at what.... 9.987cm, and to be in the high risk, I would be at 14.7848cm....

See I knew I was safe, I don't have to worry until my aorta hits about the width of a dollar bill before it may pop

Cool, right now, I am only 1/2 way to moderate, and 1/3 of the way to severe!!! I got nothing to worry about.

Thanks guys!!!

This is just another point to prove the bias against people my size. LOL

 

[Reddog]

My cardiac surgeon calculated this for me, and I'm in the low risk group as well - at a ratio of 2.5. However I'll be having surgery in two weeks because I was told that this is likely an annual risk of 1-2% vs a one time risk of 1-2%. Your ratio is marginally lower than mine, and I'm not sure how that affects your percentages, but try to find out, and then calculate your one-time-risk vs. annual risk. It's a balancing act.

Red

 

[Reddog]

Hmmm... thinking about this a little more. If I get really fat, then my surface area will increases, my ratio will be lower, and my chance of aortic dissection / rupture will be reduced! Ross tells me that I should eat the doctor.

Red

 

[Philip B]

Risk & Formulas

Risk & Formulas

I'd hesitate to place a lot of faith in formulas that offer any kind of prediction concerning aortic aneurysm size and risk. My surgeon told me that a normal aorta size for someone my size was supposed to be about the diameter of a nickel. Checkout how the diameter of a nickel compares to 5.8 cm (the size of my aneurysm when I had surgery). It's pretty spooky.

My cardiologist wasn't overly thrilled when I repeated a comment from my surgeon involving prediction of a rupture if my aneurysm got to 6.0 cm. The cardiolgist asked me if my surgeon had used his crystal ball to make that prediction.

I guess I've got more faith in advice from a medical professional whom I trust than I have in formulas. As noted by others who've posted responses, there are lots of factors that a simple formula doesn't address.

Face it, if you have a bad aortic valve and an aortic aneurysm, you'll need to get the problems fixed. When you need to have it done is something that should be determined by medical professonals whom you trust and you.

-Philip

 

[cbdheartman]

Face it, if you have a bad aortic valve and an aortic aneurysm, you'll need to get the problems fixed. When you need to have it done is something that should be determined by medical professonals whom you trust and you.

-Philip

Well, they are saying wait, and I don't want to wait! Or at least they are saying you can wait, that they'd recommend waiting, and yet I cannot see the wisdom in all that.

 

[Lynlw]

Have you thought about contacting Svensson again and asking him exactly why he recomends waiting, what test results or other things you may not know about are making him think you should wait? Maybe an email so you have in writing his thoughts and can reread everything? Sometimes when I'm talking to Justin's heart docs it is almost over whelming and everything we discuss gets a little foggy when I'm home thinking about everything that was said and I'll email them and ask for clarifcation. Honestly if it were me , unless there was a really good reason I would not wait, I know he said something about starting the waiting process for the next surgery now, but really if you are only putting it off 1 year that shouldn't make a big difference in the next surgery and it seems to me the stress of this hanging over your head would not be worth waiting. Since he's the head of the aorta and marfan's centers, it might help to get a better clarification on why he is suggesting to wait

 

[cbdheartman]

Have you thought about contacting Svensson again and asking him exactly why he recomends waiting, what test results or other things you may not know about are making him think you should wait? Maybe an email so you have in writing his thoughts and can reread everything? Sometimes when I'm talking to Justin's heart docs it is almost over whelming and everything we discuss gets a little foggy when I'm home thinking about everything that was said and I'll email them and ask for clarifcation. Honestly if it were me , unless there was a really good reason I would not wait, I know he said something about starting the waiting process for the next surgery now, but really if you are only putting it off 1 year that shouldn't make a big difference in the next surgery and it seems to me the stress of this hanging over your head would not be worth waiting. Since he's the head of the aorta and marfan's centers, it might help to get a better clarification on why he is suggesting to wait

I just sent a follow-up to his nurse and will see what she says. This what I wrote:

Also, I am not sure if Dr. Svensson will answer any more questions, but one that I do have is this: Is there some test or other background that colored his recommendation that I not have surgery yet? Knowing what I know about the average rate of increase of aneurysm size (they grow an average of a millimeter a year -- though they can stay stable for many years in people), if I grow at an average rate I will reach the 5.1/5.2 threshold for my height within a few years. While I would prefer never to have surgery(!), it seems inevitable unless I dissect or rupture. While Dr. Svensson made it clear that he would do the surgery because of peace of mind issues, I wanted to make sure I wasn't missing some factor that strongly weighed against the surgery now. The logic to me seems to point to surgery now: the risk of surgery (low in the skilled hands of Dr. Svensson) is a given now or later. But if I do it later I add the low (but not insignificant, at least pyschologically) risk of dissection or rupture in front of that low risk of surgery. If he is willing to follow up directly or through you to explain what, if anything big, I might be missing that counsels against surgery, I'd welcome that. I understand that under the generalized risk tables there might be slightly more risk of surgery now than there is a risk of dissection, but they seem pretty close.

 

[Lynlw]

I just sent a follow-up to his nurse and will see what she says. This what I wrote:

Also, I am not sure if Dr. Svensson will answer any more questions, but one that I do have is this: Is there some test or other background that colored his recommendation that I not have surgery yet? Knowing what I know about the average rate of increase of aneurysm size (they grow an average of a millimeter a year -- though they can stay stable for many years in people), if I grow at an average rate I will reach the 5.1/5.2 threshold for my height within a few years. While I would prefer never to have surgery(!), it seems inevitable unless I dissect or rupture. While Dr. Svensson made it clear that he would do the surgery because of peace of mind issues, I wanted to make sure I wasn't missing some factor that strongly weighed against the surgery now. The logic to me seems to point to surgery now: the risk of surgery (low in the skilled hands of Dr. Svensson) is a given now or later. But if I do it later I add the low (but not insignificant, at least pyschologically) risk of dissection or rupture in front of that low risk of surgery. If he is willing to follow up directly or through you to explain what, if anything big, I might be missing that counsels against surgery, I'd welcome that. I understand that under the generalized risk tables there might be slightly more risk of surgery now than there is a risk of dissection, but they seem pretty close.

That sounds good and reasonable, I hope you get some answers soon. The ONLY thing I can think of is how the size of your root compares to the rest of your aorta, wasn't the rest of /part of your aorta pretty big? If so then maybe the difference of the anueysm isn't very large compared to your aorta as it would be in someone with smaller arota measurements. I'm not expelaining this well and could be completely off base, but kind of a ratio type thing

 

[cbdheartman]

That sounds good and reasonable, I hope you get some answers soon. The ONLY thing I can think of is how the size of your root compares to the rest of your aorta, wasn't the rest of /part of your aorta pretty big? If so then maybe the difference of the anueysm isn't very large compared to your aorta as it would be in someone with smaller arota measurements. I'm not expelaining this well and could be completely off base, but kind of a ratio type thing

Is it better to have the whole thing big? Can someone explain? Or is it bad if your whole aorta is dilated?!

 

[Lynlw]

Is it better to have the whole thing big? Can someone explain? Or is it bad if your whole aorta is dilated?!

I'm not talking about dilated, I mean just normally large, like some people have bigger feet ect. IF you are starting with your normal healthy aorta that is bigger than the "normal" than the ratio with a 5.0 root would be different than a small say 5 foot woman, having a 5.0 in her normally smaller aorta.

With kids they look at a bunch of different things, because obviously a toddler has much smaller heart, valves ect than a full grown teen, there is no magic number, it all has to do with ratios, past measurements, ect so I'm wonderring IF it's the same thought process that a 5.0 in a large man is different in a small woman

 

[Philip B]

Waiting

Waiting

Well...if your doctors are saying wait and you don't want to wait, you may have trust issues and probably need to find some doctors whom you trust. Of course, fixing your situation may simply require finding some doctors who will tell you what you want to hear. You shouldn't have a major problem finding a good doctor who needs some work. I personally appreciate your desire to help stimulate the economy.

Twenty-nine years ago, my cardiologist told me that I needed valve replacement surgery immediately. I didn't like what he was saying so I decided to avoid seeing all cardiologists for twenty-seven years. I was lucky and things worked out okay for me, but I wouldn't ever recommend that anyone else act as irresponsibly as I did.

In all seriousness, it would be a good thing to have conversations with your doctors and have them explain why they feel waiting in your case is okay. They may have perfectly rational reasons for encouraging you to wait.

-Philip

 

[Ross]

In all seriousness, it would be a good thing to have conversations with your doctors and have them explain why they feel waiting in your case is okay. They may have perfectly rational reasons for encouraging you to wait.

-Philip

Yeah, I can tell you that answer. It's not in their chest, so they'll gladly side with their studies. If they owned the damn thing, you can bet they'd be having surgery yesterday.