Aortic Aneurysm ~ growth rate

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R

rutho

In April of 06, after having a CT scan with contrast, I was told I have a bicuspid aortic valve with a dilated ascending aorta measuring 4.6 X 4.7.

This month (October), I had another CT scan with contrast, and the cardiologist told me she is "very worried" about the growth rate of the aneurysm. The aneurysm has grown to 4.6 X 4.95.

My cardiologist insisted I take Toporol and re-test in 6 months.

My concern is the rate of growth of the aneurysm. Does anyone know what is considered to be a "fast" rate of growth for an aneurysm?

I am a 39 year old female, tall, not overweight, in good health.

Thank you for any help!
 
Welcome to VR.com

Welcome to VR.com

I don't know anything about aortic anyeurisms, but I want to welcome you. I'm sure someone will be along soon who will know. Weekends can be slow, but be patient. I DO know that cardiologists can be very conservative in their treatment, so you are in the right place to get information. Educate yourself regarding your condition and then figure out the direction and the rate at which you proceed.
I live in San Antonio, so I guess we're neighbors. Keep reading. Try going into the Search section and I'm sure you'll find lots of information.
Barbara
 
Hi and welcome...

If the measurements are accurate then yes your aneurysm is growing reasonably fast...if it were mine I would be getting mentally ready to meet the surgeon.

I would definately take the Toprol as it is helpful in reducing the "thumping/pounding" force of blood through the aorta...But I would not be waiting 6 months for my next check-up.

I suggest you have a read of the www.bicuspidfoundation.com and then see how you feel about waiting on this. They have info on growth rates too...Average growth rate is 0.1cm per year. Arlyss is the lovely lady in-charge over there and she has an enormous knowledge of aortic-aneurysms and the current treatment of them for BAV (Bicuspid Aortic Valve) patients.

I am very glad you found us here...ask lots of questions and you will get plenty of advice.
 
Hi Rutho!
I had my aortic aneurysm and valve fixed/replaced last year at the age of 38. A first thing I would say is that aortic aneurysms are notoriously difficult to measure accurately (various people at CCF were arguing about whether mine was 4.6 or 4.8cm from a single test.) so it may be that your aneurysm is growing faster than usual (I have also heard that 0.1cm per year is average) or it could be that the measurement was made in a slightly different spot, at a slightly different angle or interprated differently by the person reading the test. As suggested above, if it was me, I'd try to get another test done before 6 months - ideally by someone very experienced with aortic aneurysms. Hopefully, with another set of readings, it will be more clear exactly how large it is and how fast it's growing. I believe 5 cm is the recommended surgery point for those with a bicuspid valve, although if you are very tall, you might be able to wait longer (as I ended up going a little earlier because I'm quite short and - as with most things - aneurysm size is proportional to body size). Kate
 
Aneurysms are unpredictable. There is no set growth rate. Some can stay the same size indefinately and others can balloon and blow incredibly fast. Your sounds like it's ready to be dealt with now, so yes, get ready to meet the surgeon soon.
 
Someone recently posted a link to "ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease" that I can't find this AM but is a great source of information on this subject. If you can't find it send me a message and I will put more effort into my search when time permits.
Philip
 
Philip said:
Someone recently posted a link to "ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease" that I can't find this AM but is a great source of information on this subject. If you can't find it send me a message and I will put more effort into my search when time permits.
Philip
Click to expand...
Oh Philip, looky here:

http://www.valvereplacement.com/forums/showthread.php?t=7027
 
Rutho,
Austin is my favorite city and close to one of the world's most experienced and best thoracic surgeons, Dr. Joseph Coselli, in Houston. It is difficult to determine the growth rate based upon two measurements, and this rate increases as the aneursymal dilation increases. If you begin having any symptoms such as chest pain (most people don't have symptoms), surgery is recommended right away regardless of size. Yes, taking a beta blocker will mitigate hypertension and reduce the pressure on your aortic wall. Risk of surgery vs. risk of rupture or dissection are weighed when determining timing of your surgery, and 5.0cm is the recommended size before surgery for the average BAV patient. However, one must also compare the size of your ascending aorta with the size of your descending aorta. There's an excellent presentation available on the bicuspidfoundation website that illustrates this point. And it is important to determine if your ascending aorta extends into the arch or transverse part of the arch of the aorta, and this may not be determined until catherization before surgery or determined during surgery by an experienced surgeon. I highly recommend you contact Dr. Coselli for consultation. The surgeon you select will be key and one of the most important decisions you'll make.
All my best,
Mr.P
 
Thanks!

Thanks!

THANK YOU to everyone! I am truly amazed by your knowledge and the care you share with everyone on this site! I feel like I am not alone and that is HUGE when you feel like your heart is breaking!
 
I think you are lucky to have the comparison measurement.

I only have a one off measurement of 5.4-5.6 with no history of the growth rate and so i'm going under the knife on the 16th Nov to have both the aneurysm and the bav fixed.

I'd me much happier if i had a comparison measurement such as yours to make the decision a no brainer.

If i was wearing your shoes (and that would be a push as i've got size 14 feet) i'd be looking for surgery in the next 6 weeks.

Best of luck with your decision, you will find that this is the best resource for helping you come to terms with the process and your decisions....
 
Best of luck to you on the 16th!

I am fortunate to have numbers to compare the size every few months.

Dr. Michael Sweeney, who is a cardiac surgeon in Houston, TX, is helping me and I am anxious to talk with him and find out his thoughts on the growth of the aneurysm.

Lots of prayers coming your way for your upcoming surgery!
 
rutho I'm not a fan of surgeons waiting beyond 4.5cm. Mine ruptured before it ever got to 5.0. I can assure you, you do not want that to happen. I would not wish that on my very worst enemy!
 
Thanks Ross. I will put in another call to Mike Sweeney, the cardiac surgeon. I am not one to flirt with danger! :)
 
Welcome.

I want to agree withmost of what was stated.
There is no set rate of growth.
If it has changed that much, they need to go back to the last test and have it looked at by the same person measuring this one.
From there, I would start thinking of what type of valve you will want and who you prefer to do your surgery.

We are all here to answer any questions you have.
 
Rutho,
You'll be in excellent hands....I have read many good things about Dr. Sweeney.
During my surgery, my surgeon decided to replace the BAV and ascending aorta with composite valve and Dacron graft AND replace the transverse aortic arch using a "beveled hemi-arch technique...". This involved profound hypothermia and circulatory arrest and more time on the heart pump for cooling/warming (74 minutes for cooling and 150 minutes for warming...total 224 minutes pump time, cardiac ischemic time 87 minutes, total clamp time 73 minutes). Circulatory arrest time was 14 minutes. During ICU, I was told the decision to resect the transverse aortic arch was made in order to avoid another operation over the next 10 years. This was a complete surprise to me, although we discussed this as a possibility during my consultation prior to surgery. I tell you all of this in case you may want to go over this procedure with your surgeon during your consultation. Ask about the effects of extended pump time also and whether or not neurologic testing before and after is recommended. In retrospect, I think it'd be a good idea periodically over a 12 to 24 month timeframe post-op.
Hope this helps. Best of luck in everything!
MrP
 
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