Aortic root dilation: Most accurate measurement?

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J

JohnKY

Hello,

I'm writing on behalf of my wife who has recently been diagnosed with an Aortic root dilation of 4cm. This was determined through ultrasound. It has been monitored since discovered 4 years ago when at 3.2

What is the best diagnostic test to accurately measure the aortic root? Echos she has had over the last 4 years seemed to have wide margins of error varying both up and down by as much as .5 cm. Surely it's not possible for it to shrink?

Have heard of an MRA. Also the 64-slice cardio CT. Which is preferable? We would like to get the most accurate test. The difference between 4.0 and 4.5 could be serious.

She exercises carefully getting 15-30 min of cardio not exceeding 137bpm each day. She has always had a good low BP. Now hovering around 100/60. She is 38, fit and besides this trouble, in good health. She currently takes fish oil, Co-Q10 and hawthorn. She is set to begin a low-dose beta-blocker (Toprol 25mg) this week.

We are looking for a good cardiologist close to east/central Kentucky (but will travel for a good one) for a second opinion and for a more precise test. Any suggestions appreciated.

Thanks,

John
 
John,
I see that you haven't received any responses yet, so I'll throw in what I know. Unfortunately, that's not a great deal.:eek:

A 64 slice CT would be the best diagnostic tool (I believe). Have you asked her cardio to run any other diagnostic tests?

I also had a 3.4 root measurement a few years ago, before I had an aortic valve replacement, but apparently it has remained stable.
If you're in Eastern Kentucky (I'm in SE MO so I'm fairly familar with your area), you might consider Cleveland Clinic. Hopefully others will be along to add their two cents to what they know about finding a cardio there.
Good luck, and I hope you stay with us.:)
 
John,
The normal range for the aortic root is 2.0 to 3.8cm in diameter, and yes, an echo is not very accurate with a wide margin of error. I suggest a 64 slice CT scan ...the gold standard. It is also important to measure the ascending aorta and arch, as well as descending. By the way, the aorta will not shrink.
All my best,
MrP
 
Welcome, John. I can't help with your question about which test is best. However, I will recommend a good cardiologist. His name is Dr. Mark Tussey with Bluegrass Cardiology Consultants. In my opinion his one of the most thorough and caring doctors I've ever had. If you're interested, he is located in Frankfort; don't know if that's very far from you though. Let me know if you'd like contact info.

Wise
 
sinus valsalva

sinus valsalva

Hi, all!

What is 'sinus valsalva' and what are the "cut points" for it?

Ivo
 
The part of the aorta just downstream from the aortic valve where the aorta bulges a bit is referred to as the sinuses of valsalva. The sinuses (of anything) are the empty space, in this case, the empty space in front of the valve flaps.

I can't help with the cut points. Perhaps where someone, perhaps a particular surgeon, cuts??? Maybe if you posted the context someone can make sense of it.
 
english

english

Excuse my english!!! :D :p

I mean, that I saw my results showing: "sinus valsalve = 40/41mm"
I just wanted to ask, whether that is a dangerous result :)
I'm a bulgarian and my english is not my best size :eek:
 
Hi John!
I had my 4.8 aneurysm repaired at Cleveland Clinic about 18 months ago at the age of 38. I was extremely impressed with the care I received there and would encourage you to consider making the drive. This particular meaurement (and surgery when it gets to that point) are ones where you want someone with a lot of practice, and they do many of them at CCF. Sounds like your wife isn't looking at surgery in the very near future and, to be fair, I must admit that the Cleveland Clinic felt a bit anonymous and uncaring when I was at that point. However, I truly believe I received terrific medical care throughout and once my condition reached the point when I needed surgery, the Drs and nurses were extremely attentive. I don't think I ever waited five minutes for anything!

It also sounds like your wife is really committed to a healthy lifestyle and that will go a long way to helping with surgery and recovery, when the time comes. If you have any other questions, feel free to ask! :) Kate
 
I had an MRA (which is an MRI with contrast) and several 64 slice CT scans with contrast. The preparation for both consisted of sitting quietly and lowering the BP to a steady rate with the aid of BetaBlockers. The difference was that the MRA took a good half hour in that enclosed machine whereas the CT (the big Donut shaped machine) took a maybe 5 minutes. The results were the same in all cases. I would go for the CT everytime.
 
Thanks so much for all the great responses! Looks like the 64-slice CT is the way to go.

Yes, she is very conscious of her health. Heart disease runs in her family, but nothing of this nature. She is determined to do all she can to forestall the need for surgery. However we want the very best diagnostic procedures available and want her to be screened regularly.

Mary said:

A 64 slice CT would be the best diagnostic tool (I believe). Have you asked her cardio to run any other diagnostic tests?
Click to expand...

Her current cardiologist is difficult to contact and difficult to understand. Based on our experience with him so far, when he does get back to us, he will likely say further testing is unneccesary. If it were his heart, I wonder what tests he would have ordered? At any rate, a 2nd opinion and a more accurate test could hurt nothing except our bank account. So that's what we'll get.

Thanks again for the warm welcome and the priceless information!:)

John and Marti
 
Having the Right Test at the Right Time

Having the Right Test at the Right Time

Just a word of caution about the aortic root versus the ascending aorta - these words are not used precisely enough by some medical professionals. It was extremely frustrating to me with my husband - both terms were used - I finally found out that the largest bulge in his aorta was in his ascending aorta.

I suggest you have the doctor draw a picture - or show you on the images itself - where the enlargement is.

The root is a very short segment of the aorta just above the valve - as mentioned previously it naturally has 3 pouches or sinuses, called the sinuses of valsalva. It is theorized that the shape of the aortic root helps the leaflet closing motion.

The ascending aorta is just that - it begins where the root ends and the aorta goes straight up until it begins to bend - which is the arch.

The surgical options are different depending on the condition of the root. You do not mention if you wife has a normal aortic valve or not - those with bicuspid aortic valves or variations of it typically have the greatest enlargement of the ascending aorta.

I encourage you to view the slide presentation that PJ provided. Dr. Isselbacher is one of the few cardiologists I am aware of that specializes in aortic disease. If you go over his slides, you will see that an echocardiogram through the chest wall (trans thoracic) may not capture the ascending aorta. If it doesn't, you need a test that does.....

So, which test should it be? It depends.

The 64 slice CT is wonderful, but there is something to think about. It exposes the person to x-rays, which are cumulative in the body over one's life time. It's not something to have too frequently unless someone cannot have an MRI.

Personally, if I wanted a complete image of my aorta and was not concerned about coronary artery disease, I would have an MRI with contrast. There is also cardiac MRA, which shows the heart valves as well.

If I am getting ready for surgery and need a clear look at my coronary arteries, I would have the 64 slice CT. It shows both soft and hard plaque.

Or if I wanted to have a baseline once with the 64 slice CT to see my coronary arteries along with the aorta, I would consider that, and then continue with a combination of echo/MRI for ongoing monitoring to avoid x-rays.

The bottom line is that either CT or MRI with contrast will show the entire aorta. The images should be measured by someone that knows how to do it!

Best wishes,
Arlyss
 
Arlyss said:
The surgical options are different depending on the condition of the root. You do not mention if you wife has a normal aortic valve or not - those with bicuspid aortic valves or variations of it typically have the greatest enlargement of the ascending aorta.

...

The 64 slice CT is wonderful, but there is something to think about. It exposes the person to x-rays, which are cumulative in the body over one's life time. It's not something to have too frequently unless someone cannot have an MRI.


Arlyss
Click to expand...

Thanks for giving us the benefit of your experiences. We're learning a lot right now and will hopefully go our next cardiologist apppointment better informed.

According to her stress echoes all her valves were normal at the time of testing.

I'm sure you do get a large dose of radiation from the CT. Like you said, it might be good for a baseline and then monitor incrementally with the MRA's.

Thanks again,

John and Marti
 
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