CT Scan Results...Aneurysm??

shop deals on amazon
Shop deals on ebay
Advertise with us
Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
D

DavesMom

Well-known member
Joined
Apr 27, 2005
Messages
314
Location
Illinois
Morning everyone,

Had AVR replacement/aneurysm repair back in '99 and have been doing well ever since. However, since I have a BAV I pushed the doctor this year to do a CT scan. When I spoke to the nurse she said everything was stable and looked good but that I would be getting a CT scan every year from now on.

When I got a copy of the report I was surprised to see two aneurysms noted. I assume they're not large enough to worry about but I'd like to get some of the opinions of the "vets" on this board about the results. Here they are:

"At the level of the distal anastomosis of the graft, the aorta measures approximately 3.0 cm in diameter. The maximum diameter of the ascending aorta prior to the brachiocephalic artery is approximately 4.5 cm. There is aneurysmal dilation of the brachiocephalic artery. It measures approximately 2.6 cm just above its origin. The origin of the left common carotid artery is aneurysmal and measures 1.8 cm in maximum dimension."

No other significant dilations were noted on the report. Other measurements were :

3.0 - diameter of the aortic arch between the brachiocephalic artery and left common carotid artery.
2.0 - diameter of the aortic arch beterrn the left common carotid artery and left subclavian artery.
2.8 - diameter of the aortic arch just distal to the left subclavian artery.

As mentioned, the size of these must not be significant enough to worry about but if anyone has any thoughts, opinions, or prior experience with this type of thing I'd love to hear it. I just don't want to think that these are going to advance to the size where I need surgery again.

Thanks in advance and hope everyone is well.

Cheers,
Michelle
 
Hi Michelle. Yes that is an aneuyrsm in the works. When it gets to 5.0 then the risk of rupture is higher then the risk of surgery and surgery should be done. Yearly echos are prudent at this point.
 
Hi again,

Thanks for your reply, Ross. EEEEEKS! Not another one.

OK, so now I'm going to feel very stupid and ask which of the numbers needs to be at 5.0 before surgery is indicated. Is is the 4.5 maximum diameter of the ascending aorta or the 2.6 dilation of the brachiocephalic artery? If it's the 2.6 then how quickly do these things normally grow? Does this mean many years before any surgery might have to be done?

Thanks again for any info. Hope everyone is well.

Cheers!
 
4.5 max diameter. Don't feel bad, I have a 3.6 in my abdomen I'm watching. This is after my thoracic ruptured.
 
Hi Michelle -

I don't know any specifics about your measurements but I'm sure my reaction would be like yours. "EEEEEEKS!!!"

I wish the doctor had talked to you rather than the nurse; can you call him or email him? Have you been given directions in regard to your physical restrictions and such? Do they have any idea why these areas are enlarging, specifically? Scarring there, or are they on either side of a graft or something? Do they need to look elsewhere also? These are all things I would want to ask the doctor and perhaps you could email your surgeon and ask him about it all also (with your new CT scan results forwarded to him) because several members here have gotten good results from emailing their surgeons various questions.

Good for you that you requested a CT scan also! What kind did you have specifically, may I ask?

Also, I saw that you had surgery over 30 years ago to widen the aorta. Was that, do you recall, a COA (coaractation of the aorta)? One clue might be if the scar from that surgery is across your back (as mine is). I hope all goes well for you and I hope you get some good answers. Please keep us posted and take care :) .
 
Hi all,

Thanks again for all the info. I'm usually very patient but have to say I'm annoyed that the aneurysm wasn't mentioned to me even if it isn't at a critical point.

I did speak to the nurse and she's going to have the doctor look at the report again and she'll call me next week. Unfortunately there's no e-mail.

Susan, I had aortic stenosis so my first operation was called a commisuerotomy (not sure I spelled that right) to open up the valve. Coarctation has never been mentioned. Thanks for all the great questions and I'll ask them. I know I have a lot of scar tissue - gave the surgeon a lot of trouble last time.

I'm also glad I pushed for the CT. They did a chest/abdominal CT with iodine Drinking barium was NOT fun - that stuff is barfilicious. :( The CT also detected gallstones. What an amazing thing.

Hopefully I can get some answers next week.

Take care !

Cheers,
Michelle
 
Hmmm...the cardio's nurse called back a few minutes before she left for the day and said the doctor characterized the aneurysm as "mild" and that we would be doing the yearly follow up.

I saw on other sites exactly what you said, Ross - that at 5.0 or 5.5 it's time to think about surgery, but I also read these progress pretty slowly so it'll be interesting to see what next year's results are.

Still, I may call next week and see if I can get an appointment to see the cardio to get some of these questions answered.

Thanks for listening and if anyone else has any other comments please chip in!

Cheers,
Michelle
 
DavesMom said:
Morning everyone,

Had AVR replacement/aneurysm repair back in '99 and have been doing well ever since. However, since I have a BAV I pushed the doctor this year to do a CT scan. When I spoke to the nurse she said everything was stable and looked good but that I would be getting a CT scan every year from now on.

When I got a copy of the report I was surprised to see two aneurysms noted. I assume they're not large enough to worry about but I'd like to get some of the opinions of the "vets" on this board about the results. Here they are:

"At the level of the distal anastomosis of the graft, the aorta measures approximately 3.0 cm in diameter. The maximum diameter of the ascending aorta prior to the brachiocephalic artery is approximately 4.5 cm. There is aneurysmal dilation of the brachiocephalic artery. It measures approximately 2.6 cm just above its origin. The origin of the left common carotid artery is aneurysmal and measures 1.8 cm in maximum dimension."

No other significant dilations were noted on the report. Other measurements were :

3.0 - diameter of the aortic arch between the brachiocephalic artery and left common carotid artery.
2.0 - diameter of the aortic arch beterrn the left common carotid artery and left subclavian artery.
2.8 - diameter of the aortic arch just distal to the left subclavian artery.

As mentioned, the size of these must not be significant enough to worry about but if anyone has any thoughts, opinions, or prior experience with this type of thing I'd love to hear it. I just don't want to think that these are going to advance to the size where I need surgery again.

Thanks in advance and hope everyone is well.

Cheers,
Michelle
Click to expand...

I'm not sure what the parameters for these areas of the aorta are. It may be the same as for other areas but I think we need to be careful that we are comparing apples to apples.
 
I would also highly recommend Dr. Lars Svensson at Cleveland Clinic. He i highly experienced in aortic surgery and Marfan's...one of the best of the best!

Betsy
 
Measurements

Measurements

I had a bicuspid aortic valve replacement along with an ascending aorta aneurysm repair. At the time I was told by the surgeon at Scripps Memorial Hospital that the valve was not an issue (I got echos each year) and the aneurysm was considered 'slight' at 5.0 cm but that the combination of the two at the same time indicated a need for surgery. It was scheduled about a month after diagnosis. I was also told that an ascending aorta aneurysm on its own would not have indicated a need for surgery until it was 5.5 cm. After all was said and done (after OHS) my cardiologist told me that my surgeon said that I really NEEDED the surgery.

I did not have any symptoms prior to surgery which was a very weird state to be in. OK...take this otherwise healthy body and do what you gotta do.
 
I was thinking along the lines of what Betty states.

At the level of the distal anastomosis of the graft, the aorta measures approximately 3.0 cm in diameter. The maximum diameter of the ascending aorta prior to the brachiocephalic artery is approximately 4.5 cm. There is aneurysmal dilation of the brachiocephalic artery. It measures approximately 2.6 cm just above its origin. The origin of the left common carotid artery is aneurysmal and measures 1.8 cm in maximum dimension.
Click to expand...

Graft? I thought the original aneurysm was "repaired"? I guess maybe only the aortic root was replaced? And now the aorta adjacent to the repaired portion is 3.0 cm. I suppose that could be what it was upon replacement, but I'd want to know for sure. The 4.5 cm likely represents considerable progresssion, else it would have been replaced at the time of the AVR. While 4.5 MAY not be time to operate, IMO it IS time to be lining up a top notch, high volume aortic expert. That the brachiocephalic and left common carotid are aneurysmal makes be wonder, 1) how they compare to 1999 and subsequent images and 2) what this kind of progression portends. The only person I would trust to evaluate this situation is that expert.

The ACC/AHA guidelines for the treatment of ascending aortic aneurysms associated with bicuspid aortic valves recommend surgery at 5cm. http://content.onlinejacc.org/cgi/content/full/48/3/e1?ct Those guidelines do not make allowances for aortic tissue that has already been operated on, nor do I recall their referencing issues with adjacent arteries. Any re-op is more complicated, but I think these points underscore the importance of seeking HIGHLY qualified advice. Patrick McCarthy, MD at Northwestern comes to mind, he was Ross' savior when he was at Cleveland. Kouchoukos has also been mentioned and has several (many?) patients on VR.com.
 
A huge thanks to everyone for their input and any other info would be appreciated. I do have a ton of questions that the nurse is unable to answer so I'll have to schedule an appointment. Luckily my echos have all been good and I passed a stress test last year with flying colors.

Surgery may be years away but right now I'm pretty angry because had I not gotten a copy of the report I would not have known that this aneurysm, even though they consider it "mild," is there. So I would urge anyone who doesn't get copies of every report to do so.

Appreciate all the recs. I'm a bit closer to Chicago than St. Louis but Cleveland has an outstanding reputation. This would be my third OHS and I have lots of scar tissue. In fact, it caused my right ventricle to become stuck to my sternum - gave my last surgeon a bit of a problem.

Again, a big thank you to everyone.

Cheers,
Michelle
 
Just to add to what everyone else has posted, yes 5.0 seems to be the magic number and its normal to grow at 0.1 per year.

However, if you are a small person you should adjust that 5.0 figure accordingly, i'm 6ft4ins and had mine done at 5.8 i think....not that i knew about it beforehand anyway.

Being overweight and exercising excessively will tend to accelerate the 0.1 growth rate slightly.

So you should probably be planning for surgery in the next couple of years....i wouldn't wait until you reach some magic figure and then start looking...if it blows sooner than expected you are in for a rough ride.

However, they have also been known to stand still for a year or two with no growth.

As you can see, its a black art trying to track these things....but i guess i'd be looking/researching for a good surgeon in this area...especially as its not your first surgery.

Regards.
 
Hi,

5.0 is not the time to begin thinking about surgery its the time for surgery. You may want to consider a new cardio. Beyond size, the growth rate is important as well. if its more than .1 that would be agressive

Keep your blood pressure low
no heavy weight lifting in the gym
ask cardio about a beta blocker or losatran

to try to delay growth

losatran is a fda approved for high blood presure medication a study at joh hopkins showed it to stop growth in marfan mice

good luck.
 
DavesMom said:
I'm a bit closer to Chicago than St. Louis but Cleveland has an outstanding reputation. Michelle
Click to expand...

Michelle I would encourage you to seek out Dr. Patrick McCarthy at North Western. He was my surgeon at Cleveland but now heads the show at North Western.

http://nmhphysicians.photobooks.com/profile.asp?pict_id=5235&LastnameSearch=Y&Lastname=mcCarthy

Dr. McCarthy has achieved national and international recognition in the fields of complex adult cardiac surgery including, valves, cardiac transplantation, mechanical ventricular assist devices, coronary artery bypass, minimally invasive surgery, aneurysm repair and atrial fibrillation ablation. He has performed several thousand heart operations, averaging 400 per year. He has authored or co-authored more than 300 papers and 30 book chapters. He is on the editorial board of four medical journals and is a member and officer in numerous professional societies.

He was one of the youngest surgeons ever to be elected into the prestigious American Association of Thoracic Surgeons at the age of 38. He has given over 325 lectures, has been Visiting Professor 34 times and has lectured on six continents.
 
Again, a very heartfelt thanks to everyone for the information and support.

I?m only 4?11 so may have to go a bit before the 5.0 threshold. Still, I?m hoping this means at least four or five years before anything has to be done.

The bad news, however, is that I am by nature something of a worrier so I?m not a good person to be walking around knowing that there?s a surgery in my future. Guess I?d better call my doctor tomorrow about scoring some heavy duty tranquilizers. :D

Since this was my first CT it?ll be interesting next year to find out how quickly the aneurysm is growing. If high BP can cause it to worsen then I guess I have no option but to quit my job. :p It?s normally within range but I imagine at work it skyrockets to about a trillion over a billion.

Hope everyone is well.

Cheers,
Michelle
 
Annies have a mind of their own. It could grow rapidly requiring surgery within a year or it could play lolly lolly la and take it's time. You have every right to be nervous. I am and would be too until it's taken care of.
 
If kids, Make sure they are screened and others in immediate family

bav genetic underpinnings.

the good news is you know about it and can fix it.
 
If high BP can cause it to worsen then I guess I have no option but to quit my job. It?s normally within range but I imagine at work it skyrockets to about a trillion over a billion.
Click to expand...

You should absolutely, positively, unequivocally have very well-controlled blood pressure. I'm no doctor but I would go so far as to say YOU SHOULD BE ON (at least) A BETABLOCKER. Betablockers protect your arteries from rapid rise in blood pressure that put stress on fragile arterial tissue. If you are not on a betablocker, you should ask to be put on one immediately.
 
Morning all,

I have taken the wonderful advice here very seriously and am very grateful for it. I?m going to line up a second opinion and also have a call in to my doctor to talk about BP med. At home it's almost always within normal limits but I know it has to be pretty high while I?m at work.

I also need to ask about exercise ? I walk at a moderate pace every day for at least an hour and wonder if that?ll exacerbate it.

Again, thanks to everyone. I?ll keep you posted!

Cheers,
Michelle
 
You must log in or register to reply here.

Latest posts

Back
Top