Dazed and Confused

[ross3]

I?d been trying to decide about surgical repair of my enlarged aortic root (51mm) and have been greatly helped in this decision by the forum members. Thanks to all who have offered their advice!

Yesterday I scheduled with Dr. Hughes at Duke to do the repair using a David procedure.

During the course of my initial interview with Dr. Hughes last Friday he said that the MRI had shown the cavities in my heart were enlarged. He didn?t say by what amount.

Because I feel fine, lift weights, run, etc. I?ve always assumed that although my aorta was enlarged, that I didn?t have any other cardio trouble. He said that this enlargement wouldn?t affect how he?d approach the repair of the aneurysm. I didn?t think too much more about the ?dilated heart? comments because it didn?t sound relevant to what I saw as my main problem, i.e. ? repairing the aorta before it dissected/ruptured. I spent the next 5 days focusing my energy on evaluating when and where to do the surgery.

Well about an hour ago I went by Duke and picked up a copy of the MRI results because I thought it?d be good to have for my files. I was shocked to see the following within the three pages of the report:

Left Ventricle
Normal wall thickness
SEVERELY ENLARGED CAVITY

Right Ventricle
Normal Contractility
MODERATELY ENLARGED CAVITY

Left Atrium
MILDLY ENLARGED CAVITY

Right Atrium
MODERATELY ENLARGED CAVITY

And then in the summary section:
There is significant LV chamber dilation (LV end-diastolic dimension is 6.9 cm). LV wall thickness is normal, and there is normal systolic function with an LVEF of 55%. No regional wall motion abnormalities were noted.

Naturally there is a bunch of other information about the valves, aorta dilation and so forth that I?d expected to see. However, seeing that my heart is so enlarged has really got me freaked. Since Dr. Hughes hadn?t told me anything about the degree of enlargement I was thinking that this was a minor thing. The words ?severely enlarged? really hit me hard. I just don?t know what to think about this.

I didn?t get any other medical reviews of my situation prior to booking the surgery yesterday because I viewed the 51mm aorta as sufficient to confirm the *need*. I?d thought that the only real decision was where and how soon to have the surgery. Dr. Hughes seems to have plenty of experience and Duke is certainly a top facility, plus it's local.

Now I wonder if I?ve made a mistake and have been going too fast. I?m not sure what to do ? if anything.

I?d really appreciate anyone with some knowledge about this to please weigh in with your thoughts.

 

[Ross]

I don't want to shoot your hopes down, but I question whether your heart will shrink back to normal at all. Yours looks to be as bad as mine and mine is permanently enlarged.

 

[briansmom]

I don't think your moving too fast, your heart will only get worse without intervention. You mention also that you run, etc. Are you a serious athlete? Lance Armstrong's heart is very large and I don't think it is a bad thing in his case. I wouldn't worry about it too much at this point (easy for me to say, I know). Talk to the doc and see what his suggestions are, get on good heart meds, have your surgery, do your rehab and then see where you are.

 

[Philip B]

Dazed?

Dazed?

What has you confused? At 51 cm, your aortic aneurysm probably needs to be repaired. According to your CT results, you've go some enlargement of heart muscle tissue going on. In previous posts, you've indicated a lot of confidence in the surgeon and surgical facility you've chosen.

Part of the challenge associated with this kind of surgery is making sure to ask the right questions. In my case, it took more than one consultation with my surgeon and cardiologist. Even though I visited with my doctors several times about my problem and the fix, it still was hard to get my head around the whole thing.

I felt fine and didn't have any symptoms. During one of my consultations with my surgeon, he responded to a question about my need for surgery by telling me that my aorta was supposed to be about the diameter of a nickel. He then suggested I compare the diameter of a nickel with the 58 cm aortic aneurysm he was showing me on my CT scan. It was very clear that my aorta needed repair immediately.

As noted in previous posts, address the questions you have with your doctor. You may have a doctor who is very good at fixing problems like yours, but has difficulty anticipating all of the questions that are running through your head.

-Philip

 

[MarkU]

I had significant enlargement of my left ventricle prior to my AVR. Like you, I was very active and an avid weightlifter up until the onset of my symptoms about two-to-three months prior to my surgery.

My docs were very concerned sure about my enlargement and told me that it might be permanent.

I was very fortunate that it gradually reversed itself about a year after my surgery.

Although I was 'functional' within 3-4 months post-op, it took me a good year to completely recover from my surgery.

Now nearly eight years after my surgery I'm still very active, but have cut back significantly on the weightlifting to focus more on aerobic training.

Good luck.
Mark