The Great Aneurysm Repair Timing Debate

[csutherland]

Jerry's aneurysm was detected 3 1/2 yrs ago, three yrs after his AVR and Pericardial Window surgeries. At time of detection it was 5.2 or 5.3 cm. The local doc who did the other surgeries said risk of surgery was greater than risk of rupture due to scar tissue, etc. We went to Dr Kouchoukas in St Louis for a 2nd opinion and he concurred 100%.

Jerry's now 71 yrs old and the aneurysm has not grown at all according to the last CT scan in the Spring. He pretty much works and does whatever he wants. That may be his undoing, but he doesn't dwell on it. You're a much younger man so of course your situation would be different.

 

[Rain]

Monitor it closely.

Monitor it closely.

Aaron,

My son?s dilated aorta was found the summer before his senior year in highschool. (1998) It?s measured everywhere from 4.2 to 4.6 over the years since then. The cardios have all said that the main thing that will determine when it should be fixed would be if they begin to see it changing... getting larger quickly. But monitor it closely.

 

[surfsparky]

Hi Aaron,

Chris' dilated aorta measures at 4.2 and no one is even batting an eyelid! I only noticed it by reading the reports. It may not concern the surgeons just yet but it sure does concern me. I'm keeping a close eye on it!

Yolanda

 

[MrP]

For those with dilated ascending aortas and trying to determine timing of surgery, symptoms always trump aortic size as criteria for elective surgery. Symptoms of a growing aneurysm, including sharp knife-like chest pain that may come and go over the course of months, are sometimes completely overlooked by medical personnel and attributed to muscular pain or something else. Stress tests and EKG may look normal. Pain receptors in the adventia wall of the aorta may "start firing" as the ascending aorta grows in size and indicate pending rupture or dissection.

 

[KristyW]

For those with dilated ascending aortas and trying to determine timing of surgery, symptoms always trump aortic size as criteria for elective surgery. Symptoms of a growing aneurysm, including sharp knife-like chest pain that may come and go over the course of months, are sometimes completely overlooked by medical personnel and attributed to muscular pain or something else. Stress tests and EKG may look normal. Pain receptors in the adventia wall of the aorta may "start firing" as the ascending aorta grows in size and indicate pending rupture or dissection.

MrP

With that kind of information, how can we convince our Drs. that it's the aortic anuerysm causing the pain? Tests are normal...pain is attributed to muscular pain or something else, but the symptoms are completely consistant with a growing aneruysm. How do we convince the Drs? ...very difficult situation.

 

[bird lady50]

All the best Aron Lets hope that you get the op soon and good luck .

 

[MrP]

Kristy,
Describing chest pain is difficult at best...especially to someone who has never experienced this pain. In my case, I knew these incidents of sharp, knife-like chest pains were not normal and unlike any pain I had ever experienced in my life. Only after an echo and CT scan did I become aware of my 5.1 cm aneurysm and root cause of this pain. This pain was not present post surgery. Regular 64-slice CT or MRI tests at 3 month or 6 month intervals may show growth of an aortic enlargement. Regardless of the size of the aneurysmal enlargement, pain symptoms should raise a huge red flag to a cardiologist or surgeon. Below is a link to research articles at Yale Medical that may prove useful.

http://aorta.yale.edu/research.html

All my best,
MrP

 

[KristyW]

Mr. P.

I wasn't asking so much for myself, but for Jacqui and and others who are fighting their Drs. and the Drs. not believing them.

Thanks for the answer though.

 

[jjay32]

My Cardio and a surgeon, both said that with only mild stenosis, aortic replacement is recommended at 5:0cm, due to the surgery risks (2-5%). Dissection risk under 5:0cm is considered to be less than 5%, thus the reason for the 5:0cm rule of thumb (for BAV) If valve symptoms occur than that will dictate when surgery is needed. With a 4.7cm ascending aneurysm, I am just waiting at this time. Next test (December?) will show the current growth rate. A fast growth rate would change the surgery equation also.

 

[upchurch131]

I was hoping to get the forums' thoughts on why so many surgeons prefer patients wait to get an aneurysm repaired. It seems like I've heard of soooo many more people dying from rupture or dissection that the wait seems arbitrary and illogical.

Aaron,

Dr. McCarthy told me that the aneurysm tissue was pretty thin- and could have been a problem at any time. Don't forget, I was at 5.2CM.

On last weeks "Hopkins", there was a woman whose aneurysm dissected and had emergency surgery. A little too close to home for me!

 

[vprnet]

Anyone hear from their surgeon

Anyone hear from their surgeon

Has anyone heard from their cardio or surgeon that a dialated ascending aorta can recover after BAV replacement?

Mine is somehere between 4.1 and 4.3 (the echo is an estimated measurement) and I am being told by my cardio and surgeon it will likely "recover" after my BAV is replaced.

I had other cosultations at at "The Clinic" and Mt. Siani who said they would tuck it up during the surgery. Have varying opinions on the added risk of touching the aorta.


Happy Thanksgiving

BAV diagnosed 1993
ON-X scheduled Dec 10

 

[Duff Man]

I've never heard such a thing... I have however heard of people having smaller measurements... whether that's because the aorta shrank or not is a different story. I'd like to believe it's not out of the realm of possibility, but it seems very unlikely. I look at it as being permanently stretched out.

If I needed surgery today for regurgitation (or an AVR for any reason) I would insist they resect my ascending aorta to remove any dilated portion. My aorta is 4.1 - 4.2cm wide at it's widest. BUT, I'm 25 years old. I have a long ways to go with an aneurysm.

 

[terodac]

Well two years ago today I had mine fixed and a St Jude aortic heart valve replaced. Mine was 6cm and he told me I had to get mine fixed like yesterday, sometimes depending on where it is they will watch it. I know I was not going to wait and drop dead one day in front of my child. He said at the most I had only 6mnths to live. If you have a accident or anything it is death. They found mine by looking for something else, I know it has a lot to do with where it is and how thin it is also. I would never wait and watch mine grow, but there was another one of his patients that was watching hers for about four years, she did not want it done, and she did die from it one day. Your blood pressure can affect them also. Thank God I am here and today is my 2nd year anniversary! I have come a long way baby!!! LOL!! If you have one get it fixed!! NOW!

 

[abbanabba]

Hmmm... after reading this thread, I'd like your thoughts on whether I should be concerned about mine and if it's something I should get them to address during my PVR.

Aortic root
1997: 2.7cm
2002: 3.7cm
2003: 3.6cm
2004: 4.0cm

However... since 2004, there has been no change. Originally one of the reasons they were holding off on the PVR was because of the early changes to the aortic root - they told me they didn't want to do the PVR then have to do the aorta 2 years later... but since then, it hasn't changed at all.

Should the initial change bother me though, or should the fact it's held remarkably stable all this time allay any worries about it? Yes it it slightly larger than it should be, but then so's the rest of my heart, so maybe it will resolve with the surgery.


A : )

 

[vprnet]

Quick Read

Quick Read

Let me add to the library on this subject. A recent find (2006) on Aortic Dialation in BAV patients. It covers the gamit very well.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1464384&blobtype=pdf

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice.

Vince
BAV diagnosed 15 years ago
ON-X valve scheduled Dec 10
FDA Clinical Trial PROACT http://www.onxlti.com/onxlti-hv-proact.html

 

[MrP]

Abbanabba,
What method was used to measure the size of your aortic root each year?

There may be several explanations: a) the margin of error was large each time your aortic root was measured (for example, echo tests are not precise); or b) the precision of the instrument used to measure was better in recent years, and therefore, the margin of error was less (for example, 64 slice CT vs 32-slice CT); or c) your aortic root is enlarging; or d) all of the above. ????

Enjoy your week with your cousin and try to avoid the computer. Enjoy the sky, wind, water, mountains, laughter, beauty around you......

All my best,
MrP

 

[vprnet]

Could be a factor to consider in the not to far future.

http://www.valvereplacement.com/forums/showthread.php?t=28200

 

[abbanabba]

Abbanabba,
What method was used to measure the size of your aortic root each year?

I think there has been a combination of 2D & 3D Dopplers, MRIs and more recently an angiogram. I guess once they get in there and start poking around they'll probably see whether there's a problem or not.

Cheers,

A : )

 

[Duff Man]

I'm not sure if I'm sick to my stomach because of the taquitos I just ate or because of the echo results from last week. I think the nurse said it's .4 cm bigger since like 8 months ago (she was totally evasive) but I have a follow up appt with the doc on Friday. Soooo bummed.

Anyone know the recommended guidelines for elective surgery when considering aneurysm growth rate? Seems like I read >.5cm a year is go time.

 

[terodac]

Well they thought mine was right at 5 to 5.5cm, until after my bentall procedure and he told me it was more like 6cm. He also told me that I would have just dropped dead in about 6mnths or sooner if I would have been hit in the chest area or in a accident. It was truely a miracle from God they even found it, I had gone in for a stomach problem not any heart problems, but looking back I had shortness of breath. I am now 2.5 years post op! Glad to be here, and my advise would be do not wait. Go get it fixed!