? about surgery recommendations for aortic aneurysms

[Bigred]

I had a ct w/contrast and echo today. It will be a few days at least until I speak to the dr and get results. The ct tech gave me a print out of a few pics but he said he couldn't copy any to cd. Anyway, I'm far from an expert but I don't think my aorta is near 5 cm, probably more like 4.6 or 4.7 (just a guestimate on my part) I didn't even ask the tech, I know they can't relay that info directly to patients.

Anyway, from what I've read here and on the internet, 5.0 cm seems to be the standard before discussing surgery options.

Is this the same for someone that has already had an avr w/a mechanical valve? What about if there is chest pain associated?

 

[Danny]

Same boat!

Same boat!

Hello, I think we are going through just about the same thing. Mine was at 4.9 6 months ago, now its 5.2 Ive talked to a surgeon 6 months ago, and Monday. He said he wants to watch it more....Im not sure i can with my stress level. This is the greatest place to find out what you need to know. Ive vented, and still, everyone here "still" talks to me, and gives me advise and just comfort. I hope you talk to someone and they tell you what they think needs to be done. If you need to talk let me know. Danny

 

[davidswife]

David will be having a part of his ascending aorta replaced in addition to the AVR on Friday. We just got off the phone with Dr. Johnson (the surgeon) who called to go over the results of the CT scan with us. The scan showed that his ascending aorta measures 5.0cm. I am really thankful that the surgeon ordered the CT scan as we had no idea that there was any problem with his aorta. Dr. Johnson said that, of course, he would have fixed it when he did the AVR but he wanted to know (and make sure that we knew) exactly what was going to be needed to be done going in. He also said that he will not know until he goes in if the aorta has to be replaced down to the root. If so, he will use a combo unit where the dacron tube is connected to the valve. The On-X valve does not come as a combo unit so the valve will be a St. Jude's valve instead (I think he called it a combo unit - please forgive me if I am not using the correct wording). His hope is to be able to use the On-X valve and replace the aorta above the root, but if the aorta is weak all the way down to the valve then he will not leave behind a weak part just to use the On-X valve. I am actually happy that the valve was dilated enough that it needs to be replaced since if it was on the borderline then he might not have done it and we might be looking at another OHS down the road (which we are hoping to avoid by going with the mechanical valve).

Sorry, Bigred, that I can't answer your question about if it is the same for someone who has already had AVR. Just wanted to relay our experience that David is getting his aorta repaired at 5.0cm. Also, I'm assuming from your avatar that you are a Yankees fan. David is a die-hard Yankees fan and an avid baseball card collector (mostly Yankees).

Danny, if yours is actually 5.2cm then maybe you might want to get a second opinion on waiting. When I wrote to you privately I thought that the surgeon had said that he would watch it at 5.0cm but I guess I was mistaken (he must have said that he would watch it if it was less than 5.0cm). And I misunderstood what you had written, thinking that you said that yours now measured between 4.9 and 5.2 and not that it had changed from 4.9 to 5.2. I'm still learning as I go along. I still don't think you should panic but you should probably get a second opinion.

Nadine

 

[ALCapshaw2]

Nadine (Davidswife)

A Dacron tube can be sewn onto an On-X Valve (some of our members have this combo)* in only a few extra minutes. With an assisting surgeon the time can be reduced to almost nothing.

Call Catheran Burnett, RN, at 888-339-8000 ext 265 for more details. She is the Manager of Education and Promotion for On-X and was a former Surgical Nurse at Baylor during the world famous Dr. DeBakey's prime. She can tell you how they recommend using their valve with an aortic conduit (and hopefully avoid some known 'issues' by using a specially designed graft).

FYI, there was a long discussion of a Pounding Heartbeat in a patient who received one of the St. Jude Combo's with a "straight graft", described as the worst case of Vibration his surgeon (and one at Mayo Clinic) had seen. They are trying to devise some tests to measure and model his response that has been likened to a "Water Hammer" often seen in Plumbing. I will try to find that thread and add it's link later. My (engineering) guess is that there is a mechanical resonance effect going on that probably results from this particular patient's physical parameters and the parameters of the Valve and Dacron Tube (length, diameter, stiffness, heart rate, etc.)

EDIT: The Best Way to find the relevant posts from Member "Seth" is to click on "Community" on the Blue Line at the top of the page, then click on "Members List", then click on "S" (first letter) and scroll down to "Seth".

His posts are in the Post Sugery Forum beginning in February 2009 thru April 2009, and then about his 'second opinion' from Mayo Clinic a few weeks ago.

Click on "Seth" and scroll down until you find a link to "threads started by Seth". This will provide links to his threads dealing with his Pounding / Vibrating issue.

You need to know that his was an unusual and rare event.
He conducted a poll and found some others (Gustaf comes to mind) who experienced somewhat similar pounding, but to a lesser degree.

Call Catheran. She can tell you a LOT more than I can about graft options / designs.

"Briansmom" has discussed how her son's surgeon sewed a dacron aorta graft to an On-X valve for her son.
The following is from her "member profile":
3/13/07 explantation of LVAD, on-x aortic valve, dacron ascending aorta, mitral valve repair, 1 new CABG

She has been a prolific writer. It may be easier to send her a Private Mail message (PM) to discuss the details.

 

[Faye]

Nadine,
I, too, have had my ascending aorta, including the aortic root, replaced with a dacron tube along with an ON-X valve in the aortic position.

I am almost 2 years post surgery and feeling pretty darn good.

Best wishes to you and your hubby as you continue on this journey.

 

[davidswife]

Faye,

Thank you for responding. I already spoke to Catheran from On-x and have a call in to my surgeon. I have been reading Seth's posts and just came upon your reply to one of his threads where you said (on March 2nd) that you have a thumping heart and are "waiting for the day that 24 hours pass and I don't think about my valve." Are you still experiencing this? This is what I was hoping to avoid by going with the On-X and attached graft as opposed to the St. Jude's combo unit. Now that I've read that you have experienced this also (but I'm assuming to a much lesser degree than Seth), perhaps it is just a result of the graft being attached directly to the valve and is just something that has to be lived with.

Nadine

 

[briansmom]

Yes, my son has an On-X with dacron tube. His doc said that it would take him an extra 5 minutes. The only problem that my son ever had with "pounding" was related to his pacemaker activating his diaphragm. When my son got his On-X valve he was undergoing an experimental, first ever removal of an LVAD without a heart transplant. It was also the doc's first On-X valve. He would not have let me choose the On-X if he thought the lack of attached dacron would be a problem.