Aorta enlarging seven years after AVR replacement

[DanielB]

Hello everyone,
Been a while since I posted a new question, but that's because all has been pretty stable (and boring) since my AV was replaced in 2011. I have had follow-up echos every year since until 2016 when I was told I'd go to every two years since all was good. I just had my most recent echo and I have been told that the size of my Aorta has enlarged from 4.1cm to 4.4cm since my last look-see.

The valve I am told is functioning final and all other boxes were checked off as okay, so it seems odd that my Aorta would be growing now. My Cardio thinks it may just be an echo glitch and is retesting in six months.

Anyone else had such a thing crop up after a stable period after AVR?

 

[epstns]

I didn't run into that one, but I did receive a little "surprise" a few years after AVR. After one echo I saw in the notes that they noticed a small atrial-septal defect (small opening between the two atria). I had never been made aware of this from the beginning of my journey. I asked about it, and was told "It has been there since before surgery. It is so small that it is of no consequence. Just ignore it."

So, there can be variations among echo readings (different patient positions, different echo tech, different machine or transducer, etc.) that are often just artifacts. I'd go along with the doc, and just watch it for now.

 

[Superman]

I had an aneurysm 19 years after I had my aortic valve replaced with a St Jude mechanical. I was not expecting a second open heart, but had to have one.

My aorta was quite stable (roughly 3 cm) for years, then in a matter of 3 years it went from 2.6 cm - 4.9 cm. Just one of those other components of the larger congenital defect many of us BAVer’s deal with.

 

[DanielB]

Thanks for the feedback. I'll see if my cardio is right on his suspicions that this is just a variation from one tech to another, but then he thought I'd be in the waiting room longer than I was too. My reading on the subject since I posted this backs up what you experienced Superman -- it happens. I guess I'll just have to wait and see where this takes me. The journey continues.............

 

[Superbob]

Daniel, I had a combined aortic root/valve replacement back in 2005. Aortic aneurysm measured 5.4cm on surgery day, and had rapidly increased in size the previous 6 months to a year. Since then, I have echos rather frequently and have had some experiences with inaccurate (or misinterpreted) data. The first cardiologist I had after moving down here to Carolina evidently had never seen a replacement device like mine, and he and his tech mistook that device for another aneurysm. I had to gather up all the tapes/discs and whatnot and send them to my great surgeon back in Northern Virginia, who said no that's not an aneurysm. All was well. I now have a very competent cardio and tech, but there still can be glitches in echo testing and readouts. I've seen a few minor ones.

Don't know if any of this applies to you, but my opinion would be that, yes, an increase from 4.1 to 4.4 over a two-year period merits watching and I think your cardiologist is on a prudent path in re-testing in six months. Merits monitoring but as he noted, it could be a glitch of some kind. Echo is a valuable indicator but a not-always-exact one.

 

[pellicle]

Hi

...I just had my most recent echo and I have been told that the size of my Aorta has enlarged from 4.1cm to 4.4cm since my last look-see.... My Cardio thinks it may just be an echo glitch and is retesting in six months.

there is every reason to suspect that your cardio is on the right path, and a six month rexamination will no doubt establish that. Sounds like a prudent plan.

As you may have read here these things can expand then stabilize. Until you are closer to 5 its not really anything to get worried about and the guidelines suggest:

http://www.anzsvs.org.au/patient-inf...rtic-aneurysm/

"When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention. This is because, at this size, the aneurysm has a greater risk of rupture. It then becomes as safe to have an operation to repair the aneurysm, as it is to leave the aneurysm alone. Surgery may also be considered if your aneurysm is rapidly expanding on regular scans or it starts to cause other complications (see above). Rapid expansion means more than 7mm in 6 months or 10mm in one year. "

best wishes

 

[DanielB]

Superbob, thanks for for sharing the background. It seems like there's no end to knowing what can come next. Pellicule, my cardio also mentioned that 5.5 is a bit of a benchmark and said that if he found any significant results in the next echo, he would order a ct scan to get definitive data. I'm glad for that bit of insurance as not knowing is the worst thing. I also just learned that another cardio interpreted my echo as my cardio was out of town that week. Could be a part of it, we'll see. I'm more curious at this point than concerned and getting the knowledge from everyone is a great thing.