Aorta Valve replacement question...

[zztimeout]

Hi,
As you know... I am 41 male with BAV (born with) and now have a anurysum 50mm at root of ascending aorta.... I am having a TEE test tomorrow to see if they can do a David Proceedure to save it.... I asked my surgeon if I had a connective tissue disorder and he said 'NO'.... my question is..... everyone I know that has an anurusym on ascending aorta all have BAV's.... so... what I think is the BAV causes this condition.... why the hell would you want to 'keep' this valve when later you could develop an anurysum further up the arch or desceniding.... why not get rid of the dam thing and replace with tissue or mechanical....?

If I had my way.. I probably would have replaced the valve when I was 30 and not have the worry about replacment of the root of the ascending aorta..... lets face it... they say that valve replacment is routine surgury now.....

Am I missing something ???
Dave

 

[OldManEmu]

Dave the tissue is not normal or it wouldn't have an aneurysm. Not all BAV's have aneurysms however a significant percentage do.
A David procedure involves the resuspending of the native valve; his has nothing to do with aneurysms.
If the native BAV is working well and can be cleaned up and resuspended (David procedure) in the Dacron graft that replaced the aorta containing the aneurysm, why would you want to replace it with a tissue valve? If you do not want a mechanical valve a David procedure is a possible alternative.
It is important that the surgeon is experienced in determining what the likely David procedure valve life will be and that it is greater than a tissue valve.

 

[zztimeout]

Yes I understand what the proceedure is... My surgeon has done 'hundreds' or aorta root replacements and his college has done many David proceedures. He said if they can save the valve, he would do root and other doctor would do valve. Both work well together and would work on me together.

As all the people that I know who has anurusyms, they all have BAV so I thought maybe the valve itself causes the problem.... Maybe uneven spray pattern of blood pushing more on one side or something .... So one would think if you replaced the root of ascending aorta , maybe in time the arch would be the next to go.... Just a thought.... Just strange that it's rare to have the anurusym and not a BAV.

I put it to everyone.... Let's hear from anyone that has an anurusym and NOT a BAV....

Any thoughts on this,??

 

[epstns]

I had a bicuspid aortic valve with no anyrism (sp?) and when I asked my surgeon if the stenotic valve could have weakened the tissue of my aorta, he said that the "induced" weakness was an "old wives' tale" and that there was no cause and effect relationship -- only correlation being that a good percentage of BAV patients also have defects of the aorta. I was lucky and did not.

 

[camgough]

I had valve sparing aortic root replacement surgery in July 2010. I found out in May 2010 I had a bicuspud aortic valve, and also an ascending aortic aneurysm of 6.7cm. Prior to my surgery I asked one of my surgeons if they replace my aorta with the graft, will the aneurysm grow further along my aorta eg arch, descending?? He said that it was not likely since the valve and the ascending part of the aorta are developed from the same (gene, chromosome, DNA, etc....) I don't remember what exactly he said. He suggested if one was diseased, the other one would be too, but did not expect future aneurysms to develop because of the valve. I am 8 months post op and last echo, xray showed my "reshaped" aortic valve is working well, and everything else looks good! I am glad to have had this done, instead of being on blood thinners, or having a tissue valve. Just my opinion, and that is the info from my surgeons. I also had two work on me.

 

[ALCapshaw2]

Hi,
As you know... I am 41 male with BAV (born with) and now have a anurysum 50mm at root of ascending aorta.... I am having a TEE test tomorrow to see if they can do a David Proceedure to save it.... I asked my surgeon if I had a connective tissue disorder and he said 'NO'.... my question is..... everyone I know that has an anurusym on ascending aorta all have BAV's.... so... what I think is the BAV causes this condition.... why the hell would you want to 'keep' this valve when later you could develop an anurysum further up the arch or desceniding.... why not get rid of the dam thing and replace with tissue or mechanical....?

If I had my way.. I probably would have replaced the valve when I was 30 and not have the worry about replacment of the root of the ascending aorta..... lets face it... they say that valve replacment is routine surgury now.....

Am I missing something ???
Dave

I would ask this Surgeon "How can you KNOW that I don't have a Connective Tissue Disorder before you examine the tissue itself (i.e. once has opened you up).

If you are interested in a Second Opinion, I asked a Heart Transplant Surgeon I happen to know who came from Brisbane who he would recommend for your Surgery. He recommended "Bruce Garlack" (as was relayed by bdryer in two of your other threads when I was having computer problems and could not check into VR).

 

[zztimeout]

Well... had the TOE test today and yep... pizza cutter down the chest in may... The cadio said that the valve (BAV) looks good... very little leakage and would probably be saved.... the ascending aorta is 4.2cm at root and then going to 5.1cm a little bit away from it.... arch and descending all look perfect.....

Cardio said that connective tissue disorder is now way off... she said that it is a genetic issue where a cromosone did not ddo what it was suppose to do somewhere between 0 - 10 weeks in womb.... She said thats why most people that have BAV do grow the anurysum.... she said I suppose it sort of is a connective tissue issue but it only is in that area.... a 'connective tissue disorder' is a general term as there is a lot of connective tissue in the body so narrowing it down to a better diagnosis is what they have been studying in..... these 'genes' that causes the BAV and in time anurysum only forms the valve and the root of ascending aorta... another gene forms the arch and descending..... this is why it is rare for these to have problems.... not saying that dont happen but is very rare compaired to root replacements.....

The doctor Bruce Garlick also woks in the same hospital where I am going and I think he could be the second surgeon who will do the 'valve tweek' or David Proceedure where my other surgeon Dr Trevor Fayers will do the root replamement as he has done hundreds and does transplants and also lectures in Germany and other countries on proceedures and surgical tecniques....

Sounds all good... I dont care if Daffy Duck was doing it...as long as I open my eyes at the end...

Dave

 

[skeptic49]

Cardio said that connective tissue disorder is now way off... she said that it is a genetic issue where a cromosone did not ddo what it was suppose to do somewhere between 0 - 10 weeks in womb.... She said thats why most people that have BAV do grow the anurysum.... she said I suppose it sort of is a connective tissue issue but it only is in that area.... a 'connective tissue disorder' is a general term as there is a lot of connective tissue in the body so narrowing it down to a better diagnosis is what they have been studying in..... these 'genes' that causes the BAV and in time anurysum only forms the valve and the root of ascending aorta... another gene forms the arch and descending..... this is why it is rare for these to have problems.... not saying that dont happen but is very rare compaired to root replacements.....

Dave, thanks for posting that interesting analysis and good luck with your surgery in May.

Best wishes,

Jim

 

[Lynlw]

Well... had the TOE test today and yep... pizza cutter down the chest in may... The cadio said that the valve (BAV) looks good... very little leakage and would probably be saved.... the ascending aorta is 4.2cm at root and then going to 5.1cm a little bit away from it.... arch and descending all look perfect.....

Cardio said that connective tissue disorder is now way off... she said that it is a genetic issue where a cromosone did not ddo what it was suppose to do somewhere between 0 - 10 weeks in womb.... She said thats why most people that have BAV do grow the anurysum.... she said I suppose it sort of is a connective tissue issue but it only is in that area.... a 'connective tissue disorder' is a general term as there is a lot of connective tissue in the body so narrowing it down to a better diagnosis is what they have been studying in..... these 'genes' that causes the BAV and in time anurysum only forms the valve and the root of ascending aorta... another gene forms the arch and descending..... this is why it is rare for these to have problems.... not saying that dont happen but is very rare compaired to root replacements.....

The doctor Bruce Garlick also woks in the same hospital where I am going and I think he could be the second surgeon who will do the 'valve tweek' or David Proceedure where my other surgeon Dr Trevor Fayers will do the root replamement as he has done hundreds and does transplants and also lectures in Germany and other countries on proceedures and surgical tecniques....

Sounds all good... I dont care if Daffy Duck was doing it...as long as I open my eyes at the end...

Dave

How she explained it makes sense. If you are really interested or bored, you can do a search for Aorta and neural crest, pretty much the root is formed from different precursor cells than the arch in embryos.

If anyone is interested, There were some very good sessions from the 2010 AATS Annual conference about BAV - the differences in bicuspid aortas and tricuspid aorta make up, when and how to operate etc.. that you can watch the webcast on. To be honest to me at least most of them are pretty understandable, but some of the more complex details start to sound like Charlie browns teachers in my head wah wah wah..but you can understand the overall information.

http://www.aats.org/2010webcast/ the Bicuspid sessions are toward the bottom may 2nd there are 5 different sessions that would take about an hour 1/2 to watch them all, IF you want to watch them I really suggest you watch them in order since they tend to build upon what was discussed in the previous session (unlike most conference sessions that are pretty much stand alone and you can pick what ever interests you) The first one is "Pathobiology and Genetics of Bicuspid Aortopathy" then there are sessions when and what and how to operate sessions that have good info about the different types of BAV and which valves to save and which should be replaced, after the sessions there is a short panel discussion with Q&A

 

[Rosebud54]

Dave,

I had the TEE and Heart Cath this week, as well. Now they say my BAV is working "pristine". The surgeon said he will look at it when he repairs my TAA. I guess when I wake up I'll know...my pre-op is 28 Mar, maybe I'll know more then. I'm as confused as you are!

Carol

 

[camgough]

The first thing I remember after waking up from my surgery was my wife saying "they kept your valve"! I still couldn't open my eyes. but was very happy! Good luck!

 

[Country]

I had my anyerism in my root. it had compleatly pulled my valve apart so that it was severly ineffiecent. my surgeons replaced my valve with mechanical and removed the rest of my ascending aorta up to the arch. he called that part of my aorta "diseased."

also i have heard of a lady that had to have her entire aorta replaced...... all of it. years ago it was done with teflone and somehow it attached itself to the lungs. anyways it all had to be redone with dacron. i dont know what "disease" caused her condition but i find it interesting.