ElectLive
Well-known member
I thought I’d share some random bits of information on aortic aneurysms that I’ve gathered the past year, pre and post surgery. There is a lot of great information on this site already, but some of it seems to be changing, and hopefully this will also help put a lot of odds and ends regarding aneurysms in one place.
First things first, when to operate. I’ve seen all kinds of numbers here and elsewhere, some based on diameter size alone, some based on body size formulas, some seemingly based on a given doctor’s opinion. As for me, not quite a year ago, I was told by a cardiologist that my 5.0 cm aneurysm should be closely monitored, but surgery was not immediately necessary. 5.5 cm was the trigger point. Further info: my growth rate had been rapid, and I am (well, was) bicuspid aortic valve.
My own research following that appointment, some of it here, some of it on various medical sites, seemed to indicate 5.0 cm more often than not as the recommended trigger point for bicuspid patients, basically matching Marfan’s guidelines. So, I walked into my surgeon’s office for the first time thinking it was probably time to operate. He agreed. But he emphasized further that the ACC guidelines had been recently modified (Spring 2010) and that 4.5 cm would have been my actual trigger point. He clarified this trigger point by comparing the surgical risk versus the risk of dissection/rupture, and surgery was in fact the lower risk option.
Now, here’s a link (summary article plus embedded link to the guidelines) to the 2010 guidelines: http://cardiobrief.org/2010/03/17/ahaacc-release-thoracic-aortic-disease-guidelines/ It’s over a year old, so I’m sure old news for some, but probably new to a lot of folks too.
Interestingly, if you look on page 1530, the guidelines actually indicate surgery anywhere from 4.0 to 5.0 cm in bicuspid patients, depending on several factors, and there’s a related chart. Now, don’t anyone (particularly those in the 4.0 to 5.0 range) jump to conclusions, specifics of each individual patient still factor in. But the guidelines overall are certainly shifting toward a more cautious, preventative approach.
I can’t speak to the previous state of body size formulas, and if they changed too, or already reflected this in years prior. I remember doing the Cleveland formula at the time, and it indicated that my 5.0 was at the surgery point, don’t know if 4.5 would have been too.
Other stuff… I had seen several isolated studies indicating that first degree relatives of bicuspid/aneurysm patients were significantly more susceptible to aneurysms, even if they weren’t themselves bicuspid. My surgeon agreed and recommended that parents, siblings, children all get an echo. The ACC guidelines have some information on this as well. One thing harder to conclude, though, is how often to monitor, if at all, assuming no initial aneurysm evidence. Definitely no consensus here, but in a recent Cleveland Clinic valve disease webchat, a cardiologist recommended an initial echo at early adulthood, with follow-up every 10 years or so.
For my young kids, I also asked a pediatric cardiologist both locally and at Cleveland Clinic for advice, and echoes were recommended at birth (to check for bicuspid), and then with or without bicuspid, another echo at both 5 years and after the big growth spurt (teens) to recheck for aneurysm.
What else…oh yeah, brain aneurysms. I’d seen another isolated study indicating heightened risk for brain aneurysms in bicuspid patients. A cardiologist at Cleveland Clinic indicated that they occur, but it is not adequately studied. No current guidelines recommend screening. This seems the least likely to happen, and probably not worth any worry, but thought I’d mention anyway.
Another interesting thing about aneurysms is the likely connection to sleep apnea and related conditions. Please see Duff Man’s thread for more: http://www.valvereplacement.org/forums/showthread.php?37612-Aortic-Aneurysm-and-Respiratory-Issues
Finally, there was a Cleveland Clinic webchat a few months ago that had a lot of interesting info about aneurysms too: http://my.clevelandclinic.org/heart/webchat/1207_aortic-aneurysm.aspx I’m sure a lot of people already know about these, but for those that don’t, they are a great resource and opportunity to ask questions.
And, that’s pretty much it. This is not meant to be definitive or conclusive by any means. For anyone with an aneurysm and/or facing the prospect of aneurysm surgery, please research and discuss more with your own doctors. But for general reading at least, thought it might be useful.
First things first, when to operate. I’ve seen all kinds of numbers here and elsewhere, some based on diameter size alone, some based on body size formulas, some seemingly based on a given doctor’s opinion. As for me, not quite a year ago, I was told by a cardiologist that my 5.0 cm aneurysm should be closely monitored, but surgery was not immediately necessary. 5.5 cm was the trigger point. Further info: my growth rate had been rapid, and I am (well, was) bicuspid aortic valve.
My own research following that appointment, some of it here, some of it on various medical sites, seemed to indicate 5.0 cm more often than not as the recommended trigger point for bicuspid patients, basically matching Marfan’s guidelines. So, I walked into my surgeon’s office for the first time thinking it was probably time to operate. He agreed. But he emphasized further that the ACC guidelines had been recently modified (Spring 2010) and that 4.5 cm would have been my actual trigger point. He clarified this trigger point by comparing the surgical risk versus the risk of dissection/rupture, and surgery was in fact the lower risk option.
Now, here’s a link (summary article plus embedded link to the guidelines) to the 2010 guidelines: http://cardiobrief.org/2010/03/17/ahaacc-release-thoracic-aortic-disease-guidelines/ It’s over a year old, so I’m sure old news for some, but probably new to a lot of folks too.
Interestingly, if you look on page 1530, the guidelines actually indicate surgery anywhere from 4.0 to 5.0 cm in bicuspid patients, depending on several factors, and there’s a related chart. Now, don’t anyone (particularly those in the 4.0 to 5.0 range) jump to conclusions, specifics of each individual patient still factor in. But the guidelines overall are certainly shifting toward a more cautious, preventative approach.
I can’t speak to the previous state of body size formulas, and if they changed too, or already reflected this in years prior. I remember doing the Cleveland formula at the time, and it indicated that my 5.0 was at the surgery point, don’t know if 4.5 would have been too.
Other stuff… I had seen several isolated studies indicating that first degree relatives of bicuspid/aneurysm patients were significantly more susceptible to aneurysms, even if they weren’t themselves bicuspid. My surgeon agreed and recommended that parents, siblings, children all get an echo. The ACC guidelines have some information on this as well. One thing harder to conclude, though, is how often to monitor, if at all, assuming no initial aneurysm evidence. Definitely no consensus here, but in a recent Cleveland Clinic valve disease webchat, a cardiologist recommended an initial echo at early adulthood, with follow-up every 10 years or so.
For my young kids, I also asked a pediatric cardiologist both locally and at Cleveland Clinic for advice, and echoes were recommended at birth (to check for bicuspid), and then with or without bicuspid, another echo at both 5 years and after the big growth spurt (teens) to recheck for aneurysm.
What else…oh yeah, brain aneurysms. I’d seen another isolated study indicating heightened risk for brain aneurysms in bicuspid patients. A cardiologist at Cleveland Clinic indicated that they occur, but it is not adequately studied. No current guidelines recommend screening. This seems the least likely to happen, and probably not worth any worry, but thought I’d mention anyway.
Another interesting thing about aneurysms is the likely connection to sleep apnea and related conditions. Please see Duff Man’s thread for more: http://www.valvereplacement.org/forums/showthread.php?37612-Aortic-Aneurysm-and-Respiratory-Issues
Finally, there was a Cleveland Clinic webchat a few months ago that had a lot of interesting info about aneurysms too: http://my.clevelandclinic.org/heart/webchat/1207_aortic-aneurysm.aspx I’m sure a lot of people already know about these, but for those that don’t, they are a great resource and opportunity to ask questions.
And, that’s pretty much it. This is not meant to be definitive or conclusive by any means. For anyone with an aneurysm and/or facing the prospect of aneurysm surgery, please research and discuss more with your own doctors. But for general reading at least, thought it might be useful.
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