jag004
Active member
Did u ever hear of aortic dissection AFTER it was repaired or replaced during surgery? I'm wondering if that happens? I'm not as educated on these topics as I should be. I guess new aneurysms can form over time, right?
Aortic Dissection question
- Thread starter jag004
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I am no expert either, but does this study answer your question? If you are asking if dissections can occur after valve replacement or repair, the answer appears to be yes, that is possible. Presumably aneurysms are less likely to occur if both the enlarged aortic root and defective valve have been replaced; however, I'm sure aneurysms are still a later possibility because I still receive screenings for them.
http://www.ncbi.nlm.nih.gov/pubmed/9502143
RobThatsMe
Well-known member
I had a severe aortic dissection back in 2003.
The short answer is as SuperBob said, Yes, they can happen again.
The main thing that can be done by our doctors today is to redirect the main aortic blood flow away from the false lumen, and back into the main channel. They must still allow blood into the false lumen so that the other blood vessels can still obtain the blood they need to support their functions to the body. Dissections can be stabilized, and remain dormant for years if not life. That can also for no real apparent reason rear their ugly head again down the road.
The main thing I can suggest is to have annual checkups with either a vascular surgeon, or your surgeon, these checkups should include a CT or MRA of your dissected area, and in some cases, also an echo cardiogram. The doctor can compare the size of it against the prior yrs scan measurements, and determine if it is continues to be stable. It is also important that you follow the doctors orders, and keep your blood pressure normal, (beta blockers), and also not to exert yourself by pushing your boundaries when lifting or moving something. As my doctor once said, "lift, but don't overdo it, you know when you are lifting more than is comfortable"
Dr. Rosselli, of the Cleveland Clinic is an expert in the Dissection area. He has some good information on his site to read.
http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=6515
Hope this helps some,
Rob
The short answer is as SuperBob said, Yes, they can happen again.
The main thing that can be done by our doctors today is to redirect the main aortic blood flow away from the false lumen, and back into the main channel. They must still allow blood into the false lumen so that the other blood vessels can still obtain the blood they need to support their functions to the body. Dissections can be stabilized, and remain dormant for years if not life. That can also for no real apparent reason rear their ugly head again down the road.
The main thing I can suggest is to have annual checkups with either a vascular surgeon, or your surgeon, these checkups should include a CT or MRA of your dissected area, and in some cases, also an echo cardiogram. The doctor can compare the size of it against the prior yrs scan measurements, and determine if it is continues to be stable. It is also important that you follow the doctors orders, and keep your blood pressure normal, (beta blockers), and also not to exert yourself by pushing your boundaries when lifting or moving something. As my doctor once said, "lift, but don't overdo it, you know when you are lifting more than is comfortable"
Dr. Rosselli, of the Cleveland Clinic is an expert in the Dissection area. He has some good information on his site to read.
http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=6515
Hope this helps some,
Rob
Agian
Well-known member
The article Superbob posted seems to say that if you're getting your valve done, it's a good idea to replace a dilated ascending aorta at the same time. This prevents it from continuing to dilate. My future surgeon told me that a Dacron graft should last me a lifetime.
I've been told that the aortic valve and the ascending aorta have a common embryological origin. The rest of the aorta in people with BAV is usually ok. But the dilation can spread downstream, into the aortic arch, if left unchecked.
I've been told that the aortic valve and the ascending aorta have a common embryological origin. The rest of the aorta in people with BAV is usually ok. But the dilation can spread downstream, into the aortic arch, if left unchecked.
workmonkey
Active member
If you had your aorta repaired/replaced (not just your valve) the risk of dissection in the graft itself is exceedingly low, if not nearly impossible. I have a Dacron graft that replaced my ascending aortic aneurysm; I am under the impression that Dacron cannot dilate or tear, and lasts a lifetime, which is why they use it. Also, to confirm what Agian said, the section of the aorta they replace has the same genetic make-up as a BAV, so they know it is weaker tissue - which is why they replace it. The other half of the aorta (the arch through to the descending aorta in your abdomen) is totally unrelated genetically, so would only be at the same risk of dissection as in the general human population (i.e. low). Again, this is assuming you had your ascending aorta replaced - This doesn't apply if you only had a valve repair or replacement with no aortic graft.
It is worth mentioning that the new guidelines issued by AHA earlier this year reported that dissections are extremely rare even among the BAV population, even with an aneurysm. I think it was something like 2 BAV patients out of 463 that eventually had a dissection below 5.5 centimeters.
It is worth mentioning that the new guidelines issued by AHA earlier this year reported that dissections are extremely rare even among the BAV population, even with an aneurysm. I think it was something like 2 BAV patients out of 463 that eventually had a dissection below 5.5 centimeters.
Agian
Well-known member
The Aortic Root is the initial bit that connects to the heart. This is where the arteries (coronaries) that feed your heart branch off. The Ascending Aorta, per se, comes after this. Some surgeons replace the Ascending Aorta, but leave the root intact. A conduit is a graft that has a valve built into it. It is a one-piece replacement for the valve, root and ascending aorta. I wonder if anyone knows if there are advantages/disadvantages for each (different risks for clots, BE etc).
RobThatsMe
Well-known member
I agree with workmonkey's comment about the graft areas likelihood of re-dissecting is extremely low, if not impossible.
That being said, the aorta itself is much larger than a valve graft, and it is those areas that are not protected from future dissection or aneurysms, especially if you have a connective tissue disorder.
In my case, my aorta dissected from the aortic valve, all the way down through the abdomen, then branched off down to my left knee cap area. This happened in March of 2000, I had to have emergency surgery, and they gave me a 2 to 3% chance of surviving it, they even told my wife to prepare and say her goodbyes to me.
So far no additional changes to the dissection.
Since then, I have had to have a 2nd aortic surgery to replace the mechanical valve and graft installed in March of 2000 when I dissected. The reason for this was due to panus growth which was preventing the valve from opening and closing.
My 2nd surgery in Sept of 2010 involved replacing the valve, building a graft for the valve, replacing the aortic root, fixing an aneurysm they found on the side of the arch, and then to further support the dissection, they preformed a frozen elephant trunk procedure, which is really installation of a stint with 20 cm of Dacron tubing attached inside the aorta. The stint is sewn in to the aorta at the top side, and the Dacron tubing extends downward in the aorta. This directs the pressure of the main blood flow through the aorta through the Dacron tubing, thus reducing the impact of the pressure against the aortic walls in that area.
14 years after my initial surgery, all is still stable, and I remain an active person.
Rob
That being said, the aorta itself is much larger than a valve graft, and it is those areas that are not protected from future dissection or aneurysms, especially if you have a connective tissue disorder.
In my case, my aorta dissected from the aortic valve, all the way down through the abdomen, then branched off down to my left knee cap area. This happened in March of 2000, I had to have emergency surgery, and they gave me a 2 to 3% chance of surviving it, they even told my wife to prepare and say her goodbyes to me.
So far no additional changes to the dissection.
Since then, I have had to have a 2nd aortic surgery to replace the mechanical valve and graft installed in March of 2000 when I dissected. The reason for this was due to panus growth which was preventing the valve from opening and closing.
My 2nd surgery in Sept of 2010 involved replacing the valve, building a graft for the valve, replacing the aortic root, fixing an aneurysm they found on the side of the arch, and then to further support the dissection, they preformed a frozen elephant trunk procedure, which is really installation of a stint with 20 cm of Dacron tubing attached inside the aorta. The stint is sewn in to the aorta at the top side, and the Dacron tubing extends downward in the aorta. This directs the pressure of the main blood flow through the aorta through the Dacron tubing, thus reducing the impact of the pressure against the aortic walls in that area.
14 years after my initial surgery, all is still stable, and I remain an active person.
Rob
Forrest
Well-known member
Rob,
That’s an incredible story of survival. Reminds me how much to keep appreciating my second chance at living a full life. I’ll even bank some of this for a third chance down the road
.
That’s an incredible story of survival. Reminds me how much to keep appreciating my second chance at living a full life. I’ll even bank some of this for a third chance down the road
.
