Aortic Root Dialation

[Faye]

Good Morning to all!
I am looking for information about Aortic Root Dialation so I can be prepared with questions for my surgeon tomorrow - the discussion was supposed to be about my upcoming AVR but now....

I had an echo in February and the measurement was 33. On my MRI last week, the measurement was 40. During my heart cath last week, the card said upon his initial look, he thought the measurement was 42 or 43. It seems I am going downhill fast on this one.

How is aortic root dialation fixed? Are there any questions I should ask my doc?

Thanks in advance for your help!

 

[Mike C]

The aortic root will be repalced with a dacron graft during the same operation as your avr. I think the major question is when to operate. Certain valves come with a graft attached such as st judes, on some ohters the valve is sewn into graft and heart.

It seems the typical time to operate is when you near 5cm, with the exception of a dramtic increase over a short period of time.

The MRI is a much more reliable measueremtn than echo but it seems like a mighty big jump even between the tests. I think the echo measurement may have been off, you may want to have your cardio look at actual echo to confirm.

It would be a big increase in a short period of time which would warrant attention if acurate.

 

[Faye]

Mike - thanks for the info. I had no idea that the graft was (could be) attached to the valve. My AVR will be next week - hopefully, they can fix both problems at the same time!

Does the root replacement affect recuperation or add limitations post surgery?
Faye

 

[Superbob]

I had the combined leaky valve and enlarged aortic root. They were replaced with a combined stentless root/valve -- the Medtronics Freestyle. Was out of the hospital in 5 days. Don't know that there was any additional recuperation time because of it being a combined root/valve instead of just an AVR. I don't think there was.

All best wishes to you for a successful surgery.

 

[dot4toto]

Hi Faye,
I just had this surgery, and I was about 5.3 cm.

The questions that came up with my surgeon helped me to undrstand that it all depends on the heart valve sinsues.
They could'nt tell until they got inside, if the sinsues were part of the wideness of the aorta or if they were uneffected. That tells the surgeon a lot about what he CAN do and can't do.
Mine happened to be uneffected which meant that he used dacron to replace the aorta then used my good sinuses then a bio- valve (I wanted).

I didn't know until after surgery. If my sinuses were not useable he would have had to do it another way.
Ask your doctor about that because I think it detemines the way a lot of this goes.

I didn't know or understand any of this until our talk had gone on for a long while. My husband and I talked with the surgeon for about an hour. I think going into that appointment knowing I wanted a bio valve made the consult go in a certain direction.
If you like your doctor and trust him then that's part of the solution. He will talk with you until you are comfortable and understand why he has to do your repair a certain way. I just asked questions until I got it. Also my husband was another set of ears and heard things I didin't because of the emotions I had I wasn't the best person to "get" everthing the doctor was saying. So take someone with you, it sure helped me.
Good luck and you're going to be fine!

 

[Tom F.]

In addition to the above, another option is a "David type" valve sparing procedure. If you have an otherwise normal aortic valve they can sometimes replace the enlarged section of the aorta, and then sew the new sectionto your aortic valve. This way you keep your own valve. If you google "valve sparing" along with aorta you will see a fair amount of information about this surgery. I underwent the valve sparing surgery in 2002. Good luck.

 

[aussigal]

I think if I were you I would be reading the MRI measurement as the most accurate one...the other methods are not quite so reliable...The 64 slice CT scan is also a very reliable way to measure any dilatation of the Aorta...if you have both these done and they are the same or within about 1mm then you can be reasonably sure that they are fairly accurate.

Yes...they can fix both the Aorta and valve at the same time...A composite graft (with aorta & valve in one) is an ideal way to be fixed in this situation. I had this done and it is referred to as a "Bentalls procedure". My aneurysm was worse than my valve but I chose to have the valve replaced at the same time in a "Bentalls" so as to try avoid an AVR in the future. As far as I know it didnt add any time to my recovery and I dont feel anything different in my chest from having this strange looking thing inside me.

 

[MrP]

Each measurement technique has a different margin or error, and thus, results differ between each. There's no way of knowing from these measurements whether or not your aortic root has grown between measurements. Although enlarged, your dimensions may be within normal range for your size, age, etc. If you have a BAV in need of replacement, replacement of aortic valve with composite Dacron graft may be a good idea.