Aortic root

[themalteser]

Hello all - I always feel guilty when I have not posted for quite a while, then I post again. Hope someone can help me with this question please.

I had an MRI last January and showed that my aortic root is 45 x 42 mm. Cardiologist not concerned. I was looking at some old documents of mine and seen an MRI report from year 2010, it showed that my aortic root was 44 (cusp to cusp) x 33 mm (commisure to commisure).... (The MRI was done in different hospitals).... So, I am a bit concerned. Could this be an error, or maybe he measured a different commisure ? Is commisure the separation of cusps? Perhaps the measurement was performed at the shorter distance?

Your opinion will be much appreciated.

 

[pellicle]

Hi

.... (The MRI was done in different hospitals).... So, I am a bit concerned. Could this be an error, or maybe he measured a different commisure ? Is commisure the separation of cusps? Perhaps the measurement was performed at the shorter distance?

well MRI's are not accurate, they are a guide. That's why they only know the measurement at surgery. Both figures are estimates from the operator and the surgeon knows that too. I would put that as fuzzy measurements. Have you looked at the print outs? It would be like measuring something on paper from a blurry photo.

Hold tight , trust your team till you have a better reason not to

 

[themalteser]

Thank you Pellicle. It's nice to read your post before I try and sleep! I will keep on ruminating otherwise.

 

[ottagal]

Hang in there, Malteser. I also have aortic dilation and have had an MRI to follow up on it beside my echo

An MRI is more accurate than an echo and that is why it was ordered for me, but no test is 100% accurate . Did you have the gadolineum contrast dye used in both MRI's? Apparently, this shows more accurate imaging.
I can't answer your question about the commissure measurement changes, but if it would put you at ease, why don't you ask your cardiologist for feedback comparing the two MRI's and states your concerns.

 

[ottagal]

Hang in there, Malteser. I also have aortic dilation and have had an MRI to follow up on it beside my echo

An MRI is more accurate than an echo and that is why it was ordered for me, but no test is 100% accurate . Did you have the gadolineum contrast dye used in both MRI's? Apparently, this shows more accurate imaging.
I can't answer your question about the commissure measurement changes, but if it would put you at ease, why don't you ask your cardiologist for feedback comparing the two MRI's and states your concerns.

 

[pellicle]

Hi

Thank you Pellicle. It's nice to read your post before I try and sleep! I will keep on ruminating otherwise.

hope you got some sleep.

Don't know if this article helps you or not, in all likelyhood you already knew this, but its interesting reading:

http://www.annalscts.com/article/view/1400/2025
[h=2]Leaflet attachments[/h]
As the leaflet attachments insert in the wall of the aortic root they form a crown shaped, thick fibrous structure, often termed the “annulus”. This description is unfortunate as the word annulus implies a circular structure in contrast to the “crown” shape of the leaflet attachment (14). The points where the leaflet attachments run parallel - distally upstream towards the ascending aorta - are called the commissures.

 

[cldlhd]

As others have said an mri isn't 100 % accurate. My aneurysm was supposed to be 4.8 cm but after surgery my surgeon said it was 4.99 cm. I'd round it to 5.0 but hey he's a surgeon plus he's German so there's that.

 

[themalteser]

That is funny cldlhd! He probably engineered the measurements!. 4.99 ).....

Thanks Pellicle for the information, this is really helpful. I'm surprised that, the article that the sinus of valsalva has thinner wall structures than the rest of the aorta. That's where my dilation is. It's nice to see clearly the commisure and cusps. Perhaps my first radiographer measured the smallest commisure distance, if this make sense?

Ottagam - I did not had any dye with MRI, but I had that with my CT. the CT showed an even larger measurement (47mm) which is even more confusing!

 

[Dan Zulu]

My pre op root measurements were all over the board, from 3.8 to 4.7. It measured 5.0 in surgery shortly thereafter. How tall are you? Did you calculate your aortic surface index?

 

[themalteser]

Hi dan - thanks for your post. I am 5ft 11 inches. How can I calculate the aortic surface index please?

 

[Dan Zulu]

http://emedicine.medscape.com/article/424904-treatment#d1
Read the section entitled "Approach considerations"

 

[themalteser]

Great thank you. So I calculated, BSI (2m squared and root of 4.6( that puts me in the low risk section for now . That's helpful.

 

[Dan Zulu]

I would recommend asking your doctor to calculate your Z score and then using that discussion to elicit the doctor's candid recommendations. For example, I asked multiple surgeons why the medical community balanced the risk of death in surgery against the annual risk of dissection (rapid death) when the surgery was inevitable anyway (in my case). Only one surgeon would even answer that question! He didn't try to push me into surgery, but said that yes, I would need my aortic root replaced at some point in the next year or two, so there was no benefit to waiting. I also didn't want to take it for granted that I would always have such good health insurance to cover the cost of OHS. There are many good threads on this forum about the risk issue. Good luck with your situation.

 

[themalteser]

That is true. Was your aorta dilating at a fast rate? How long ago you found out about your dilation?

 

[Dan Zulu]

Because the measurements were so varied we didn't have definitive rates of growth, but it had been there a while. Between diagnosis and surgery was nine months.