Can I please have some expertise opinion...

[themalteser]

Hi Guys,

Me again..... Can I please have some of your expertise on this, I' m just a bit concerned, however, my professor said that I shouldn't be, and that I have nothing to worry about.

A couple of months ago, I had an MRI scan, who showed the following:

1. Dilated aortic root, with maximum diameter at the sinus of valsalva (4.4cm cusp to cusp and 3.3cm commisure to commisure) No Aortic Coarctation, Bicuspid Aortic Valve. No AR. Maximum Velocity across the valve 1.1m/s
2. Left Ventriuclar Volumes, ejection fraction and mass index are within normal limits, Normal LV Wall tickness (Maximum basal septal tickness 10mm) No regional wall motion abnormality
3. Right Ventricular volumes and ejection fraction are within normal limits, NO RV wall thinning, aneurysm formation or regional wall motion abnormality. RVOT appears normal
4. Dilated RA 62 x 66mm Prominent LA 41 X 58mm
5. Other valves appear normal and compitent. Pulmunary artery of normal calibre, pericardium of normal tickness.
6. Aortic Annulus - 31mm, Across sinuses - 44 x 33mm, Sinotubular Junction - 34mm, Asecending aorta - 32mm, Arch Upper - 21mm, Arch Mid - 19mm, Arch Distal - 18mm, Descending aorta 19mm

2 MONTHS AFTER I HAD A CT SCAN, AND SHOWED.

Aortic root is dilated being 30mm at the aortic annulus, 47mm at the mid sinus, and 34mm at the sinotubular junction, these dimentions are in the coronal plane on end diastolic phase, The ascending aorta shows mild diffuse dilation with a maximum diameter of 3.5 cm in the mid part.

Coronary arteries arise normal, and no evidence of disease.

Apart from I don't know whether I should worry, or whether I should trust my top professor and not to worry, as he said that I would probably not need any surgery for many many years. It seems to me that from MRI to CT scan, there is a little bit of difference, which one shall I really trust, MRI or CT scan ?

Including with this, my echo report shows 4.2cm across the sinuses, so that's a bit confusing aswell.

Can someone provide me with an opinion please..

Thank you so much.

Regards,

 

[Country]

This is just a small piece of info here because i dont know a whole lot about the numbers and what not but here ya go.

an mri is a much cleaner and clearer image.... prob the best picture that your doc can look at.

a ct scan .... depending on the resolution(16 slice, 64 slice or even a higher resolution then that) really can provide a picture that is a little "cloudy" or unclear. which makes me think that they kinda "guess" what your dimensions are?

an echo is very basic.... but done by the right tech and it can give you some good info. (this is where my doc started with me)


i dont understand why they would order an mri first to show proof of a problem. they prob could have gotten enuff info from an echo to diagnose you. and then moved onto an mri to get the best picture.

doesnt make sense to me why they would start you off with a mri and then dose you with all that radiation from the ct scan, exsp when the picture quality sucks compared to a mri. and hits you with a lot of radiation for no reason.


i would trust the mri .... that is the best.



ETA: i think that maybe i was confused by the order of your tests..... did you have the mri done the most recently?

this is just my opinion with my expierences ..... not absoultly positive about the facts. someone will be along soon, i am sure, to provide more info

 

[themalteser]

Hi country,

Thankyou for providing me with your valuable opinion, I had echos first, than I decided to speak to a top professor here in the UK, who suggested me to have more test, for clinical and research purpose. I first had the MRI December, which showed the above figures, so he came back to me, and was very reassuring, he said that I will probably not need anything done for many many years, he than suggested a CT with contrast, he said that it's purely research, but also clinical to keep a baseline. The CT came up with the above figures, which the root was slightly more in size then the MRI, but, before I've been given with the figures, the professor told me that he is happy that I don't have to be concerned at all, and that he will repeat MRI in a year time.

When I saw the figures, I got a bit worried, since CT and MRI reported differently. The professor is a top professor, But was just checking whether anyone had such discrepancies?

 

[Mentu]

If you are not reassured that there is no immediate problem, perhaps, you could have another doctor look at the test results. I felt rather insecure when I was first told that my aortic valve was stenotic but not to worry about it. Without knowledge and experience with these things, it is hard for one to evaluate how serious something may be. For me, it took eight years to become a problem but for some people the problems never develop further. Now that you know you might have a problem in the future, it is important for you to have regular check ups. I would suggest you begin now keeping a file of your test results so that each year you can compare the most recent with previous results so you can follow any change that is taking place. If you work with spreadsheets, it can make comparison much easier to enter the data in a spreadsheet each time you have a test so that you can follow changes and ask about their relevance.

Larry

 

[Gregory]

themalteser,
I don't want to speak out of turn, but want to weigh in just the same. I am also BAV. My sense is that a 47mm root (or mid sinus) on CT is relevant and I would urge you to see an adult congenital heart disease specialist to determine how best to manage and track this metric. i'm not expert, but i think a 4.7cm measurement in your ascending aorta or aortic root is larger than normal and you should perhaps look into a beta blockade or at the very least ensure your blood pressure is well managed and that you are not engaging in any exercises that may not be helpful (like lifting heavy weights). I don't know what your top professor is, but people with congenital heart issues should see specialists in my humble opinion - even if all is well.

good luck

 

[themalteser]

Hi mentu, thankyou for your help, I'm an accountant, so yeah, spreadsheets will be good to use

Gregory, my professor is a world renowed cardiothoracic surgeon, and knighted for his services by the queen. I'm on 25mg atenolol, and doing ok with them. The discrepancy of figures between the 2 scans, with only a month apart is my main worry, and was wondering, perhaps different scanners provide different results and that is why the professor advised me that I shouldn't be concerned at all.

I jog every other day, been advised not to lift ridiculous weights, but can train arms. I'm 5.11feet and weigh 84kg. Been also informed that it is very likely that, if I ever need surgery, this won't be for many years.

Sorry for writing too much, just want to give you all the whole picture. Oh, and my BAV is tricuspid, but two leaflets are rudimentary(little).

 

[Country]

well i never had a mri done but i had an echo that said i had a anyerism of 3.9 and a bav. then i had a ct scan done that said my aortic root was 4.5cm. with the asending aorta at 3.6

i shared this ct scan with dr raisse in LA and he said that it was a terrible ct scan and that i should run to la and have some tests down there..... so i dont know if the ct scan was that bad or if dr raisse was just wanting a new client.

but anyways my surgeon liked the tests.

the quality of test depends on the resolution.... but your mri is prob more accurate!

and now that you know about your condition, you wont be surprized like me

i pushed for surgery right away and my doc was surprised by how "diseased" my aortic root and asending aorta was.... he called it "paper thin"

a second opinion might not be out of line! you can never have enough info... esp if you arent getting answers to your questions.

 

[normofthenorth]

You folks seem to have more faith in MRIs than I do. My experience with them has been pretty poor, like having experts judge the shapes of clouds. I'd always thought that most CT images were clearer. Not based on fancy studies, I admit.

TheMalteser, I think it's reasonable for two consecutive tests, even on the same day, to show slightly different numbers. If the two tests use different technology, that makes it even more reasonable. Whatever you do DO NOT assume that the difference between the two test results is from changes in your heart and Aorta during the intervening month! In my experience, many of these tests use a lot of professional judgment, and different professionals use different judgment.

All that said, it probably doesn't hurt to get another opinion. Do you have (or have you met with) a Cardiologist, as well as a surgeon? Most of us have one of each, which sometimes gives us a little more info, kind of like a second opinion.

 

[themalteser]

Hi all,

Firstly, I'm really appreciating all your responses, so valuable in here, really grateful.

I have a cardiologist who sees me every 6 months to repeat echo, however, since he was very reassuring about my condition, I wanted to get a second opinion, just in case (he is a brilliant cardiologist, but being me, I wanted to see someone else just to make sure) so I saw professor Magdi Yacoub (he's amazing!) who ordered more tests, for clinical and research purpose, and must admit, his reassurance was all I needed, but, it's just when I read the 2 reports, from 2 different scans(they've been written by different radiographers) I got a bit concerned, in my naive mind thinking that my aorta grown by 3-4mm in one month.

 

[jjay32]

In my opinion there is a margin of "error" of about .2 cm when doing readings of echo's, mri's and ct scans. So your numbers are close. My guess that is why your doctors are not that concerned with the 2 sets of numbers. To give you an example. I had an echo done in 2008 showing my aneurysm at 4.8, had a ct scan done and it showed 4.65, later 2009 echo showed 4.6, 2009 showed 4.6 and then 2010 showed 4.8 again. the 2008 and 2010 echo was done by the same tech, the other two by someone else. so there is some subjectivity involved. I would say that as long as you are getting it checked out on a regular basis, that you are in good hands.

 

[Gregory]

Sounds like you have good people around you / following you. Wishing you decades of no growth! I am sure you will follow things carefully.