Complexities of replacing/preserving Ascending Aorta in BAVD

[Bad Mad]

It's been a long time since I've posted on here but a private message I received prompted me to come on to catch up and share my journey!

Diagnosed in 2001 with BAV, I had my Aortic Valve replaced with homograph in February that year. Ascending Aorta was 3.8cm at the time so that wasn't touched. In December 2007, I had my Aortic Valve replaced with a 25mm ATS mechanical valve. Prior to surgery my Ascending Aorta was measuring around 4.5cm, so the plan was to either a) graft the aorta or b) perform a bentall.

When the surgeon went in he discovered the aorta to be measuring at 4.3cm and explained that he felt the dilatation was primarily being caused by the diseased valve and not an occurrence of BAV. He also spoke about the elastic properties of the aorta being very normal/strong and said the entire (very badly calcified, leaking and narrowing) homograph was removed very easily which was having some consequence for the aorta. To my shock and dismay he told me he decided not to perform any procedure on my aorta as he felt the risk of infection through foreign material + additional procedure was greater than the risks of it re-dilating in the future. I should say the surgeon had 30 years of experience with excellent results. But needless to say, I was rather sceptical.
I did come on here at the time thinking some sort of re-enforcement had been performed but as it transpired, this was not the case.

For 4 years Post-surgery I ran into problems with my cardiologist as he was never able to give me a definitive measurement of my aorta which left me wondering if any re-dilatation had actually occurred. He kept telling me it was fine and then one day he said it wasn't. I asked for a CT scan to confirm this, to which he refused. At that point, I changed cardiologists as I felt he was bluffing his way - in 2012. Immediately the new guy organised an MRI scan which was followed up with a comparative MRI 12 months later - June 2013. Thankfully both scans measured my ascending aorta at 4.3cm, the same size as pre-surgery in 2007 - so no signs of re-dilatation thus far in 6 or so years. Maybe the surgeon was much cleverer than I gave him credit for, or maybe my aorta will re-dilate in the future, who knows! I spoke with his assistant (during the operation) a few months ago and he seemed to think this would be very unlikely. Anyway, it just goes to prove how complex BAV can be, and how different approaches can be taken in different cases.

My surgery was filmed and screened as part of a BBC documentary which I must upload at some stage!

Hope to come on here more often as the forum was a great support for me both pre and post surgery

 

[river-wear]

Thank you for sharing your story. I just had an aortic valve repair where my valve diameter was large at 31mm and ascending aorta was 4.0cm. The surgeon did leaflet repair, annuloplasty to reduce the valve diameter to 24mm and an aortoplasty (which is probably what your surgeon initially had in mind). It's great to hear your aorta has not grown any larger over six years! I have heard that they can somehow assess the properties of the aorta to predict the likelihood of future issues while performing surgery. I hope you continue to do well.

P.S. The surgical fellow working with my surgeon was an Irishman who came over to expand his experience.

 

[Bad Mad]

That's interesting Michelle and good to hear your story. Sounds like they wanted to take the preservation route with you also.

Hope you are recovering well after surgery