Hi whalepilot,
I started having my aorta tracked over 10 years ago. At the time, they discovered it with an echocardiogram and it measured in the 4.0 to 4.5 range. We tracked with an echo for a number of years until it reached the 5.0 range. The measurement on the echo is somewhat subjective as the technician picks the measurement points and depending on angle and precision can vary a little. At the 5.0 mark, they started measurement with an MRA which is a version of an MRI. That was supposed to be a more accurate measurement. We did that for a while and when it reached 5.5, they began to talk about surgery. I had a slight to moderate regurgitation. The concern they had for me was rupture of the aorta and not so much valve leakage. After consultation with a surgeon, they decided that surgery was needed. The measurement at that time was 5.6. My surgeon was of the mindset that surgery and recovery are better at the 5.5 range instead of waiting until the 6.0 point. They generally talk about surgery between 5.0 and 6.0. There is some thoughts that waiting until 5.5 is a better choice than going ahead at 5.0. Of course, there are lots of other things that come into play for the decision. Before the surgery they did a arteriogram (spelling?) and said I had no clogged arteries. They also did a cat scan and with that measurement, I believe they said I was up to 6.4. Now, I'm not sure if it grew from 5.6 to 6.4 in that timeframe (less than two months) or if the measurement is just different with the two tests. I still have two aneurysms on the descending aorta and they seem to be using the cat scan to monitor those.
I had the first surgery in June of 2001. At that point, the selection of valve decisions for me was 1 - repair of my valve, 2 - homograft, 3 - bovine, 4 - mechanical. I didn't want to deal with the coumadin or the clicking of a mechanical. The estimates seem to be 15 to 20 years with the homograft, so I knew that would probably mean a repeat surgery. My first hope was repair, since the leakage wasn't so bad. But, the surgeon was concerned when he got in there that the original had been stretched too much with the enlargement. So, we did the homograft and needed a piece of dacron to make up the difference between the aortic root with the homograft and the length of the aneurysm.
That valve developed a leak in less than 18 months and was more severe than my original. So severe that I had a redo surgery in January of this year. The replacement valve had developed holes in the leaflets. Since the surgery was so close to the original surgery, we decided to go with the mechanical to hopefullly eliminate any future surgeries. Still out for debate on whether that was the right decision.
Sorry for the length of the message, more than you asked about. I believe if it is just the size of the aorta, they will probably talk about 5.0 and greater. My surgeon and cardiologist think that 5.5 or greater is the right number. I would ask them about your natural valve and whether surgery earlier or later would affect that. Hopefully, everything else is in good shape and you can keep your valve and just repair the aneurysm.
