Do mildly dilated aortas revert normal after AVR?

[barrie]

I have a BAV and am going for AVR on 26/2/09.My ascending aorta has a max diameter of 4cm and is termed mildly dilated.I've pushed this with my surgeon who believes that this is post stenotic dilation and may revert back to normal in time.He will do something about my aorta at op if it is too thin but otherwise he says the guidelines for operating on an aneurysm are 5-5.5cm.I know of the association between BAV AA and dissection.Does anyone know whether biopsies of the aorta can be done at op to show whether the connective tissue disorder(cystic medial necrosis) is present?Has anyones dilated aorta actually shrunk after AVR?I certainly don't relish another OHS in years to come to repair a thoracic aortic aneurysm.:

 

[Curtsmum]

Sorry cant aswer your questions, just wanted to wish you the very best of luck with sugery and hope you have a speedy recovery.

 

[Bina]

Okay, I've dug out my echo reports and here is what I have going back a few years before my surgery.
Year 2002 aortic root 25mm
Year 2003................28mm
Year 2004................30mm
Year 2005 significant root increase found on Heart Cath. Surgeon made note to verify it during surgery.
He did say that usually when he replaces the valve the root will relax.

Year 2006 aortic root 21mm (post-op)
Year 2007................23mm
so, I am in the same boat, watching that root very carefully, and taking BP meds.

 

[JaneBerm]

Same boat, same problem

Same boat, same problem

I'm in almost the exact same place as you...I have BAV with mildly dilated aorta currently at 3.9 cm. My surgeon has ruled out a minimally invasive AVR procedure so that he can have a full view of the aorta and make measurements to determine if he will have to do something about it.

My surgery is scheduled for Tuesday, Feb. 24 so it looks like you'll get some info on my outcome before you go under. I'm also very interested in having it taken care now, rather than having to go through all of this again down the line in a few years. I'm hoping that there are some more responses to this question.

Jane

 

[barrie]

Same Boat

Same Boat

Best wishes for Tuesday Jane.I doubt whether any answers for this question will influence the plan now.I have complete faith in my surgeon and will trust his decision.What I would change however is that if I knew I would need surgery for a thoracic aneurysm down the line I would go tissue valve for now and avoid warfarin long term.I've chosen mechanical on the single reason of not wanting another valve surgery as I'm 57 and may well outlast the tissue valve.None of us have a crystal ball though do we!! Hope all goes well for you.

 

[skeptic49]

Barrie,

You may want to visit the "stickys" in the Bicuspid Valve Forum here on VR and follow the links. There is a lot of information to read. The literature seems to indicate that rate of aortic dilation is independent from the degree of aortic stenosis and dilation will probably continue after bicuspid aortic valve replacement. One study that came to that conclusion is here.

Best wishes,

Jim

From the study I linked:

Conclusion
Post-stenotic aortic dilatation is most commonly seen in
patients with a BAV. The degree of this dilatation, however,
may not be related to the degree of AS and does not
appear to be influenced by the occurrence of AVR. It is
likely that the dilatation of the ascending aorta is due,
mainly, to intrinsic pathology within the aortic wall rather
than the haemodynamic effects of a dysfunctional AV.
There is controversy as to whether the ascending aorta
should be replaced at the time of initial AV surgery, if the
diameter of the aorta is < 5.5 cm. Most of the evidence
suggests that the aorta will continue to dilate at an
unknown rate. With improvements of surgical technique
and perioperative management resulting in decreased
morbidity and mortality following ARR, replacement of
the ascending aorta should probably be considered for
diameters of 4.5 – 5.5 cm. Other therapeutic strategies
being investigated that may reduce the rate of dilation are
β-blockers, statins and the new synthetic MMP inhibitors.

 

[barrie]

Dilated aortas

Dilated aortas

Thanks for the info Jim.Bina's info however shows that the root does shrink after AVR but then start to dilate again.Since the aorta has to be opened to perform AVR,its a pity that an aortic biopsy isn't done because if it shows cystic medial necrosis then future aneurysmic dilation is inevitable.I wonder if any of the docs have thought of this?

 

[Faye]

I, too, had a dialated aorta along with my stenotic valve. My surgeon and I discussed my options before surgery. There was one option I was not comfortable with but as far as the other options I left it in the hands of my surgeon with the very strong message to fix it if he thought it would require surgery in the future - I DID NOT want to go through OHS a 3rd time.

I ended up having my ascending aorta replaced with a dacron graft and when I woke up my surgeon told me that I did have cystic medial necrosis so at least in the hospital where I was, they did do a biopsy during surgery.

Good luck as you move forward - once you have made your decisions, you will find peace!

 

[abbanabba]

OK, so I had a PVR, but a dialating aortic root was also an issue associated with the deterioration of my valve. In 1998 it was around 2.5cm, by 2006 it was 4cm and holding steady. I got hold of my 2 week post-op echo and it showed it was now 3.8cm. Now I'm prepared to concede that such a small amount may simply be due to the interpretation at the time, but this is the first time in 3-4 years it has changed - and for the better. I'll be looking forward to seeing what my July echo shows.


A : )

 

[MrP]

The margin of error in measurements of the aorta is a function of the instrumentation and is considerably greater for an echo compared with a CT scan or MRI which are much more accurate (and costly).

 

[vprnet]

I had BAV with an ascending aorta that measured 4.1 X 4.3. My surgeon replaced the ascending portion with Dacron that he connected to an ON-X 2.7mm mechanical valve.

From what I read on BAV, it seemed to me to be a good decision.

Good luck with yours....

vprnet (54) BAV replaced with ON-X 27mm and Dacron conduit Dec 19 2009 NYPH Wiell Cornell

 

[JeffM]

My aortic root measured 4.0cm also a couple weeks pre-AVR per a CT scan. My cardio felt it would minimize after surgery. Unfortunately, I don't plan to get another scan until Sept. '09, which will be 1 year post op. I'm eager to know if I'll have similar results to Bina's.