The last one indicated mild stenosis and moderate to severe eccentric aortic insufficiency and the aneurysm measured 56mm. I can't help wondering if I am doing the right thing; is surgery really necessary? I know most people would advise me to trust my surgeon, and I do for his operating skills, but like they say..."when you're a hammer everything's a nail".
You don't have to just trust your surgeon...you can "consult" the consensus recommendations of the expert surgeons throughout the country by reviewing the relevant practice guidelines for your condition. According to the Thoracic Aortic Disease Guidelines (
http://content.onlinejacc.org/cgi/reprint/j.jacc.2010.02.010v1.pdf), you actually should have
already had the surgery. Those with a bicuspid aortic valve are now recommended to have an asymptomatic ascending aortic aneurysm repaired between 4.0 cm and 5.0 cm (50 mm) in size (see Section 15.2 of the Guidelines - page 22 of the pdf).
Is it really necessary? Well, the best surgeon in the country would not be able to guarantee you that it is absolutely necessary in your specific case because no one can guarantee when your particular aorta will fail. But based on the history of biscupid patients in general, failure occurs sooner rather than later, and most importantly, failure can be sudden and life-threatening even in the absence of prior symptoms. And any surgeon can tell you what the risk is if failure (rupture) should happen, and trust me it is not pleasant news.
I walked into pre-surgery at the age of 35 with zero symptoms. It may have felt a little strange instinctively, but there was no question it was the safest decision. Surgeons are in the practice of evaluating risk, and when the risk of surgery is less than the risk of waiting, that's when they recommend surgery.
Now, in the absence of the aneurysm, perhaps your valve could wait a little longer. But when surgeons operate to address one condition, the threshold for related conditions is lowered. In other words, it's the "fix it while we're in there" philosophy to avoid a later surgery. It works both ways. Some have an aneurysm repaired a little early due to a failing valve, some have a valve repaired/replaced a little early to fix a failing aorta.
Most importantly, none of us are trying to put undue fear in your head, we just want you to be aware that oftentimes what's medically best in our lives feels instinctively wrong - primarily because of lack of symptoms. But asymptomatic patients or patients with only mild symptoms are common with valves, and asymptomatic patients are actually the majority with aneurysms. Surgeons want us in the best situation for success, and we're all actually pretty lucky to have a relatively low-risk environment to fix our problems and resume normal lives. You should as well. Best wishes.
