One more: Why does Cedars-Sinai Recommend at 4.5 cm?

[cbdheartman]

I came across this website (http://www.csmc.edu/pf_5594.html) withi this Q&A:

I had coarctation of the aorta repaired as a child. I have recently been diagnosed with an ascending aortic aneurysm of 4.6 cm. My aortic valve is also bicuspid. Did the coarctation cause this problem I have now? Are there special considerations for someone like me regarding aortic surgery?

Coarctation (narrowing) of the aorta may be found along with bicuspid aortic valves. The underlying reason why they occur together in some people and not in others is not understood. However, what is clear is that there is a genetic condition that may include both bicuspid aortic valves and weakened aortic tissue. With the passage of time, the aortic tissue continues to weaken and degenerate until the walls of the aorta balloon out, which is called an aneurysm. Generally, with the presence of bicuspid aortic disease (BAD) and an ascending aortic aneurysm greater than 4.5 cm prophylactic, surgical replacement of the aorta is recommended. ​

Does anyone know why they go so low with their recs? And if that is the case, why don't more folks recommend it at 4.5 cm?

 

[MissMelis]

I'm not positive, but I've read some similar things that say if an aneurysm is present along with BAV, then they recommend it sooner...possibly since those with BAV AND aneurysm may have weaker tissue.

Interesting link though...I hadn't seen this one yet, so thanks.

More knowledgeable opinions to follow, I am sure!

Melissa

 

[cbdheartman]

And am I right to assume that if you have a BAV you have BAD?

 

[MissMelis]

I think the terms are used interchangeably, yes.

 

[tobagotwo]

They're smart, in my book.

As pointed out in another post, the crossover point where having the surgery is statistically safer than waiting is closer to 4.5 cm than 5.0 (for everyone), and those with BAV, Marfan's or other connective tissue disorders are more likely to have dissections than those without.

Best wishes,

 

[ALCapshaw2]

As Bob pointed out, it's a trade-off between Rupture / Disection / Death from the Aneurism vs. Surgical Risk.

The Better the Surgeon(s), the Lower the Surgical Risk, and the Lower the Cross-over point.

Once an Aneurism begins to 'grow', there is a small but finite (NON-ZERO) risk of a morbid event or mortality.

There seems to be a popular misconception that if you are below some "magic number" (5.5, 5.0 cm) that you are Totally Safe and above that "magic number" you are at great risk. That concept is TOTALLY BOGUS. Aneurism Risk is NOT a Step Function (mathematical definition of step function).

Look at the Graph of Risk vs. Aneurism Size.
Compare the risk at 4.5 cm to the risk at 5.0
Not much difference. Q.E.D.

'AL Capshaw'

 

[thenewmarket]

I hope this discussion encourages others who come here to be aggressive about their care. I am soooo grateful that when my husband's 5.1 aneurysm was found that we did NOT accept our local surgeon's recommendation to wait until it reached 5.5. I truly feel that my husband would not be here if we had waited. We were in shock when his aneurysm/BAV were found, but needless to say.....we've weathered the storm and life is precious.

 

[Ross]

I hope this discussion encourages others who come here to be aggressive about their care. I am soooo grateful that when my husband's 5.1 aneurysm was found that we did NOT accept our local surgeon's recommendation to wait until it reached 5.5. I truly feel that my husband would not be here if we had waited. We were in shock when his aneurysm/BAV were found, but needless to say.....we've weathered the storm and life is precious.

As a note to this post, I can't count how many members we've had that once opened up, the aneurysm was found to be much larger then what the tests showed and really were in grave danger.

 

[skeptic49]

Even some "renowned" surgeons (like the one I am seeing) seem to want to wait until 5 cm. I'm going to be pushing my guy soon on this, and I'll go elsewhere if I find out I'm over 4.5 the next time I get tested.

BTW, if your BAV is stenotic like mine, then that makes it a triple whammy: an aneurysm in the face of BAV with AS, becuase, according to one study I read, the AS produces hydrodynamic (jet) forces that further stress the aorta. Great.

Jim

 

[Buffy41]

When they found I had an Aneurysm it was already at 5.6, and the cardiologist still had me wait. Six months later at my next appointment I had a new cardiologist and he wanted it to be dealt with immediately. I'm thankful now not to have to worry about it any longer.

 

[MissMelis]

GEEZ...after reading all this I am getting all worried about my aneurysm again. 1 more week until MRI and 10 days after that to see doctor. This has been the longest 6 months of my life, I think.

cbdheartman - as far as I'm concerned, you're only waiting for it to get worse...so why wait?

I hope you're able to sift through all this info and reach a decision that you're comfortable with.

Melissa

 

[gustaf]

I had the same as you. From what I have understood now, it seems that the risk is greater if you have the whole package (BAV, aorta aneuyrism, coarctation), therefore the recommendation to go to surgery earlier.

They are all related, and not effects of one or another. An untreated coarction will increase the BP, and can therefore put more pressure on the aorta however.

Interesting to note that Cedars are not really consistent. Theyare back on 5 cm on the timing page. http://www.csmc.edu/pf_3885.html#3

::g

::g

 

[COLLEEN S]

I'm not positive, but I've read some similar things that say if an aneurysm is present along with BAV, then they recommend it sooner...possibly since those with BAV AND aneurysm may have weaker tissue.

Interesting link though...I hadn't seen this one yet, so thanks.

More knowledgeable opinions to follow, I am sure!

Melissa

Yes, Melissa, I saw the same thing somewhere!

 

[RvUsa]

I love this place, it really makes me believe that I am not alone, and I am not over reacting to my situation. I just feel like, "it's not gonna get better on its own" and I am going to have surgery some day, and I have a chance of croaking by waiting... SO WHY THE HECK ARE THEY MAKING ME WAIT!!!!

 

[Ross]

I love this place, it really makes me believe that I am not alone, and I am not over reacting to my situation. I just feel like, "it's not gonna get better on its own" and I am going to have surgery some day, and I have a chance of croaking by waiting... SO WHY THE HECK ARE THEY MAKING ME WAIT!!!!

That's why, in your case, we all suggest getting that 2nd opinion. To me, the clowns that saw you are saying that they'll see you again when your dying or dead. More important for you to lose weight then have a life saving surgery and that's just plain wrong. Sure, being overweight is going to make it very difficult to recover, but at least you'll be recovering and not dead.

 

[Nancy]

A lot of times, what is thought to be fat, prior to surgery is actually fluid retention due to poor heart function. We have had many members who have been amazed when they lost quite a bit of weight after surgery.

I have seen my own husband, who was a naturally slim and fit man, gain 25-30 pounds in fluid alone. And a lot of times it was in his stomach area, which leads many inexperienced doctors to think it is just fat.

Have a family friend who has severe CHF, and he gained 14 pounds in a week and a half.