Question Re: Aneurysm Developing Post AVR

[ottagal]

Hi Folks
I am coming up to 4 years since my AVR surgery. At my latest appointment, a new finding on the echo had been discovered: 4 cm dilation in the distal ascending aorta. The cardiologist has booked an MRI to get a view of the whole aorta.
I am looking for other members who have experienced this post AVR and would appreciate any feedback. I am very petite so the 4 cm is a little worrisome.
A few questions for those who have been in a similiar situation:
1. Were you put on a beta blocker to attempt to slow the progression?
2. How long after your AVR was yours discovered?
3.Size and and location
3. How often were you monitored and what diagnostic tool was used?

Last, but not least! How long were you monitored until it was repaired?


Thanks in advance for your input. As always, it is so greatly appreciated.
I hope everyone is keeping well!

 

[pellicle]

Hi

4 cm dilation in the distal ascending aorta. The cardiologist has booked an MRI to get a view of the whole aorta.

oh ... well 4cm in itself isn't enough information to know if this is "serious" .. a lot depends on other relationships.

I am looking for other members who have experienced this post AVR and would appreciate any feedback. I am very petite so the 4 cm is a little worrisome.

I'm no hulk hogan either and (IIRC) mine was 5.something when found

A few questions for those who have been in a similiar situation:
1. Were you put on a beta blocker to attempt to slow the progression?

nope, they whacked me in for surgery inside of 3 months.

2. How long after your AVR was yours discovered?

nearly 20 years. Valve was still functioning but leaking somewhat. With the Aneurysm it was a simple and obvious decision to replace the valve (again).

3.Size and and location

right above the valve, before the arch.

3. How often were you monitored and what diagnostic tool was used?

I had an angiogram after it was identified and then it wasn't monitored.

Last, but not least! How long were you monitored until it was repaired?

as above, not monitored, repaired with a graft and valve replaced within 3 months.

finally, don't panic, just let the doctors guide and advise. Follow their directions and enjoy your life as normal.

best wishes

 

[Agian]

Mine is 4.1 and will eventually need repair, because it is likely to get bigger. I suspect one can sit on this for a while with no major dramas. From what I've read it's not unusual for the ascending aorta to continue to 'grow' after simple valve replacement.

 

[Fundy]

I don't have ascending aorta anneurysm yet anyway. But I remember Maryka mentioning she took losartan and felt that it did stop her anneurysm progression for years. I also remember others doing the same and the progression didn't stop. She seemed to have quite a bit of background knowledge about its trial use with marfan patients. I believe she still posts frequently at heartvalvepatients.org

 

[Bina]

As far as I know I've got a 'normal' ascending aorta, but pre-surgery my aorta root was enlarged enough to get the surgeon's attention. It's the first thing that I check
on my echo reports and so far-so good.
We do have several members here who have had ascending aorta issues and hopefully they will post here and share their experiences.
Take a deep breath and stay calm

 

[ottagal]

Hi

4 cm dilation in the distal ascending aorta. The cardiologist has booked an MRI to get a view of the whole aorta.

oh ... well 4cm in itself isn't enough information to know if this is "serious" .. a lot depends on other relationships.


I'm no hulk hogan either and (IIRC) mine was 5.something when found


nope, they whacked me in for surgery inside of 3 months.


nearly 20 years. Valve was still functioning but leaking somewhat. With the Aneurysm it was a simple and obvious decision to replace the valve (again).


right above the valve, before the arch.



I had an angiogram after it was identified and then it wasn't monitored.


as above, not monitored, repaired with a graft and valve replaced within 3 months.

finally, don't panic, just let the doctors guide and advise. Follow their directions and enjoy your life as normal.

best wishes

Thanks for responding to all my questions, Pellicle! I did get a chuckle out of your reply 'I am no Hulk Hogan'. I will wait to see what the MRI shows and try and take things from there. It seems that most of the members with aneurysms seemed to develop them many years after AVR (if at all). I was hoping to be able to get alot more 'mileage' with my bioprosthetic valve. It never occured to me that an aneurysm would possibly result in a 'sooner' surgery and not valve deterioration. Here's keeping my fingers crossed.

 

[ottagal]

Mine is 4.1 and will eventually need repair, because it is likely to get bigger. I suspect one can sit on this for a while with no major dramas. From what I've read it's not unusual for the ascending aorta to continue to 'grow' after simple valve replacement.

Thanks Agian,
Here's hoping that this dilation stays stable for a long time...(for both of us!).

 

[ottagal]

I don't have ascending aorta anneurysm yet anyway. But I remember Maryka mentioning she took losartan and felt that it did stop her anneurysm progression for years. I also remember others doing the same and the progression didn't stop. She seemed to have quite a bit of background knowledge about its trial use with marfan patients. I believe she still posts frequently at heartvalvepatients.org

Hi Fundy,
Thanks for posting the Losartin info and for refreshing my memory on Maryka's situation. Cardio said I could start a beta blocker again, but that the research is not robust for the bicuspid aortic valve crowd re: aneurysm progression and beta blockers etc. He left it up to me. He also said they are extrapolating data from the results for the Marfan crowd and making assumptions for the BAV group. It would be nice to see some good data for us BAVers what meds slow down aneurysms Here's hoping...

 

[ottagal]

As far as I know I've got a 'normal' ascending aorta, but pre-surgery my aorta root was enlarged enough to get the surgeon's attention. It's the first thing that I check
on my echo reports and so far-so good.
We do have several members here who have had ascending aorta issues and hopefully they will post here and share their experiences.
Take a deep breath and stay calm

Hi Bina
Glad your ascending aorta is staying the same. That's the way it should be.
That's the mantra...Keep calm and Carry ON....

 

[rtblount]

I had a bicuspid aortic valve repaired in 1997. It was discovered in about 2007 that I had an ascending aortic aneurysm of 5.2 cm. It was monitored every year until 2011 by CT scan and the 2011 scan indicated that it had increased to 5.5cm. On the suggestion of my cardio in Savannah, GA we contacted the Cleveland Clinic in Ohio and the aneurysm was surgically repaired by Dr Lars Svensson on 1/23/12. The operation has been a great success and I can't say enough about the great care i received and the quality of the facilities. You don't say whether your valve was bicuspid or not but it is very important in determinig whether or not there is a probability of a aneurysm developing. It is much more likely in the case of bicuspid valves.

 

[ottagal]

I had a bicuspid aortic valve repaired in 1997. It was discovered in about 2007 that I had an ascending aortic aneurysm of 5.2 cm. It was monitored every year until 2011 by CT scan and the 2011 scan indicated that it had increased to 5.5cm. On the suggestion of my cardio in Savannah, GA we contacted the Cleveland Clinic in Ohio and the aneurysm was surgically repaired by Dr Lars Svensson on 1/23/12. The operation has been a great success and I can't say enough about the great care i received and the quality of the facilities. You don't say whether your valve was bicuspid or not but it is very important in determinig whether or not there is a probability of a aneurysm developing. It is much more likely in the case of bicuspid valves.

Thanks for sharing your story. Glad that you are doing well!

 

[ottagal]

Thanks for sharing your story. Glad that you are doing well!

Rtbount. Will respond once at a computer. I just lost my whole response.

 

[pellicle]

Rtbount. Will respond once at a computer. I just lost my whole response.

pardon me, but I just wanted to share that I think I know how you feel I've had massive hassles with trying to enter thing here (VR) on my tablet only to have it 'vanish'.

Drives me spakko ... I know that doesn't help but in the spirit of "misery loves company"

 

[ottagal]

pardon me, but I just wanted to share that I think I know how you feel I've had massive hassles with trying to enter thing here (VR) on my tablet only to have it 'vanish'.

Drives me spakko ... I know that doesn't help but in the spirit of "misery loves company"

Yes, that is exactly what happened, Pellicle! Like magic my reply 'vanished' in thin air. It can be frustrating for sure.

 

[ottagal]

You don't say whether your valve was bicuspid or not but it is very important in determinig whether or not there is a probability of a aneurysm developing. It is much more likely in the case of bicuspid valves.

RTblount,
Yes, I did have a bicuspid aortic valve. I certainly appreciate your story and for sharing the good news that you are doing so well! My root and ascending aorta were measured prior to surgery and because the ascending aorta was only mildly dilated there was no need for further treatment. This "new" aneurysmal finding is in the "distal" ascending aorta which I understand isn't as common for aneurysm formation in the bicuspid population and a trickier area (one of my readings?).

Were you put on beta blockers when your aneurysm was discovered? It seems that many who have aneurysms either have them 'fixed' with AVR surgery or they are discovered much later post AVR.

It would be great to hear from other members who had theirs discovered post AVR.

Just wondering if anyone had it discovered sooner after surgery as I am not yet even onto my 4th valversary.
Thanks so much,
Input is always appreciated.

 

[AZ Don]

It would be nice to see some good data for us BAVers what meds slow down aneurysms Here's hoping...

I believe there are a number of studies underway regarding Losartan and those with BAV. In the meantime the data available indicates to me that it may help and will likely not hurt so I am taking Losartan to hopefully inhibit the development of any new aneurysms. I would probably be looking to take a higher dose if I had a current aneurysm. I am only taking 25mg/day because I am also on Metoprolol following my recent aneurysm repair and my Dr. doesn't want to lower my BP too much.

 

[ottagal]

QUOTE=AZ Don;544197]I believe there are a number of studies underway regarding Losartan and those with BAV. In the meantime the data available indicates to me that it may help and will likely not hurt so I am taking Losartan to hopefully inhibit the development of any new aneurysms. I would probably be looking to take a higher dose if I had a current aneurysm. I am only taking 25mg/day because I am also on Metoprolol following my recent aneurysm repair and my Dr. doesn't want to lower my BP too much.[/QUOTE]

Thnks for the input AZ Don. I have only seen studies that look promising for Lozarten and aneurysms for those with Marfans. Please share what you found on BAV and Lozartan. I would be most interested!

 

[iedude]

QUOTE=AZ Don;544197]I believe there are a number of studies underway regarding Losartan and those with BAV. In the meantime the data available indicates to me that it may help and will likely not hurt so I am taking Losartan to hopefully inhibit the development of any new aneurysms. I would probably be looking to take a higher dose if I had a current aneurysm. I am only taking 25mg/day because I am also on Metoprolol following my recent aneurysm repair and my Dr. doesn't want to lower my BP too much.

Thnks for the input AZ Don. I have only seen studies that look promising for Lozarten and aneurysms for those with Marfans. Please share what you found on BAV and Lozartan. I would be most interested![/QUOTE]

I had an 5.2 AA BAV with mod stenosis/regurgitation and was put on cozzar( losartan potassium ). The AA went from 5.2cm to 4.7cm in four years. Both times measured with MRI. I also took copper supplements. The valve gave up in the end and the AA/valve was replaced in surgery.

The effects of losartan ( compared to metoprolol) are extremely mild and it's available in generic form.

Ask your cardio as always ....

 

[Lily]

It's one of the things those of us with bicuspids fear!
I have no useful information to add but wanted to tell you my thoughts are with you; hoping for the best for you!

 

[AZ Don]

Hi,
Here are a couple threads from this forum re. Losartan and BAV:

http://www.valvereplacement.org/for...aortic-enlargement-Anyone-try-this-drug/page2
http://www.valvereplacement.org/for...rtan-Cozaar-for-BAV-with-aneurysm-says-expert

Here is a link to a study on the effects of Losartan on those w/ BAV:
http://clinicaltrials.gov/show/NCT01390181

It is in progress so no results yet - they are currently recruiting participants with BAV and aneurysm. I thought there were other studies but in looking just now the other links I found also pointed to the University of Michigan, so I think they are the same study.

There is a good description here of the process of aneurysm development in those w/ BAV and mention of Losartan:
http://circ.ahajournals.org/content/119/6/880.full
It does state: "Whether Marfan data can be extrapolated to BAV aortic disease is debatable."

I am strongly influenced by the fact that one of the leading researchers of Losartan and Marfan's (Hal Dietz) apparently believes that there may be similar benefit in those with BAV as well as the fact that there is little harm. I discussed Losartan with my Cardiologist and he thought it was a good idea for me to take it, but in a limited dose because he also wants me on Metoprolol and doesn't want to lower my BP too much.

Given the high risk of aneurysm in those of us with BAV, this is certainly an area of research to keep an eye on.

Don