Tricuspid aortic valve with ascending aneurysm...unusual?

[thenewmarket]

This might be a silly question but is it unusual to have a tricuspid aortic valve and an ascending aortic aneurysm? All tests indicate my husband's aortic valve is tricuspid. It just seems that all the information concerning valves and aneurysms point to bicuspid valves as the problem. I know the valve is not always the cause of an aneurysm but how common is a tricuspid valve with an aneurysm?

Given a choice do you repair the tricuspid valve or replace it?

 

[Arlyss]

Hi,

There are a group of people, I don't think anyone knows how many, whose aortic valve leaflets appear to be the "normal three", yet they develop an ascending aortic aneurysm, similar to those who clearly have abnormal bicuspid (unicuspid, quadricuspid are rare variations) leaflets.

It is possible that the abnormality of these valve leaflets is just not detected by today's imaging. I am wondering what is wrong with the valve? Is it leaking (regurgitation, insufficiency) ? If so, that would point to abnormal tissue that is weak and can no longer perform its function well, similar to the failure of the tissue in the aneurysm of the aorta.

When the valve is not clearly bicuspid, and the person does not fall into another obvious syndrome such as Marfan or Ehlers-Danlos, it just means that not enough commonality has been found to give this condition a distinct name. It is often just called "TAAD" for "Thoracic Aortic Aneurysm and Dissection", whether the heart valves are involved or not.

The repair versus replace decision for an aortic valve is not a simple decision. If the tissue is abnormal, it is difficult to know if a repair will "hold". (Mitral valves are much more commonly repaired.)

I wish you the best in searching for surgical expertise that is state-of-the-art regarding both the valve and the aorta.

Best wishes,
Arlyss

 

[Mike C]

If other disorders have been ruled out such as marfans, I would guess the valve may actually be a biscuspid which they cant get a good look at or is presenting as tricuspid.

In regards to repair or replace, it depends on the condition of the valve. The question you may want to ask is vale sparing or replacement rather tahn repair.

Mike

 

[thenewmarket]

Thank you for your responses. I was beginning to feel like the "Lone Ranger" as I researched all the information. We highly suspect that my husband had undiagnosed rheumatic fever as a child (this was in the early 60's). He has no physical features of Marfan Syndrome, no history of Marfan in the family, and no symptoms that coincide with Ehlers-Danlos. He is 51 and has already had a total hip replacement. There was no explanation for the hip replacement, no arthritis, no avascular necrosis, etc. His surgeon felt that he had either had an illness as a child or suffered a severe trauma to the hip. My husband remembers missing most of his first grade year with ear infections and fever. There is no family history of heart disease or aneurysms. We have an appointment at Cleveland Clinic in the near future and we hope to obtain more specific answers.

We realize he may be presenting with a tricupid valve, and that it may be determined to be bicuspid.

Again, thanks for your responses.

 

[Ross]

Your not the lone ranger, mine was tricuspid. Mine was repaired, but never normal after the aneurysm ruptured, so it was replaced in 2002. I made sure of it on my last Cardio visit to ask because we've discussed Bicuspid in length in here. How normal is it? Good question, obviously not nearly as many as Bicuspid folks, but they still happen. I had a left total hip replacement when I was 37, due avascular necrosis of the left femoral head caused by years of Prednisone use for my lung disease. I now have a 3.6 cm abdominal aortic aneuyrsm to worry about as well. I'm 45 now.

 

[Tom F.]

You described the exact condition that I faced in 2002, normal valve, but ascending aneurysm. This is less common that aneurysms with bicuspid valves, but it happens. In fact the David type valve sparing surgery which fixes the aorta and leaves the valve in really intended for folks presenting with this condition. I had a valve sparing, also called a repair, in 2002, and it seems to be holding up well.