Hiyas:
Been awhile since I posted and thought I'd share the info I received in January.
To recap: I had a EBT CT scan of my heart at Swedish Hospital in Sept '09. I do this every few years just to watch for heart disease and because they do walk-ins for $200. Good news: no plaque to speak of. Bad news: ascending aorta dilated to 4.6 cm. Good news: pulled the one I did in 2006 and said "oh it was 4.6cm then, too." Too bad they didn't catch it THEN, but oh well.
Had another CT at my local hospital, confirmed the diagnosis. Rest of the aorta is fine. Decided I wasn't too happy with the answers I was getting locally so I looked around for real experts and picked Dr. Liang at Stanford and Dr. Miller as the surgeon if that became necessary. That's where we pick up the story.
In January I went down to Stanford and met the team in the Connective Tissue/Cardiac section. They are extremely nice, all of them! Dr. Liang is very informed. They did an Echo the right way and finally I got confirmation that I do indeed have a BAV. The image showed up beautifully, the tech really did a good job. Could see the fused leaflets and everything. I'm asymptomatic for that and the regurg is minor, so Dr. Liang said that Dr. Miller is an excellent choice as he's the master at the valve-sparing surgery. He doesn't believe I'll need a valve replacement. No sign of Marfan's or a connective tissue disorder.
The ascending aorta was confirmed at 4.7cm (although the CT is probably a bit more accurate). He told me that the mortality rate at 4.7 is less than the mortality rate for surgery (although both are significantly under 1%), and said that he didn't recommend surgery right now, but if I insisted, he would. I agree with him as surgery will put me out of commission for awhile and I work offshore. I am starting with a new company next month that has short and long term disability so if/when I do need surgery I will be (mostly) covered financially, which is a relief.
So basically, we're at "watchful waiting". He said that the fact that it's been the same size since 2006 (and maybe years before that, 2006 was my first chest CT) is a good sign. He doesn't like the accumulated radiation from regular CT's, so we're going to be doing their fancy 4-d MRI annually. He believes it will eventually start to grow and I will eventually need surgery, and for the Stanford team, that number seems to be 5.0. In the meantime, I'm not supposed to lift anything that causes me to "strain", and I keep my BP nice and low with an atenolol in the morning and a lisinopril at night with no side effects. This is working very well; I just had my offshore physical and running on the treadmill, my systolic BP stayed under 140 even though my heart rate was at 160 for the stress test. The chest and back discomfort I occasionally have was explored and he believes it's not aneurysmal pain as it can be affected by movement or diet, and it doesn't correspond to when my BP is higher (ie, during exercise).
Also, apparently the root is fine and most of the arch is OK so the inominate artery won't be affected during surgery, which means that I don't have to be on bypass or frozen for as long.
Anyway, that's me. How're you?
Equusz, RN, EMT-P
Been awhile since I posted and thought I'd share the info I received in January.
To recap: I had a EBT CT scan of my heart at Swedish Hospital in Sept '09. I do this every few years just to watch for heart disease and because they do walk-ins for $200. Good news: no plaque to speak of. Bad news: ascending aorta dilated to 4.6 cm. Good news: pulled the one I did in 2006 and said "oh it was 4.6cm then, too." Too bad they didn't catch it THEN, but oh well.
Had another CT at my local hospital, confirmed the diagnosis. Rest of the aorta is fine. Decided I wasn't too happy with the answers I was getting locally so I looked around for real experts and picked Dr. Liang at Stanford and Dr. Miller as the surgeon if that became necessary. That's where we pick up the story.
In January I went down to Stanford and met the team in the Connective Tissue/Cardiac section. They are extremely nice, all of them! Dr. Liang is very informed. They did an Echo the right way and finally I got confirmation that I do indeed have a BAV. The image showed up beautifully, the tech really did a good job. Could see the fused leaflets and everything. I'm asymptomatic for that and the regurg is minor, so Dr. Liang said that Dr. Miller is an excellent choice as he's the master at the valve-sparing surgery. He doesn't believe I'll need a valve replacement. No sign of Marfan's or a connective tissue disorder.
The ascending aorta was confirmed at 4.7cm (although the CT is probably a bit more accurate). He told me that the mortality rate at 4.7 is less than the mortality rate for surgery (although both are significantly under 1%), and said that he didn't recommend surgery right now, but if I insisted, he would. I agree with him as surgery will put me out of commission for awhile and I work offshore. I am starting with a new company next month that has short and long term disability so if/when I do need surgery I will be (mostly) covered financially, which is a relief.
So basically, we're at "watchful waiting". He said that the fact that it's been the same size since 2006 (and maybe years before that, 2006 was my first chest CT) is a good sign. He doesn't like the accumulated radiation from regular CT's, so we're going to be doing their fancy 4-d MRI annually. He believes it will eventually start to grow and I will eventually need surgery, and for the Stanford team, that number seems to be 5.0. In the meantime, I'm not supposed to lift anything that causes me to "strain", and I keep my BP nice and low with an atenolol in the morning and a lisinopril at night with no side effects. This is working very well; I just had my offshore physical and running on the treadmill, my systolic BP stayed under 140 even though my heart rate was at 160 for the stress test. The chest and back discomfort I occasionally have was explored and he believes it's not aneurysmal pain as it can be affected by movement or diet, and it doesn't correspond to when my BP is higher (ie, during exercise).
Also, apparently the root is fine and most of the arch is OK so the inominate artery won't be affected during surgery, which means that I don't have to be on bypass or frozen for as long.
Anyway, that's me. How're you?
Equusz, RN, EMT-P
