What Diameter Aorta Requires Replacement?

[cldlhd]

When discovered in October of 2012 mine was 4.5 cm. February of 2013 it was 4.7. This is when I first saw my surgeon. He wanted to operated in 2 weeks.
I needed more time. My surgery was a month later. At this point it had grown to 5.0. So my understanding has always been 5.0 is time for surgery!!!!

Well we had the same surgeon and I got the impression he still liked the 5.0 guideline. I think it was AZDon who said they're guidelines.

 

[pellicle]

Hi

I agree with your scheduling requirements. I told my surgeon back when I was having my homograft done that I was not willing to quit my semester and jeapordise my degree. With some short discussion we scheduled for right after my last exam.

I also think its stupid to wait till your health has degraded to perform what is essentially unavoidable surgery. I see that such is now becoming more accepted in the literature too.

But:

Plus I need to teach my wife a few things like how to operate our audio-video system, in case I don't make it!

I sincerely hope you are not going to phrase it that way. Sure people may seem like they are participating in kidding around but dont even joke about some things!

People remember things in the future, and you just never know how that may seem in the situation to her.

Best wishes

 

[DachsieMom]

To answer the question posed to me earlier, I had an echo, TEE, CT scan and cardiac cath prior to surgery. Those were all under 4. I think ranging from 3.4-3.8. The 4.5 was from the pathology report, so it is possible the aorta was stretched from removal? The op notes stated that my aorta was very large for my body size. My additional factor was that my sister's was 4.8, but was the worst the surgeon had ever seen (very thin walls, holes) and my aorta walls were also very thin, with a structure that looked like hers.

 

[Ultrarunner]

Ultrarunner...just wondering if you are dealing with a high volume center? I don't know what part of Canada you live in, but my experience has always been that I have been seen quickly and in a timely manner depending on what the issue isexpert opinion.

I'm not sure if it's considered high volume, but the surgeon I'm supposed to see operates in St Paul's hospital, which is well regarded for it's cardiac department. It is also three blocks from where we live so it would be convenient for my wife to visit, I waited for a full year to see the cardiologist, so a few more weeks to see the surgeon should be bearable.

 

[Ultrarunner]

A big thank you to everyone who has contributed so far! I think I have a clearer idea of the near term future thanks to your personal experiences.

 

[ForeverThankful]

I had an echo that showed the aneurysm at 4.8cm, (also a BAV in not so great shape, and BTW I'm a 5'2" female). Based on that measurement the surgeon wanted me to schedule surgery within an 8 week window. I scheduled it in exactly 8 weeks, needed some time to prepare emotionally and to decide on valve type. In surgery the aneurysm actually turned out to be larger than 6cm! And also turned out to be across the entire aortic arch which wasn't picked up at all on the original echo.

Another case of an aneurysm being larger than predicted on an echo.

 

[Ultrarunner]

I had an echo that showed the aneurysm at 4.8cm, (also a BAV in not so great shape, and BTW I'm a 5'2" female). Based on that measurement the surgeon wanted me to schedule surgery within an 8 week window. I scheduled it in exactly 8 weeks, needed some time to prepare emotionally and to decide on valve type. In surgery the aneurysm actually turned out to be larger than 6cm! And also turned out to be across the entire aortic arch which wasn't picked up at all on the original echo.

Another case of an aneurysm being larger than predicted on an echo.

That's a huge discrepancy! It's interesting that all of these anecdotes so far have had the physical measurement higher than the diameter based on a scan.

 

[cldlhd]

And echo isn't as accurate as a CT scan for measuring aneurysm size.

 

[Ultrarunner]

And echo isn't as accurate as a CT scan for measuring aneurysm size.

I was pointing out the discrepancy between scan (echo or CT) and measurement after surgery. In a number of cases this difference was much bigger than the usually minor differences between echo and CT. My echo and CT all showed the same diameter.

 

[Ultrarunner]

I finally had my first visit with a cardiac surgeon. He studied under the surgeon who developed the cross section formula to determine when to replace an aorta, in spite of the fact that I'm at 10.0, which is right on the line where Cleveland would recommend replacement, he wants to wait. He said the mortality risk of the surgery is 3% to 4% and my risk of dissection each year is less than that.

So I'll get an echo every 6 months and a CT scan every year. In the mean time I'll just have to avoid dissecting. What he wouldn't do is give me guidelines on running, such as a heart rate, BP, or distance limit.

I was told to think about what type of valve I want so they have that on file. I'll have to start reading through the Valve Selection discussion.

 

[AZ Don]

Well it's a shame that your surgeon won't accommodate your preferences and the cross section formula. You could always try another surgeon but for something like this you want to stick to the better surgeons in your region at least. You will find more discussions on valve selection than you know what to do with, but either choice works.

 

[Ultrarunner]

Perhaps there are reasons specific to Canada that I'm unaware of. Maybe it will be easier when the diameter is at least 5.0 cm. Hopefully more studies will be done to fine-tune the guidelines.

 

[Ultrarunner]

You will find more discussions on valve selection than you know what to do with, but either choice works.

It seems to me that a tissue valve now would make sense. My cardiologist said in future, all valve replacements will be done by threading a mechanical valve through an artery. If I get a biological valve now, I could get the mechanical one later without opening up the chest a second time.

 

[MethodAir]

Perhaps there are reasons specific to Canada that I'm unaware of. Maybe it will be easier when the diameter is at least 5.0 cm. Hopefully more studies will be done to fine-tune the guidelines.

They will repair an ascending and root aneurysm when the diameter is < 5 cm in Canada.

 

[cldlhd]

It seems to me that a tissue valve now would make sense. My cardiologist said in future, all valve replacements will be done by threading a mechanical valve through an artery. If I get a biological valve now, I could get the mechanical one later without opening up the chest a second time.

I thought the POTENTIAL valve threaded through an artery would be another tissue not mechanical?

 

[Ultrarunner]

They will repair an ascending and root aneurysm when the diameter is < 5 cm in Canada.

In your case, you had to have surgery because of your valve, so they also did the aorta. My BAV isn't too bad yet, so the surgeon said he would do a valve sparing procedure if it doesn't get worse before the aorta surgery. Have you heard of other Canadians getting their aortas replaced

 

[Ultrarunner]

I thought the POTENTIAL valve threaded through an artery would be another tissue not mechanical?

You are right. It is tissue. But it is inside wire mesh so I assume one would need to be on an anticoagulant like a mechanical valve.

 

[pellicle]

You are right. It is tissue. But it is inside wire mesh so I assume one would need to be on an anticoagulant like a mechanical valve.

as far as I know all tissue prosthesis are covering a metal frame to give them structural integrity.

the reason for AC therapy with the mechanicals is a combination of reasons (including pressure jets just on opening and closing. Stop a hose with your thumb and see what I mean).
Also I understood that with a valve in valve the diameter gets smaller on the replacment, which is not what an active person wants. But then they are not currently for active people, they are for frail, "almost on deaths door" people.

I find it curious that so many active people (who would really benefit from a mechanical valve) have a strong interest in the wrong type of valve for their "needs" (IE one developed for people so frail they will not likely survive surgery which normal healthy people do)

PS I think C is the type Dick has, which are no longer in use.

 

[AZ Don]

It seems to me that a tissue valve now would make sense. My cardiologist said in future, all valve replacements will be done by threading a mechanical valve through an artery. If I get a biological valve now, I could get the mechanical one later without opening up the chest a second time.

While TAVR may certainly be a possibility, no one can see the future so it hasn't always worked out as expected for some. I've read on this forum of others who got a tissue valve, being told that there next valve could be done through the artery. Then the valve needed to be replaced and the TAVR procedure wasn't yet approved for them, and so they had another OHS.

FWIW, My BAV was well functioning so it was spared when my aortic aneurysm was repaired. I was told I had a 50% chance of not needing to replace the valve and that it should last at least 15 years anyways. 2.5 years later and it is no longer a question of if I will need another valve, but when. I still think I made the right choice, but I didn't think I would be consulting with a surgeon again so soon (appt in January).

 

[Ultrarunner]

Thanks pelllicle and Don. I apologize for my valve ignorance. I've been concentrating entirely on the aorta replacement so far. I made assumptions that I shouldn't have. You make a great point about the through the artery valve being smaller, As an active person, this wouldn't be a good fit. So maybe I should leave it out of my planning entirely.

Don, given your experience, perhaps opting for the valve sparing procedure may not be the best.plan. I haven't been given an estimate of how long my valve would last. All I know is the regurgitation is "Mild-Moderate" at the moment. Maybe I should just get everything done at the same time. I'm sorry you have to go through surgery again so soon.