AORTIC REGURGITATION

[kennytobin]

BAV  chronic AVR  left ventricle 6.2  no symptoms  age 58.5  CAT angiogram  3.7 aortic root  4.2 ascending aorta
SHOULD I REPLACE valve now or wait?

[kenkeith]

When the leaflets of the aortic valve do not come together well, it is possible for blood to flow back or leak into the heart again. This is called regurgitation or insufficiency. This leakage puts a strain on the heart, because it must re-pump some of the same blood again. As a result, the left ventricle becomes over loaded and stretches in diameter (dilated). Your LV dimension at 6.2 cm indicates an enlargement (normal is 3.5-5.7 cm).  A dilated LV can cause poor contractions and reduce blood flow causing heart failure.  Also, an enlarged LV can cause arrhythmia (irregular heartbeats).
In the early stages of this disease, symptoms are apparent during exercise only.

The decision to have aortic surgery is carefully made, considering your risk factors, including their overall health and ability to tolerate surgery.  Generally, surgery is suggested when the risk of aortic tear or rupture is greater than the risk of having surgery. Following are several things an aortic surgeon will consider regarding the timing of surgery:

     • Size of aneurysm...root greater than 4.0 cm
     • Aneurysm growth rate ....05 cm 6-12 months (usually).
     • Type of aortic disease present....BAV is a syndrome that includes valve as well as aorta tissue impairment
     • Whether or not there are aortic symptoms such as chest or back pain
     • Family history (whether or not the aorta dissected or ruptured at small aortic sizes in other family members)

A great deal of attention is paid to the size of the aorta, because as the aorta gets larger, the odds are greater that it will tear or rupture. A great deal of attention is also paid to the risk of having surgery. The most experienced aortic surgery centers have successfully lowered the risk of aortic surgery. In these experienced centers, it should be possible to have surgery done sooner, at smaller sizes, before the aorta tears or ruptures.

The aortic aneurysm size at which surgery is suggested varies somewhat between surgeons and centers. When thinking about having thoracic aortic surgery, it is important to keep in mind that:
    
      • Surgery should be done in an experienced aortic surgery center with a low rate of complications and death and good long-term results.
      • Surgery decisions are made based on several factors, not just size alone.
      • Surgery decisions are made on an individual basis.
      • Surgery is generally offered to those with the most fragile aortic tissue earlier, at a smaller aneurysm size, due to a greater risk of rupture or dissection.

When or whether or not to have surgery depends on many factors that I have included with the post.  It is not possible for someone to have a conclusion without weighing all factors with a cardiologist and surgeon.