BAV & Dilated Aorta Questions

[Rson]

Hi, I have recently been diagnosed with a Bicuspid Aortic Valve with mild regurgitation through a stress echo and a dilated ascending aorta through a CT with contrast.  I am scheduled to have a repeat in 1 year to look for changes.

After reading the information from the Cleveland Clinic, I have a few questions.

1.  My CT with contrast gave the following measurements.

                                              Ascending               Descending
Proximal Thoracic Aorta           3.8 cm x 3.7 cm       2.1 cm x 2.3 cm
Mid  Aorta                               3.3 cm x 3.5 cm       2.1 cm x 2.2 cm
Distal Aorta                             3.2 cm x 3.4 cm       2.0 cm x 2.0 cm

So by Cleveland standards, my ascending aorta would be considered an aneurysm because it is 1.5 times that of the adjacent aorta.  Is this correct?

2.  I've also been trying to calculate at what point I would want to have surgery if it is ever needed.  You have a formula for that and it should be under 10, if over, it would be time for surgery.  When I take my largest point 3.8 cm, and my height 5'  4 3/4 " and use your formula I come up with 8.8.  If I do it at 4.1 cm and my height I am past the 10 point.  So would I have the surgery that early (4.1 cm)?  I know it is usually 5 cm or above.

Thank you  

[CCFCardio MD2]

The dilated aorta is not the same as an aneurysm.  Dilated ascending aortas are not uncommon in patients with bicuspid aortic valves.  Given your dimensions you are not yet a candidate for surgery as the risk would likely outweigh the benefits.  However, if you become a candidate for surgery due to worsening of your aortic valve you should discuss with your surgeon whether repairing the root should be done at the same time.  With your dimensions you still might not benefit from aortic root repair.  You are right that most surgeries are done if the dilation grows larger than 5cm regardless of whether the valve needs repair.  You don't "automatically" qualify for surgery if your root gets larger than 4.0cm, though given your height you might benefit from surgery sooner than a taller patient.  

Continue your routine imaging and stay in close discussion with your cardiac surgeon.  You would likely benefit from a beta blocker as well.

Best of luck.

[Rson]

Thank you for taking time to answer my questions.  I know that at this point I will just monitor yearly for growth and hope that it doesn't change to fast.  Then hopefully surgery will be far down the road or not at all.

When you say that a dilated aorta is not the same as an aneurysm, is that because of the size?  Is it considered one only when it hits 4.0 cm?  

Which of these measurements is my root?  I'm not sure what area of the ascending aorta the proximal, mid and distal are, can you explain?

My cardiologist has put me on Simvastatin 20 mg and 1/2 of Metoprolol 25 mg.  I did not have high blood pressure so she only is giving me half.

What do you think would be a reasonable size that I would want to question surgery at my height?

Thanks again!!!