Bicuspid heart valve with dilated Aorta

[tdrummer]

I'm 46 years old, 5-8, 160 lbs and in very good physical condition. I've been active my entire life. I walk nearly 20-miles a week, play the drums regularly, golf, tennis, etc. I don't have high blood pressure or heart rate, I eat healthy and have had no symptoms such as chest pains or shortness of breath. But, I was recently diagnosed with a slight murmur which led to a round of tests including: Echo.,  Ultrasound, Stress, and CT of the heart. What they found is a Bicuspid heart valve and a dilated Aorta (5.5). My Cardiologist put me on a BB (Coreg CR), 20mg a day. He also said that due to the dilation of my Aorta being 5.5cm, that I'm close to needing open heart surgery to repair/replace. He will monitor now every 4-6 months to check the status of the Aorta. My question is: should I seek a second opinion or another CT to verify the measurement? I realize that all medical things considered, it could have been much worse, but yikes!!! Open heart Surgery!!!
Thanks in advance for any help and consideration.

[tdrummer]

sorry for the delay in responding, but I really appreciate your insight and comments.

Many Thanks, TD

[kenkeith]

You had a CT scan or an MRI gives the most accurate image of the entire aorta.  I don't believe another CT scan would be beneficial, but the different interpretation of the images may be opined regarding size....aortic dilation should be carefully monitored by echocardiography and aortic root replacement recommended more aggressively for patients with BAV (bicuspid aorta valve) with aortic dilation ( 4 to 5 cm) than for those of patients with tricuspid valve ( 5 to 6 cm).

Consideration should be whether or not the bicuspid valve can be saved as the abnormal blood flow from a bicuspid aortic valve was the main cause of enlargement of the ascending aorta, and an ascending aortic aneurysm has been observed in the presence of a normally functioning bicuspid aortic valve. .

For some insight, bicuspid aortic disease is increasingly being understood as degeneration of the medial layer of the aorta, resulting in an aortic wall that gradually loses its strength. This condition causes the aorta to over stretch with each beat of the heart, eventually leading to formation of an aneurysm. Secondary to the anatomical nature of the ascending aorta (which is relatively free inside the pericardium), and its exposure to maximal blood flow from the heart, the aortic root and ascending aorta are the most common sites of aneurysm formation.

When the rate of growth of the aneursym (size greater than 4.0 cm) and when size is greater than 5.0 cm then surgery begins to be an option.  Close monitoring will help determine the rate of growth, and the orginal, normal size varies among individuals