When to operate

I have a Bicuspid Aortic valve. I have been echoed twice in the last six months as well as 12 years ago when the BAV was identified. My valve is calcium free,not stenotic and there is no regurgitation.My original echo 12 years ago showed a 4.5 cm dilation of the aortic root. Both recent echoes showed a growth to 4.7 cm. My blood pressure is around 106/78 without medication. My cardiologist has suggested another echo in a year as the dilation seems to be growing very slowly. Does this course of action seem prudent?
In perusing this site (which I found  to be a great resource) between recent echoes I got the sense that others in my situation seem to be much more concerned about an aneurysm of this size and a possible dissection.
I am in Toronto we have a great heart center here and I'm not so concerned about the eventual surgery but I don't want to be putting myself at greater risk than I need to.
Is 5 cm considered the time for surgery with a BAV or given my situation would I expect surgery when my root grows to 5.5cm Thanks for any thoughts. Steve in Canada

[Momto3]

Hi Steve,

Welcome to the Heart Forums!!  Hope you are finding lots of good information in the current and archived posts.

I'm not real familiar with BAV, but it seems to me that I have heard "5" is the magic number.  Sounds like everything is stable and you're doing well.  Be sure to let your doctor know if you have any change in symptoms between appointments.  

connie

[upchurch131]

I am in the middle of a surgery determination with similar conditions.  I have a BAV with aortic dialation.  My echo in October 2007 was 4.9.  My last echo (April 2008) indicated an aortic root measurement of 5.3 cm with moderate reguritation.  Yesterday, I just had a cardiac CT scan and should have the report in the next five days.  I am also told the magic number is 5.  I haven't been specifically told this but am assuming an aortic root replacement is probable with the valve replacement.  My cardiologist is going to refer me to the surgeon.  I am nervously looking at my valve replacement options as I am 53 and do not wish to repeat any such surgery when I am 70.  I am also nervous as I have some spinal issues that might require surgeries in the near future and I don't want to be playing with the possibility of strokes.  Seems like a catch 22.

I'd also like to hear from anybody with similar symptoms or success stories.  One question, how secure is an aortic root repair and how long will it last?

upchurch131

[KlynnC]

I am 39 years old and also have a BAV, however with  moderate regurg and an enlarged ventricle and my aortic root is only 3.5cm (the high side of normal) and I have good ejection fraction (65%), I have been  very active my whole life so it was a bit shocking to learn. One thing that I have learned is that anyone with this diagnosis should be sure to have a CT or MRI of the entire aorta because it is apparently not just a valve problem, but is now being considered a connective tissue disease that affects the medial layer of the aortic wall, making it weak and therefore prone to aortic aneurysms or dissections - mainly in the ascending aorta, but could be anywhere. Another factor involved is people with BAVD are more prone to brain aneurysms and some other disturbing things. (Ugh!) I'm no expert, but just kind of paraphrasing what I read. I just had my first echo in Jan and a CT with contrast in Feb and I went to a cardiologist today to get prescriptions for my 2 children (2 and 4) to have echos done because it is hereditary. The cardiologist also ordered a stress echo for me because I am having some chest pain with exercise and I read on this forum that another guy had a stress echo, so I suggested it to the cardio and she seemed to think it was a good idea (least invasive).
A great and informative site to check out is the bicupid aortic valve foundation - tons of info ( a little scary at first, but in a supportive way)  and also the cedars-sinai medical center in LA - they have a thoracic surgeon there that more or less specializes in this and he has a page of FAQ about aortic valve and aneurysms, etc. Let me know what you think if you check it out, this is all new to me and I am doing everything I can to be proactive without over-reacting....A delicate balance!
Sorry I couldn't offer any real experiences, but I think these 2 websites can answer a lot of questions.
Good Luck!

[Steve_Canada]

Just an update for all of you in my boat. My most recent echo of my ascending aneurysm showed it had grown to 4.9 cm. The cardiologist and I agreed that it was time for the more accurate CT to be done.  To my surprise the aortic root is now at 5.4 cm while the ascending aneurysm is still at 4.9. I am being scheduled for an angiogram this week with surgery to follow within a month.  I had been reassured with the slow growth of the aneurysm but shocked to find out that my aortic root had grown to this size. Despite the concern of the radiation involved with a CT I would encourage all of you with similar slow growing aneurysms  nearing the 5.0 cm point to request a CT at least once as your aneurysm approaches the danger area.
I will provide details of my surgery for those of you, like me, share this scary situation. I am relieved that I will soon have the surgery and can put this constant worry behind me.
Thanks to medhelp for all the info over the years

[skydnsr]

Steve, thanks for the update.  You seem very well-informed about the issues involved in your situation.  You make an excellent point that echo estimates of aortic size are just that, estimates, and that CT or MRI scanning is required for accuracy.  Good luck with your upcoming surgery.  Having had the same type of operation myself, I wish you the best.

[Steve_Canada]

Hello Everyone. I had my ascending aortic aneurysm surgery on June 28th. Everything went well. It turns out that my ascending aneurysm was 5.6 cm at the time of repair. My bicuspid valve was functioning perfectly so it was left alone as well as a small dilation of my aortic root at 4.3 CM.
I was out of the hospital in 4 days and home to feel the odd sensations after cardiac surgery. Pain was minimal but it took 4 weeks before I could sleep on my side again.
As I healed i noticed many little oddities in the way my body responded to the surgery.
I found that by checking in with the post op forum of Valvereplacement.org that all of the things that I felt were just the normal post op bodily grumbles.
Despite the fact they give a "what to expect" sheet when you leave the hospital they can't explain every sensation that you feel in a brochure so having the folks that have gone through it reassure you at Valve Replacement .org was most appreciated.
Every day gets better and although I may face another surgery for my aortic root in 10-15 years I'm not worried,
Good luck to everyone facing this worrisome ordeal.