aortic aneurysm after aortoplasty

[annie10]

I am a 47 yr. old female.  I had aortic valve replacement for a bicuspid valve in 2000.  At that time, a 4.9 cm. aneurysm was "repaired" with angioplasty.  This information has only come to me recently, with the discovery on CT scan of a 4.4 cm. aneurysm in the ascending aorta.  My question:  The angioplasty doesn't replace the aortic wall, merely reduces the diameter.  This tells me the aortic wall is still composed of thinner, more fragile material.  This latest aneurysm seems to me to be an additional expansion of already thin aortic walls.  Is this thinking correct, or is there information to contradict this?  My surgeon is reluctant to operate, but has failed to reassure me that I am not at greater risk of rupture than a person with a 4.4 cm who has not had previous angioplasty. I am having chest pain which the cardiologist and surgeon seem to think is "all in my head" because I hadn't mentioned it in my first visit with my cardiologist.  (I have just moved to the area, and have all new doctors) My visit to the cardio was to ok me for another minor procedure.  I mentioned having my yearly echo done, where the aneurysm was discovered.  He got the last echo, and said that part of the aorta had not even been scanned, so there is nothing to compare with.  The cardio and surgeon are both saying this has "probably" been there all along, so I shouldn't be too alarmed.  Is watchful waiting adequate, or should I get another opinion ASAP?

[Cleveland Clinic]

Annie,

I'm not sure what you mean by repaired by angioplasty. Often times an aortic aneurysm is repaired with a graft when a bicuspid valve is replaced. Angioplasy refers to ballon dilitation of a blood vessel and is usually performed for narrowing of arteries.

Sometimes at the end of a aortic repair an anuerysm can form. I would be interested in interval change of your anuerysm, and 4.9 cm lies within the range that is usally followed medically unless there was evidence of rapid expansion. I would probably repeat a scan in 3-6 months and see if there was any significant change. If not you could probably be followed yearly.

good luck

[annie10]

I'm sorry, I meant aortoplasty, not angioplasty.  I also had a brother who died of a "massive heart attack" at age 33.  (no autopsy done)  I am very scared, and I don't feel like my doctors are taking this seriously enough.

[Schmoomcgoo]

Hi Annie.  I'm very sorry you find yourself in a position where you are worrying about an aortic aneurysm for a second time in your life--as if once weren't enough!  I also have a BAV and an ascending aortic aneurysm, so I know how worrisome it is, but having never been through surgery to correct same, I can only imagine how disheartened you must be.

I really don't know much about aortoplasty, but it seems to me that it is really not done anymore, for whatever reason. With a brother who died at 33 of an essentially unspecified cardiac event, I am going to trust that I cannot alarm you.  If I do, I apologize. IMO, you should be evaluated at a large, high-volume center with an aortic clinic--there are several such centers in the country, Cleveland Clinic among them.  I can't imagine having peace of mind in your situation without a game-plan from a surgeon who has dealt with aortic aneurysms adjacent to aortoplasties.  Even at a regional heart center I would guess you might be the first--or one of a handful--that a surgeon has seen.

I visit a forum for heart valve replacement patients and their families where you would undoubtedly find valuable emotional support and ample comisseration, but no medical advice.  It is called valvereplacement.com.  Go there and register.  And hang in there. ~~~HUG~~~

[pbanders]

This article may be of interest to you on aortoplasty on patients with bicuspid aortic valves:

http://ats.ctsnetjournals.org/cgi/content/abstract/73/3/720

[annie10]

Thank you both for your responses.  It helps to know someone is listening.  I have read as much information as I can about aortoplasty (which isn't very much).  From what I've read, it probably wasn't the best choice for me with BAV and a 4.9 aneurysm, but at the time I wasn't given any choices.  I didn't find out about the FIRST aneurysm until just a couple of weeks ago!  I think someone dropped the ball on that one, but I can only try to deal with what is happening now.  I am trying to figure a way to get evaluated at Cleveland Clinic- there are several things to be worked out including transportation, finances and time off work.  I really wish I hadn't made that mistake in my original question!  The doc who answered was quite tactful in his answer to a question that didn't make any sense!
Thanks again for your concern.

[Schmoomcgoo]

It is my understanding that the Cleveland Clinic will do long distance consultations where you send all imaging studies (not reports, but CD's of the actual TEE, CT, etc.--I'm sure they'd advise) and test results and what-have-you and you get a (telephone?/written?) consult with an actual expert.  I do not believe insurance covers it in most cases, but the cost is somewhat more than a typical surgical consult yet quite a bit less than airfare, hotel, lost work, etc.  There are times when only a face-to-face will do, of course, and maybe this is one of them.  I just thought you might want to check this out. Please do visit that website I mentioned--you'll be received warmly and made to feel like you're not at all alone.  Take care.

[marmalade]

Hi Annie,

There is a lot of information at www.bicuspidfoundation.com.
Take good care and keep up the posts on your status if you can...I too have a bicuspid valve and ascending aortic aneurysm and have found that being proactive in my care saved my life.

Marmalade