aortic root enlargement with bicuspid aortic valve

[Marie82765]

I am a relatively healthy 44 year old female with a previous history of breast cancer at age 28, BRCA1 positive. I have a bicuspid aortic valve which was discovered when I was about 20 years old, and have had no problems with it in the past.  Within the last year I have had MANY episodes of SEVERE chest pain which begins in my diaphragm area, to mid sternum and will sometimes radiate to my left arm and jaw and even through to my back. This pain can last from a few seconds to several hours. It does resolve with nitro and/or morphine. I have had multiple tests performed including an arteriogram, which was normal. Recently, I had an echo which revealed an enlarged aortic root, mild biscuspid regurgatation, mild mitral regurgatation, and mild tricuspid regurgatation. Could this be the cause of my pain and if so what can I do about it? Also, I have significant family history of heart disease, my mother passed away at 59 of sudden cardiac death and my dad at 74 of massive heart attack. He had had bypass surgery at 50, 60 and stents placed at 70.

[skydnsr]

Sometimes regurgitation is worse than it looks on an echo.  Sometimes the root is bigger than estimated on an echo, also.  With your family history and the symptoms you are having, you need expert care from a cardiologist who knows about bicuspid aorta syndrome.  

I would be expecting a CT scan of the chest and abdomen, and/or a transesophageal echo (TEE) of the chest to be the next test ordered.  It would not be acceptable to me for my doctor to simply treat symptoms with nitro and morphine and let it go at that.  Somebody needs to figure out what exactly is wrong and what needs to be done about it.  

The ascending aorta (or any other part of the aorta) could be enlarged, in addition to the root, and that could well cause pain.  If that is what is going on, it is very serious. Aortic aneurysms, which is what we are talking about, can be easily ruled out by means of CT scanning.  

The most common site for an aortic aneurysm in a person with bicuspid disease is the root and ascending aorta -- sometimes one, sometimes the other, and sometimes both.  I believe that ascending aortic aneurysms can often or usually can be ruled out with a transesophegeal echo.  I know they can be ruled out with a CT scan.  In any case, the TEE gives a more accurate look at the heart than the transthoracic echo does.

Sometimes an enlarged ascending aorta can even be seen on a simple chest x-ray.  Mine was seen and noted, but the significance of it was discounted at the time.  If you have had a chest x-ray lately, you might get the radiologist's report and see if it says anything about ectasia, ectasis, enlargement, dilatation, or dilation (they all mean the same thing) of the aorta.  

[kenkeith]

Mild regurgitation of valves almost always does not cause any symptoms.  An enlarged aorta root shouldn't cause any chest pain.  Because your pain can be controlled with nitro indicates there may be vessel blockage.  There is about a 20% probability the anteriogram test is false negative.