dilated aortic root

35 yo male. Otherwise health except for significant reflux.   Bicuspid AV.  Got CT aortogram today found dilated aortic root of 4.0 cm.  Spoke to cardiac surgeon who said would only repair if got larger then 4.5 cm.  Height is 6.1, weight is 165.  Had symptoms of severe reflux in november which were eventually controlled with omeprazole.  However, doc wanted to check heart.  Stress echo totally normal except for BAV.  Rec. was for aortic root imaging, but life got in the way, however completed today.  I have a couple of questions.

1. Could 4.0 cm dilation at root not involving rest of aorta be cause of "reflux" symptoms.  Aorta tapers to normal very quickly.  Keep in mind symptoms controlled on omeprazole with little to no breakthrough.

2. What is recommendation for young patients?  Bio vs Mech.  When should you get repaired?

3. Couldn't find clinical guidelines, are there any?

4. Are there other options for anti coagulation besides coumadin (plavix, ASA, enoxaparin)

[kenkeith]

Reflex symptoms can sometimes be mistaken for a heart issue but there is no connection.

Usually when the dilation exceeds 4.0 cm it is medically referred to as an aneurysm and if and when the size increases to 5.0 cm then there is consideration to intervene to prevent a rupture...4.5 size may be a consideration for risk with specific conditions such as BAV.

Sometimes the aorta valve can be preserved with any procedure to correct an aneursym, but if a valve replacement is the only option then the mech valve is recommened because the bio does not have a very long life span compared to metal.  Coumadin is the only option for mechanical valves due to the risk of blood clots...requires frequent testing for the correct level of antiplatet properties.

http://circ.ahajournals.org/content/106/8/900.full

Thanks for sharing, and if you have any further questions or comments you are welcome to respond.  Take care,

Ken

[Younique1]

My aorta was 4.0 when I had mine repaired.  I have a connective tissue disorder though.  To be on the safe side, check out the National Marfan Foundation website and the Loeys Dietz website.  I was always termed to have Marfan syndrome but the diagnosis changes after my surgery and now it is Loeys Dietz.  Just google those and you can find out more.  You have to be your own advocate and don't let any doctor tell you that you don't have to have the surgery until 4.5 or 5.0.  Do your homework and arm yourself with knowledge.  Thank God I did, it saved my life and my 2 childrens lives.  Best of luck to you!

[kenkeith]

There is a distinction between bicuspid aorta valve from Marfin...there are different clinical features and pathophysiology, and data from Cleveland Clinic studies suggest that bicuspid aortic valve disease is caused by a connective tissue disorder that also causes other circulatory system problems. People with bicuspid aortic valve disease also may have abnormal coronary arteries, aortic aneurysm or an abnormal thoracic aorta (the portion of the aorta that passes through the upper chest) and unstable (labile) high blood pressure.

Obviously when there is a range of values as a quide for intervention and that does not preclude exceptions.  

For some insight from the leading medical community, Cleveland Clinic: In the most severe cases, when symptoms are present at birth or in early infancy, surgical repair of the valve must be performed immediately. In other cases, people can go their whole lives without knowing they have BAVD.

About 80 percent of people with BAVD will require surgical treatment to repair or replace the valve and part of the aorta, usually when they are in their 30s or 40s. Cleveland Clinic specialists can determine the best time to do the surgical repair and whether multiple repairs to the valve and aorta can be done at the same time if needed. As of December 2008, they have operated on 3,700 patients with BAVD, the largest experience in the world in treating this disease.

For the patient who has stenosis and symptoms, the preferred treatment is to replace the valve with a mechanical or biological valve. The mortality rate for this procedure at Cleveland Clinic is less than 1%.

When regurgitation is present, the aortic valve can be repaired successfully. Cleveland Clinic is one of only a handful of centers in the world to repair bicuspid aortic valves, and 91% of patients who undergo the procedure here do not need another valve operation for at least 10 years. After repair, if failure does occur, it will take place in the first year to 18 months after surgery - but thereafter the risks of re-operation are low. However, because the valve is abnormal,it is likely that it will need to be replaced after a few decades.

An aorta that is enlarged and forming an aneurysm can be repaired, but at Cleveland Clinic we more often replace the damaged section with a section of plastic tubing that is sewn into position. The timing for repair of an aortic aneurysm is critical. When the valve is faulty and the aorta has enlarged to greater than 4.5 cm, we repair the aorta at the same time we repair or replace the valve. If the aorta has enlarged but the valve is still good, the optimal time to repair the aorta varies. At Cleveland Clinic, we have developed a special mathematical formula we use to determine this, based on the patient’s height and weight and the size of the aorta - surgery is usually recommended when the aortic cross sectional area in square centimeters, divided by the patient's height in meters is more than 10.

Ken

[nickppatel]

Read my prior posts regarding angiotensin receptor blockers (ARBs) and how they can help stabilize or shrink the aortic root, thereby avoiding surgery.  Click my screenname to look at the old posts.  Feel free to message me.