I have a bicuspid aortic valve with regurgitaion(no stenosis). At my last cardiolgy appointment my doctor recommended surgery in the near future(most likely the Ross Procedure.) Unfortunately I have to wait until mid-November before my heart condition will be covered. My cardiologist said that my left ventricle has begun to dilate (I think internal dimensions of 6.6 up from 5.9 last year?) He also mentioned a shortening fraction of 32% Can you explain these numbers to me please. Also he prescribed Altace to lower my blood pressure, which until recently has been excellent and to help with the fatigue that has become progressively worse over the last year. If I take this medication until November, will it reverse the dilation to my left ventricle, and if so would that be a longer term treatment alternative to surgery?
Thank you so much for providing this service. When my cardiologist told me I needed open heart surgery, I was a little shaken and did not really have the opportunity to ask many questions. Gaining info helps me to feel a little more in controll.
There is no medical treatment for severe aortic regurgitation, and actually
surgical correction is indicated prior to the development of symptoms for any
reurgitant valve. I repeat that no medication can halt the progression of nor
reverse the valvular dysfunction that is called aortic regurgitation. As your
surgeon suggests, it would be best to have the surgery as soon as possible.
The left ventricle (main pumping chamber) is the chamber of the heart that is
responsible for pumping blood in to the aorta, and so it is this chamber that
receives all the back-flow or reguritation from the incompetent aortic valve.
Hence it is this chamber that must adapt to the changes in pressure and volume
that come along with aortic regurgitation. One of the ways that the left
ventricle adapts is by dilating, much like a water balloon does when you add more
water. The normal diastolic internal dimension for the left ventricle (at the
Cleveland Clinic)ranges from 3.5-5.7 centimeters. Of course dilation of the
ventricle would be any measurement greater than 5.7cm. Once there is
a record of the internal dimensions of the left ventricle in systole (contraction) and diastole
(relaxation)one can assess the fractional shortening (calculate)by comparing the difference
between the numbers in an equation. The actual normal values must be obtained at your institution
as this is not routinely measured here, however one would expect that any number below 50%
would indicate decreased function. Back to my original statement now, regardless of any echo
measurement, surgery should be performed on anyone with severe regurgitation ASAP and preferably
before the onset of symptoms.
As for the Ross Procedure, this is still not widely accepted as the best way to
replace an aortic valve, thus I suggest you have a thorough discussion with your
physician regarding all the alternative surgeries as well as the pros and cons
of each. Good Luck.
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