Pediatric Heart Expert Forum
aortic aneurysms
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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aortic aneurysms

Hi,
I have a question regarding aortic aneurysms as a result of congenital defects.

I have a bicuspid aortic valve as well as a repaired coarctation of the aorta. My coarc was fixed once at the age of nine days and again at the age of five. It was fixed using a Dacron patch.

My question is in regards to my risk of aneurysm formation. As per the Internet, some studies make it sound like a Dacron patch is very risky for aneurysm formation, others make it sound not risky at all.

I am now 33 with no other issues regarding my coarc. There is talk of my aortic valve eventually being replaced. I also have a subaortic membrane, moderate aortic stenosis, and ASD. I am monitored by a cardiologist twice a year. I was monitored by a pediatric cardiologist until age 27, but I eventually switched over to an adult one.

Despite the above, I am healthy. No high blood pressure and not overweight. I do not smoke,  and I exercise routinely.

My question is what the risk for aneurysm formation is for a Dacron patch for someone who had surgery nearly thirty years ago at a young age. I am also curious as to my risk overall with all my other heart issues.

I do have routine echocardiograms, and occasional TEE's, and I am wondering if those are sufficient to see if an aneurysm has formed.

Thanks so much!
Jennifer
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Dear Jennifer,

Overall, the medical literature does say that there is an increased risk of aneurysm formation in association with Dacron patch repair of aortic coarctation.  Interestingly enough, as well, the American College of Cardiology just recommended routine cardiac MRI or CT scanning for coarctation patients over age 18, because transthoracic and transesophageal echocardiography can easily miss aneurysm formation.  My recommendation at this point is that you should be seen by an adult congenital heart disease (ACHD) specialist.  Unfortunately, internal medicine-trained adult cardiologists typically know very little about congenital cardiac disease, both in their repair as well as their "unnatural" history.  I cannot say your specific risk without evaluating you, but I can say that the risks associated with repaired coarctation plus bicuspid aortic valve include aortic aneurysm, hypertension, progression of aortic valve insufficiency and/or stenosis (leakage and/or obstruction), and aortic root dilation.  As well, there can be an increased risk of intracranial aneurysms.  At minimum, it is great that you are exercising--I would recommend that you not do any significant isometric activities (heavy weight lifting, etc.), especially with the moderate subaortic stenosis.  Finally, with the atrial septal defect, I cannot say how large the defect is, and therefore cannot tell you whether it should be closed, or not, at this point.  An ACHD specialist can fully evaluate you and advise you regarding all of these things.
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
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The Children’s Hospital of Philadelphia
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