Moderate Aortic Regurg./Moderately Dilated Aortic Root Followup

[francie12]

My son, 13 yrs, has a bicuspid AV with mod. aortic regurgition.  His LV dimension is now at 5.4 cm, up from 5.1 a year ago.  His ascending aorta is moderately dilated.  Our new cardiologist has prescribed Lisinopril.  He would like to see my son in one year to follow-up.  My questions:  Do you concur that now is the right time to start the medication, as opposed to waiting until LV is more dilated?  Is it safe to go to one year folow-ups rather than six months at this stage?  What do you at the CCF think about their idea, if needed in the future, of attempting an AV Repair first and then going to the Ross Procedure (in the same operation) if the repair fails?  Thank you!  You provide an unbelieveably great service.

[CCF-M.D.-MJM]

Hi Francie,



Sorry to hear about your son's heart problems. I should prefice my remarks by saying I do not practice pediatric cardiology and never see patients in this age range.



If this were an adult, yes I would start a medication at this time.  It might even be reasonable to add a beta blocker, but beta blockers at this age my have some less than desireable side effects.



The follow up question is more of a judgement call. If you would prefer a 6 months follow-up, it would not be unreasonable and I am sure your doctor would be willing to reevaluate.



Both a repair and a ROSS procedure are reasonable at this age.  If your emphasis is for fewer long term surgeries, a mechanical valve would decrease the need for future surgeries, but, as I am sure you are aware, requires coumadin.



I hope this helps and good luck.