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How soon before I need surgery?
I have both a bicuspid aortic valve and a dilated ascending aorta at 4.2 cm. My last echocardiogram said that my bicuspid aortic valve had moderate aortic insufficiency and a normal sized aortic root with the dilated ascending aorta at 4.2 cm. It also stated that I had mild mitral regurgitation, mild tricuspid reguritation with estimated PASP 27 mmHg. I don't entirely understand what all of this means. I am 5'4" and weigh 250 pounds. I have lost 50 pounds over the last 2 years. My blood pressure is normal. I am going for a repeat echo in July. How likely is it that I will need surgery soon? Why is it more likely that a person with a bicuspid aortic valve needs surgery when she has a dilated ascending aorta also?
This discussion is related to dilatation of ascending aorta.
This discussion is related to dilatation of ascending aorta.
No one can tell you exactly how soon you are going to need surgery. It could be now (if your last echo was a while back), it could be in six months, it could be in a year, or it could be in ten years. It depends how fast the BAV deteriorates and how fast the aneurysm enlarges.
With the numbers you state, unless you are already very elderly (80+) or you have serious comorbidities (meaning additional health problems), you have a good chance of living long enough that you will need surgery at some point. To be blunt about it, if you have already lived out your expected longevity, then maybe you are going to die of something else before you have to have surgery for this. But if you are relatively young, and you have no other serious health conditions that might kill you before you become a surgical candidate, then you will likely need aortic surgery.
You need to keep up the monitoring of your heart and aorta, and time will tell. Both BAV and ascending aortic aneurysm tend to get worse, as time goes on. If and when either your BAV or your aneurysm gets bad enough, either one of them can kill you. The BAV stresses your heart in many ways, several of which are potentially fatal. Aneurysms can rupture or dissect, and either event is usually fatal unless you happen to be on an operating table at the time. The bigger the aneurysm, the higher the risk of rupture or dissection. You want to have surgery before those bad things happen, obviously. You also want to have surgery before you have permanent heart damage from the BAV.
Congratulations on your 50-lb weight loss. The closer you can get to an optimal weight for your height, the lower your surgical risk will be. Anaesthetic dosage is based on your body weight, and the more anaesthetic they have to give you, the harder it is to bring you out of it successfully. Also, if you have a lot of extra body fat, it makes the dissection more complicated and prolonged (in terms of getting to your heart for the actual procedure), and that also adds to surgical risk. Also the heavier you are, the harder it is to get up and walk after surgery, which helps you recover faster and helps to prevent complications. Walking after surgery is very, very important.
Still another reason to continue with the weight loss is that the more body weight you are carrying, the more work your heart has to do, and the faster it is going to get to the point that it can't cope with the additional stress of a defective aortic valve. And finally, morbid obesity is often associated with diabetes. Diabetes itself increases surgical risk, even when the diabetic person is not overweight. If the diabetes is caused by the obesity though, sometimes the diabetes will get better or even go away if the person loses enough weight.
Good luck.
With the numbers you state, unless you are already very elderly (80+) or you have serious comorbidities (meaning additional health problems), you have a good chance of living long enough that you will need surgery at some point. To be blunt about it, if you have already lived out your expected longevity, then maybe you are going to die of something else before you have to have surgery for this. But if you are relatively young, and you have no other serious health conditions that might kill you before you become a surgical candidate, then you will likely need aortic surgery.
You need to keep up the monitoring of your heart and aorta, and time will tell. Both BAV and ascending aortic aneurysm tend to get worse, as time goes on. If and when either your BAV or your aneurysm gets bad enough, either one of them can kill you. The BAV stresses your heart in many ways, several of which are potentially fatal. Aneurysms can rupture or dissect, and either event is usually fatal unless you happen to be on an operating table at the time. The bigger the aneurysm, the higher the risk of rupture or dissection. You want to have surgery before those bad things happen, obviously. You also want to have surgery before you have permanent heart damage from the BAV.
Congratulations on your 50-lb weight loss. The closer you can get to an optimal weight for your height, the lower your surgical risk will be. Anaesthetic dosage is based on your body weight, and the more anaesthetic they have to give you, the harder it is to bring you out of it successfully. Also, if you have a lot of extra body fat, it makes the dissection more complicated and prolonged (in terms of getting to your heart for the actual procedure), and that also adds to surgical risk. Also the heavier you are, the harder it is to get up and walk after surgery, which helps you recover faster and helps to prevent complications. Walking after surgery is very, very important.
Still another reason to continue with the weight loss is that the more body weight you are carrying, the more work your heart has to do, and the faster it is going to get to the point that it can't cope with the additional stress of a defective aortic valve. And finally, morbid obesity is often associated with diabetes. Diabetes itself increases surgical risk, even when the diabetic person is not overweight. If the diabetes is caused by the obesity though, sometimes the diabetes will get better or even go away if the person loses enough weight.
Good luck.
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