Aa
Aortic root dilatation 4,8
Hello, I am 35 years old (male) and I have had a repair of the coarctation of the aorta at the age of 3 and an aortic valve replacement at 22. Now I have been diagnosed with an aortic root aneurysm (4,8) and I would like to ask your opininon on when do you think a surgery should be done.
I didn't get the link to the article, but I'll look at it if I can find it. Did you sent it to my inbox?
MRI just tracks the size and shape of the aneurysm, which I assume is what the author means by "biophysical properties." If you're going to have to undergo repeated measurements of an aneursym, MRI can be preferable to CT, because MRI gives you no exposure to ionizing radiation.
Any tests based on serum markers (that is, blood components) would have to be investigational at this point, as far as I know. For your doctor to be able to give a blood test that would tell him when to do surgery would be like the Holy Grail of aortic medicine. Again as far as I know, there is nothing like that available that a practicing physician can actually order. I'm thinking that this author has to be talking about research -- either research that is underway now or research that he hopes will be done in the future.
The fact that there is no blood test is the reason why doctors continue to rely on statistical models for decision-making about surgery. They look at the outcomes of many other people in similar situations to yours, and they infer from group outcome data the type of outcome that is likely for you. If they could do a blood test that would measure serum markers for your aortic tissue status, they could do a better job of homing in on what is a likely outcome for you as an individual. But right now, as far as I know, they can't do that.
MRI just tracks the size and shape of the aneurysm, which I assume is what the author means by "biophysical properties." If you're going to have to undergo repeated measurements of an aneursym, MRI can be preferable to CT, because MRI gives you no exposure to ionizing radiation.
Any tests based on serum markers (that is, blood components) would have to be investigational at this point, as far as I know. For your doctor to be able to give a blood test that would tell him when to do surgery would be like the Holy Grail of aortic medicine. Again as far as I know, there is nothing like that available that a practicing physician can actually order. I'm thinking that this author has to be talking about research -- either research that is underway now or research that he hopes will be done in the future.
The fact that there is no blood test is the reason why doctors continue to rely on statistical models for decision-making about surgery. They look at the outcomes of many other people in similar situations to yours, and they infer from group outcome data the type of outcome that is likely for you. If they could do a blood test that would measure serum markers for your aortic tissue status, they could do a better job of homing in on what is a likely outcome for you as an individual. But right now, as far as I know, they can't do that.
Arur Evangelista in his article (of which I’ve sent you the link) writes:
“To identify patients at risk for thoracic aneurysmal disease or those at risk for rapid expansion of a known aneurysm, analysis of biophysical properties using MRI or serum markers such as matrix metalloproteinases and endogenous inhibitors could permit both monitoring of the natural history of ATAA disease and surgical staging.”
I know MRI, but I was not able to find kinds of tests are those conducted by serum markers. Do you know anything?
“To identify patients at risk for thoracic aneurysmal disease or those at risk for rapid expansion of a known aneurysm, analysis of biophysical properties using MRI or serum markers such as matrix metalloproteinases and endogenous inhibitors could permit both monitoring of the natural history of ATAA disease and surgical staging.”
I know MRI, but I was not able to find kinds of tests are those conducted by serum markers. Do you know anything?
There is a close enough association between BAV and the connective tissue defect that, in recent years, people who have BAV are generally considered to have a more generalized connective tissue defect until proven otherwise. BAV is considered a predictor for other problems. People with BAV are put in a different statistical group, for decision-making purposes. I guess you could say that you don't know about your own aortic tissue for absolute sure, until you have your aneurysm repaired, and the tissue is tested in the path lab. But, to be blunt, you can be pretty sure you do have the tissue defect, simply because you have the aneurysm. There is no other ready explanation for your aneurysm. If your aneurysm and your BAV are independent, it's like lightning striking twice. Again, check the website of the Bicuspid Aortic Foundation in Los Angeles, for a lot of good information.
How can I know for sure that I have defected aortic connective tissue? Do any of the specialized tests performed show this clearly (I mean ECG, CT etc.)?
Would you be out of danger if you were to put on ten more pounds? No, obviously, you would be no more in or out of danger, under those circumstances. Putting on ten more pounds is not going to change the fundamental condition of your aortic tissue.
The ASI (aortic size index) is just a number, kind of like your age is just a number. On the day that you turned 21, were you any more or less of an adult than you were the day before? In any meaningful sense, no. You were just in a different category, because the number changed. It's the same with this.
If you were to put on ten pounds, your body surface area would be greater, and so according to the model, your aorta could be bigger without being "too big." But the cut-off point for what is considered too big is arbitrary. It is just a line that was drawn by the researchers, because they had to draw the line somewhere. At 132 lb., you are barely on one side of the line, and at 142 lb., you would be barely on the other side of the line.
The ASI formula allows for prediction, and that makes it a help in decision-making. It is still necessary to use common sense and to consider other information. That is why talking to your doctor to see what he makes of this is a good idea.
Now, here is the kicker. On the other bar graph, the one for BAV/Marfans, your status does not change, if you gain ten pounds. According to the newest research, which Valley Heart and Vascular seems to be aware of, BAV is a syndrome that often or usually includes a connective tissue defect. That means that the aortic tissue of people who have (or who have had) a BAV is weaker than normal. That, in turn, means that surgery is indicated sooner for those with either BAV or Marfans than for those without. That is why there are two bar graphs. The one on the right is the one that is more applicable to you.
The ASI (aortic size index) is just a number, kind of like your age is just a number. On the day that you turned 21, were you any more or less of an adult than you were the day before? In any meaningful sense, no. You were just in a different category, because the number changed. It's the same with this.
If you were to put on ten pounds, your body surface area would be greater, and so according to the model, your aorta could be bigger without being "too big." But the cut-off point for what is considered too big is arbitrary. It is just a line that was drawn by the researchers, because they had to draw the line somewhere. At 132 lb., you are barely on one side of the line, and at 142 lb., you would be barely on the other side of the line.
The ASI formula allows for prediction, and that makes it a help in decision-making. It is still necessary to use common sense and to consider other information. That is why talking to your doctor to see what he makes of this is a good idea.
Now, here is the kicker. On the other bar graph, the one for BAV/Marfans, your status does not change, if you gain ten pounds. According to the newest research, which Valley Heart and Vascular seems to be aware of, BAV is a syndrome that often or usually includes a connective tissue defect. That means that the aortic tissue of people who have (or who have had) a BAV is weaker than normal. That, in turn, means that surgery is indicated sooner for those with either BAV or Marfans than for those without. That is why there are two bar graphs. The one on the right is the one that is more applicable to you.
Firstly I’ve arranged an appointment with my physician/surgeon next month. I need to let him know about all these I have come across and ask for his opinion regarding these findings. Then, according to what his position will be, we’ll see what options I have.
To be honest, there is one thing that makes me wonder a little about this study. Let’s say that I decide to start eating (healthy food of course) and I put on 10 more lbs. That will automatically set me out of danger! Does this make sense to you?
To be honest, there is one thing that makes me wonder a little about this study. Let’s say that I decide to start eating (healthy food of course) and I put on 10 more lbs. That will automatically set me out of danger! Does this make sense to you?
Have an Answer?
You are reading content posted in the Aneurysm Community
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
In this latest Missouri Medicine article, Richard J Weachter, MD, details the pros and cons of new blood thinner drug Dabigatran (Pradaxa).
Are there grounds to recommend coffee consumption? Recent studies perk interest.
Salt in food can hurt your heart.
Get answers to your top questions about this common — but scary — symptom
How to know when chest pain may be a sign of something else
If your doctors are telling you to wait to have the aneurysm repaired, it's because, in their judgment, the risk of surgery is not yet justified. They have data about the risks of different courses of action. The data that they use has been derived from the outcomes of many, many patients over the years. Again, the doctors' strategy is to wait until the risk of doing surgery is less than the risk of not doing surgery. Their judgment in most cases is that, at 4.8, it is still riskier to operate than it is to do nothing.
Thoracic aortic aneurysm repair is a very complex operation in which a small but significant number of people will either die or have life-changing comlications such as a stroke. You don't want to take that risk until you absolutely have to. If the aneurysm should start to grow faster than expected, the odds change. If you should start to have chest pain that is thought to be related to the aneursym, the odds change.
I'm sorry you have this aneurysm, and I do know what it feels like to get this news. When I was told I had an aortic aneurysm, my only thought was, "get it out." But if your doctors are telling you to wait until 5.0 or even 5.5, you are getting standard advice. If you have not yet talked to a surgeon, it would be fine to go ahead and do that, just to get the additional imput.
While you are "in the waiting room" for surgery, it is important to control blood pressure, because hypertension puts excessive stress on the vessel walls. It's important to keep your monitoring appointments, so you know what is up with the aneurysm. It's also important, and perhaps this is even the most important thing, to find a way to keep calm and be peaceful and enjoy your life.
Post again, any time you want. I will be thinking about you.