Aortic root dilatation 4,8

Prodromos

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.

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skydnsr

The doctors use a statistical model which shows that the possibility of a rupture is remote until the aneurysm reaches a size of 5.0 or greater.  A rupture at 4.8 is not impossible, but it's not likely. The decision as to the timing of surgery is a matter of playing the odds.  The risk that you will die in surgery is not zero.  It is necessary to balance out which is the greater risk:  operating or not operating.

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.

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skydnsr

I did look over the Yale study on the ratio of aortic diameter to body surface area, and I also spent some more time looking at the Valley Heart and Vascular website. All of the information looks valid to me. I'm not an expert, just an informed patient, but I didn't see anything that looked obviously wrong.

So now you know that, by the standards of certain experts in the field, you already meet criteria for aneurysm repair surgery. What do you think you'll do?

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skydnsr

Okay, never mind about the xa.yimg. It is a yahoo server, so I guess it is as safe as anything else on yahoo, lol. I'll look at everything you provided and think about it and get back to you. In the meantime, I invite you to look at the Bicuspid Aortic Foundation's website. You can just google it. They are good people.

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skydnsr

Thanks for the additional info. I will definitely look at the cts journal article and post any thoughts about how it relates to your situation. Before I click on xa.yimg, what is that website, please? Are you fairly confident that it is something that is secure from malware? It may be perfectly fine; I'm just cautious about clicking on things that I don't recognize.

Regarding the BAV, experts have found that it can be associated with connective tissue problems that are similar to, but less severe than, Marfans. A good source of general information about this is the Bicuspid Aortic Foundation. They have a website (and it is safe to visit).

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Prodromos

I was born with a BAV, but as you already know I've had it replaced with a mechanical one, so now I think I am not cosidered to be a BAV patient, is that right? As far as for Marfans, no, I don't have it. I just don't like eating too much!

The link to the study is the following:
http://ats.ctsnetjournals.org/cgi/content/full/81/1/169

(Davies RR, Gallo A, Coady MA, et al. Novel measurement of
relative aortic size predicts rupture of thoracic aortic aneurysms.
Ann Thorac Surg 2006;81:169e77.)

See also:
http://xa.yimg.com/kq/groups/20470750/1626261030/name/Aneurysm+of+the+ascending+aorta.pdf

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skydnsr

Also, can you give me a link to the study that the quote came from?

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skydnsr

I have not seen that website before, but it looks like it has some good information on it.  As far as the formula goes, yes, the ratio of body surface area to aortic diameter is a consideration in deciding on the timing of surgery.

On that page with the calculator, did you notice that on the two bar graphs, there is a separate one for Marfans/BAV?  I assumed initially that you have BAV, because of the age at which you had your valve replaced.  But now that you have mentioned your height and weight, I'm wondering if you have Marfans.  Either way, the connective tissue problems associated with BAV and Marfans do consitute another risk factor.

I'm going to have to study that website.  Is there some interpretative text for the bar graphs?

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