Aneurysm

[DavesMom]

I was very interested to read the formula that CC has for the timing of aneurysm repair. It says, "At Cleveland Clinic, we have developed a special mathematical formula we use to determine this, based on the patient’s height and weight and the size of the aorta - surgery is usually recommended when the aortic cross sectional area in square centimeters, divided by the patient's height in meters is more than 10."

I'm 54 and had AVR/aneurysm repair in '99. Three years ago a CAT scan showed an ascending aortic aneurysm measuring 4.4cm. To be honest, I'm a bit skittish about this aneurysm because the surgery in '99 was my second one and the surgeon had problems due to scar tissue. (My right ventricle is stuck to my sternum.) Also, I have a BAV and understand they are often repaired earlier than the 5cm normally mentioned.

I was very surprised when I used this formula to see if my aneurysm should be repaired. I am quite short - 4'10" - and very thin. Now, if I've calculated this correctly my 4.4 aneurysm has a cross sectional area of 15.20. (2.2 x 2.2 x 3.14). My height in meters is 1.47. So 15.20 divided by 1.47 = 10.34.

I'll admit that I'm a math idiot but did I calculate this correctly? If so, it looks like my aneurysm needs to be repaired. Are there other factors that play into this decision?  I also have aneurysms of the braciocephalic artery (the CAT scan said this is "significantly dilated") and the left common carotid artery.

Thanks in advance for any information.





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[DavesMom]

Not that it makes much difference, but I was wrong and have only known about the aneurysm for two years.

[DavesMom]

Thank you so very much for your reply.

This aneurysm was found accidentally three years ago and hasn't changed since.  It wasn't there when I was operated on in '99 so I have no clue as to how long it took to get to the 4.4 stage. I've been told that I have connective tissue disease, which I understand is pretty common with a bicuspid aortic valve.

As I said, I tend to be a bit nervous about this because I've been told a third open heart surgery will be risky for me due to the scar tissue and I don't want the aneurysm to get to the point where it might rupture

Can the braciocephalic and left common carotid arteries rupture?

Thanks again.  I appreciate your time and knowledge.

[Cleveland Clinic]

Yes.  Your calculation is correct.  However, since the aneurysm was previously repaired is there any evidence that there is progressive dilation, or has this number been stable for quite some time now.  If there isn't any progressive dilation for quite some time now, then you could continue to monitor this.  I would recommend seeing someone here at the CC for a second opinion.  The specialists in the imaging department in the cardiology have most experience with this isssue.