Ascending Aortic Dilation - Ascending Aortic Aneurysm

Posted by rory @rory, Apr 2, 2018

I was diagnosed in 2012 with ascending aorta dialation of 4.1 cm. In 2013 no change. Finally went back to dr in 2017 and echo showed 4.3 cm. 2 months later dr made me have a chest scan which read 4.5 cm. which is correct? Echo or scan? Dr wants me to have another in 6 months. Very stressful.

@dixitworld

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

Jump to this post

Guys please anyone had my situation?

REPLY
@dixitworld

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

Jump to this post

Hi @dixitworld,

I can imagine your stress and worry about making the right decision! I'm tagging two of our stalwart Mentors, @hopeful33250 and @predictable as they will perhaps be able to provide some thoughts that might help you.

REPLY
@dixitworld

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

Jump to this post

@dixitworld

I would first like to welcome you to Mayo Connect and to thank you for posting about your health concern regarding an aortic valve problem.

I understand your concerns, I have an aortic valve (with aortic insufficiency) that some doctors think need replacing, but not all. I could only wish for a concise decision from two doctors so that I could have some confidence on making an informed decision and going forward.

In thinking about your situation I'm wondering how this change in your EF (which you state is now 50) is affecting your symptoms. How are you feeling? What type of symptoms are you having? Has your energy level, ability to exercise, changed since your EF has dropped to 50?

I have one cardiologist who says "we treat the patient, not the report." Which basically refers to treating the symptoms the patient is having (in my case I have a hard time exercising without a lot of fatigue, however, my EF is still at 60). While I have a leakage of the aortic valve, I also have some loss of functioning with the heart muscle which results in more fatigue, especially upon exercise.

Perhaps thinking about your symptoms can help you move forward. Also, a third opinion in a matter like this would certainly not be inappropriate, especially if you seek out a good heart center with an excellent reputation. I'm not sure what geographical area you live in but Mayo has 3 facilities in the U.S. (Minnesota, Florida and Arizona).

I look forward to hearing from you again.

Teresa

REPLY
@dixitworld

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

Jump to this post

Hi @dixitworld. I am glad to make your acquaintance and to follow along with you as your heart valve issues are resolved. I won't be able to offer any vital information about your heart valve, because I haven't encountered that. My son-in-law did 20 years ago, and his surgery fixed his problems; he is in good health and hardy enough to enjoy hiking, hunting, and other outdoor activities.

My experience has been with enlargement of the left ventricle and thickening of its wall, which has reduced my EF somewhat in the last 8 years. I also contracted atrial fibrillation in the left atrium about 4 years ago. Even so, the combination of the two conditions has not greatly hindered my lung or heart functions, although my endurance has fallen off somewhat, and I have given up bicycle racing as a result.

We have the good fortune to be helped in this case by a real trooper, Teresa (@hopeful33250), who has had an experience like yours. She also has given good advice, I think, in suggesting a third opinion — and especially from doctors at a Mayo Clinic, or at a nationally recognized cardiac center. Another possibility that occurs to me, since you spotlighted the expertise of the two cardiac surgeons you have dealt with: Could they be persuaded to coordinate their recommendations for valve surgery and agree on a course of action? This would relieve you of the burden of being a referee between competing surgeons with differing treatment plans. Perhaps the three of you could get together and develop a strategy that you'd feel comfortable with. Whaddayathink?
Martin

REPLY
@hopeful33250

@dixitworld

I would first like to welcome you to Mayo Connect and to thank you for posting about your health concern regarding an aortic valve problem.

I understand your concerns, I have an aortic valve (with aortic insufficiency) that some doctors think need replacing, but not all. I could only wish for a concise decision from two doctors so that I could have some confidence on making an informed decision and going forward.

In thinking about your situation I'm wondering how this change in your EF (which you state is now 50) is affecting your symptoms. How are you feeling? What type of symptoms are you having? Has your energy level, ability to exercise, changed since your EF has dropped to 50?

I have one cardiologist who says "we treat the patient, not the report." Which basically refers to treating the symptoms the patient is having (in my case I have a hard time exercising without a lot of fatigue, however, my EF is still at 60). While I have a leakage of the aortic valve, I also have some loss of functioning with the heart muscle which results in more fatigue, especially upon exercise.

Perhaps thinking about your symptoms can help you move forward. Also, a third opinion in a matter like this would certainly not be inappropriate, especially if you seek out a good heart center with an excellent reputation. I'm not sure what geographical area you live in but Mayo has 3 facilities in the U.S. (Minnesota, Florida and Arizona).

I look forward to hearing from you again.

Teresa

Jump to this post

My EF is 65 and more currently , I think my post was not clear. I had EF down at age23 when my valve was changed.
Now I don’t have any valve issue or EF issue. I have aortic root and asc aorta aneurysm.

REPLY
@dixitworld

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

Jump to this post

My current surgeon are Craig Miller at Stanford and Dr Svensson at Cleveland Clinic. What I understand is more surgeon in diff hospital I talk more diff opinion comes up resulting in more tension and headache. I was looking for any patient similar in condition like me who can tell what was done in his or her case

REPLY

Hello All

I am 31/M
I had my bicuspid aortic valve replaced 8 years back with ATS Mechanical 22 Mm valve.
Now I am diagnosed with ascending aorta size of 5.2 and aortic root of 4.4.
I talked to 2 surgeons in diff hospital.
One surgeon says that no need to replace well functioning mechanical valve and will cut root just before the valve and cover the little rim and existing valve with graft.he gives reason if a mechnical valve passes 1 year successfully it typical remain forever and should not be changed. His recommendations is not to touch the place where valve is sewn to root.

Other surgeon is of opinion that when we will open we will be able to see the condition of root and if it need to be replaced we will put new composite graft already fitted with a new St.Jude valve.
He also believe my current valve is 100 percent functioning but as per him existing valve should have some tissues deposited and replacing a new is always better.

What to choose. Both surgeon are top notch surgeon in diff hospitals

REPLY
@dixitworld

My current surgeon are Craig Miller at Stanford and Dr Svensson at Cleveland Clinic. What I understand is more surgeon in diff hospital I talk more diff opinion comes up resulting in more tension and headache. I was looking for any patient similar in condition like me who can tell what was done in his or her case

Jump to this post

Thank you for providing additional information and details about your medical history, @dixitworld. I hope that others will be able to post and offer their own experiences. Do you have any family members or friends that can listen to your choices (or go with you to appointments) and help you discuss your concerns?

REPLY

quit the stress. only can make it worse. Do work outs, bike, no heavy lifting over 50 pounds, keep BP under control and realize that you know what may give you problems in future. Most people do not. Mine is 4.7, wet to cleveland clinic, dr told me i have 10 more years. What ever. live your life and quit worrying.

REPLY
@bryanfox

I was diagnosed in August 2019 with an ascending aortic aneurysm, measured at 4.2-4.3cm via CT scan and confirmed by a vascular surgeon and two cardiologists. Last week, I went back to recheck and see if there had been any growth. I opted for an MRA to avoid the radiation, and because the cardiologist said it would provide the same accuracy. The imaging showed that the aneurysm was/is now 3.9cm, which is great news, but also somewhat implausible, because everything I've read and heard from doctors is that these do not shrink on their own. I did start medication for hypertension after the initial diagnosis (olmesartan) last year, and my BP is now normal, but it wasn't dangerously high before (peaking at 140/90 last year). That's the only medication I am on, and there haven't been any other major lifestyle changes.

Is there a possible reason for this disparity in imaging results? I'm cautiously optimistic, but also confused.

Thanks

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Hi, I think you are right about the aneurysm not shrinking. However, the measurements you have had are all pretty close and the different tests and different technicians can result in different numbers. The most important factor is to determine if the aneurysm is growing and if so, at what rate. My ascending aortic aneurysm has been at about 3.9 – 4.1, depending on the test, for years and years. I am hopeful I will never need surgery. The aneurysm no longer controls my life but I am careful about what kind of exercise I do and how much I lift. I too have high blood pressure, controlled with meds. I wish you good health and a stable aneurysm.

Donna

REPLY

I was diagnosed in August 2019 with an ascending aortic aneurysm, measured at 4.2-4.3cm via CT scan and confirmed by a vascular surgeon and two cardiologists. Last week, I went back to recheck and see if there had been any growth. I opted for an MRA to avoid the radiation, and because the cardiologist said it would provide the same accuracy. The imaging showed that the aneurysm was/is now 3.9cm, which is great news, but also somewhat implausible, because everything I've read and heard from doctors is that these do not shrink on their own. I did start medication for hypertension after the initial diagnosis (olmesartan) last year, and my BP is now normal, but it wasn't dangerously high before (peaking at 140/90 last year). That's the only medication I am on, and there haven't been any other major lifestyle changes.

Is there a possible reason for this disparity in imaging results? I'm cautiously optimistic, but also confused.

Thanks

REPLY
@bryanfox

I was diagnosed in August 2019 with an ascending aortic aneurysm, measured at 4.2-4.3cm via CT scan and confirmed by a vascular surgeon and two cardiologists. Last week, I went back to recheck and see if there had been any growth. I opted for an MRA to avoid the radiation, and because the cardiologist said it would provide the same accuracy. The imaging showed that the aneurysm was/is now 3.9cm, which is great news, but also somewhat implausible, because everything I've read and heard from doctors is that these do not shrink on their own. I did start medication for hypertension after the initial diagnosis (olmesartan) last year, and my BP is now normal, but it wasn't dangerously high before (peaking at 140/90 last year). That's the only medication I am on, and there haven't been any other major lifestyle changes.

Is there a possible reason for this disparity in imaging results? I'm cautiously optimistic, but also confused.

Thanks

Jump to this post

Hi, @bryanfox – I wanted to let you know I have moved your post here to this discussion called "Ascending Aortic Dilation – Ascending Aortic Aneurysm" so that you can talk with others who have had a similar situation. Hoping that @cobweb @hopeful33250 @dixitworld @rory and others will return to this discussion to respond to your question about MRA vs. CT scan in measuring ascending aortic aneurysm.

Have you gotten the chance to ask your doctor specifically what he or she thinks about the disparity in your imaging results?

REPLY
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