Sunday, December 21, 2008

What Will The Surgeon Suggest?

So, I have a bicuspid aortic valve with moderate stenosis and a dialated aorta. I meet with my surgeon again on January 6 after I get my tests done. What will be his recommendation: wait?...or surgery? It's not clear cut, it seems to me. In the literature, there is a great deal of controversy about both the timing and the extent of heart valve and anuerysm surgery. Some studies recommend replacing the dilated aorta if it is over 5 cm, others are at 4.5 cm, and another is at 4 cm. Mine was recently measured at 4.3 cm. The valve is moderately stenotic. If I just had the valve problem in isolation, waiting until it reaches severe in terms of numbers could be the recommendation, except that I do have mild symptoms. The presence of symptoms usually triggers surgery. But I also have the aneurysm. Will the combination of the two seal the decision for surgery now? I'll just have to wait for January 6 to find out the answer.

Here's a paragraph from one paper in the Journal Of Cardiothoracic Surgery (Mar. 06) that addresses the BAV/aneurysm conundrum:

Another surgical approach suggested for the management of BAV, associated with a dilated ascending aorta less than 5.5cm is to carry out AVR with wrapping of the ascending aorta. This method has a low morbidity and mortality rate and was seen to decrease the risk of further dilatation, aneurysm formation and dissection [54,55]. More recently this procedure has been carried out using an external support made to fit the patient's aorta. This was done using digital information from magnetic resonance images to make a replica of the patient's aorta and then computer-aided design to produce the tailored graft [56].

Sounds interesting...a custom made aortic "wrap." I wonder if this will be an option for me?

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