Monday, June 1, 2009

Vacation And Status Update

Photo: The cloister at Moissac, France
Dan and I just returned from a great 2-1/2 week trip through Southern France. At the end of the trip we flew to Lisbon for a couple of days. I felt fine during the trip but a little more tired than I would have liked after we got back. It was probably just jet lag.

I'm now pretty much convinced that the pressure and tightness that I feel in my throat is due to the enlargement of the aorta pushing against the esophagus or other nearby structures. This started about a year after I first learned that I had a valve problem. At first I felt the pressure only when I really exerted myself like when I would jog for exercise. But now I feel this pressure even when I'm not doing anything strenuous. It feels like my heart is beating right up into my throat. That's about the best way I can describe it.

I've read some articles recently that help me to better understand the relationship between bicuspid aortic valve disease, aneurysms and aortic stenosis. Unfortunately, aortic stenosis combined with BAV and an aneurysm is sort of a triple whammy - not good! The stenosis (narrowing of the aortic valve) produces hemodynamic forces (a jet) that stress the aorta, according to one studay I read. There is a lot of debate about when to have surgery for an aortic aneurysm, i.e., at what size aneurysm. 5.0 is usually the trigger point for surgery except for Marfans patients. For those with Marfans, 4.5 seems to be the trigger size. Since bicuspid valve disease is in some ways similar to Marfans, there seems to be some who feel that 4.5 should be the trigger point for BAV patients. Then there is the whole body size calculation that figures in to the equation. Bigger people may have naturally larger aortas, so for them the surgery trigger size might be larger. However, there is a risk of rupture or dissection at just about any size. So the debate goes on. I'll find out if my aneurysm is growing and if so, at what rate, when I get tested in the Fall. If he aneurysm is stable (not enlarging,) that's one thing, but if it is growing at more tan .1 cm per year, that is of great concern.

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