Tuesday, December 30, 2014

The Risk Of "Smaller" Aortic Aneurysms

CT scan of my aortic aneurysm

Aortic dissection is a medical emergency. Those of us with BAV have to be concerned if we have an accompanying aortic aneurysm, even if the aneurysm is relatively small. Consider the results of this research:

IRAD (International Registry of Acute Aortic Dissection) produced a paper entitled: “Aortic Diameter > 5.5 cm Is Not a Good Predictor of Aortic Dissection” in the journal Circulation in 2008...investigators found that an astounding 60% of acute aortic dissections occurred in aneurysms that measured less than 5.5 cm at the time of diagnosis, 40 % in those that measured less than 5 cm, and approximately 25% at sizes less than 4.5 cm... investigators do not give us guidance on why thoracic aneurysms can and do rupture or dissect at these 'smaller' sizes, but it is important to recognize that they can and that we take them seriously in terms of risk stratification and counseling.

The new 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease acknowledges the risk. Here is the recommendation for patients with BAV undergoing AVR:

Class IIa2.Replacement of the ascending aorta is reasonable in patients with a bicuspid aortic valve who are undergoing aortic valve surgery because of severe AS or AR (4.2.3and5.3.3) if the diameter of the ascending aorta is greater than 4.5 cm. (Level of Evidence: C)

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