Cleveland Clinic Formula For Aneurysm Surgery

Photo: One of the lovely roses in our garden.

This summer has been quiet on the medical front. Other than the fact that I get easily winded and I do not have any reserves to call upon in a situation that calls for extra physical effort or exertion, I feel fine. As my aortic stenosis progresses and the valve opening gets smaller and smaller, my heart just can't pump enough blood through my aortic valve to support increased levels of exertion. I am disappointed that I can't do all that I want to do or used to do physically. For example, I'm afraid to go out actually swimming in the ocean in water any deeper than about waist high, because if I were to get caught in a current, I simply no longer have the strength to fight my way back in. I used to be able to handle this sort of situation, but I can't anymore.

When you have an aortic aneurysm, it's like having a defective tire on your car. It could blow at any time. However, to get it fixed surgically, it has to be a certain size. I've been trying to find this formula for a while now.

An aorta that is enlarged and forming an aneurysm can be repaired, but at Cleveland Clinic we more often replace the damaged section with a section of plastic tubing that is sewn into position. The timing for repair of an aortic aneurysm is critical. When the valve is faulty and the aorta has enlarged to greater than 4.5 cm, we repair the aorta at the same time we repair or replace the valve. If the aorta has enlarged but the valve is still good, the optimal time to repair the aorta varies. 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.

Source: http://my.clevelandclinic.org/heart/...e_disease.aspx

If I understand this correctly and my calculations are correct, here are two examples:

I am 6'5" tall, which is 1.96 meters. Currently my ascending aorta is at 4.5 cm diameter, which calculates to a cross sectional area of 15.9 cm2. 15.9 divided by 1.96 = 8.1 which is less than 10, not time yet for surgery.

If and when my ascending aorta reaches 5.0 cm in diameter it will then have a cross sectional area of 19.6 cm2. 19.6 divided by 1.96 = 10, which is the recommended trip point for surgery on my aorta.

I'm a taller than average person. Based on a person that is, say 5'10 inches tall, the calculations are different. A person that height will have a calculated formula factor of 8.9 when her aneurysm is at 4.5, still not yet time for surgery. However, when her aneurysm reaches 4.7 cm, her formula factor rises to 9.8, and when the aneurysm is 4.8 cm across, her formula factor is then 10.2, and surgery would be recommended according to the Cleveland Clinic formula.

The Plan

I'm "stable" for now and due for another echo next year. My cardio thinks I have a couple of years before the numbers would perhaps dindicate the need for intervention. It's not great to have this hanging over me for the indeterminate future. I also face the prospect of a long slow decline in my physical condition as the aortic stenosis worsens. Finally, nobody likes walking around with an aortic aneurysm. However, I have to make the best of the situation, keep enjoying life, and that's what I plan to do.

Cardiologist: "A Couple Of Years Before Trouble"

My visit with cardiologist Dr. Keane yesterday went well. He believes my condition is stable and that it will be at least a couple of years before my condition becomes problematic. My next appointment is in a year. He believes that this is safe. So I'll have my nech echocardiogram in April 2011.

Vacation Fun

We went on a one week cruise to the Caribbean recently. I had the opportunity to do some snorkeling and underwater photography, which I really enjoy. Swimming and snorkeling in the sometimes choppy ocean gives you a workout. So far I have not noticed any difficulty in doing this sort of activity. The only signs I have of valve disease continue to be the palpitations and throat tightness I sometimes experience. I also wake up many times after a night's sleep actually feeling tired. It's like my heart gets no rest even at night fighting against the stenosis. I guess this situation will continue this way for the forseeable future.

Winter TIme Fitness Challenges

This winter has been difficult for me in terms of keeping up my exercise and activity plan. Since walking is my preferred activity, when it gets cold and particularly when it gets snowy and there is ice on the ground, wlaking is tough. Yesterday we got 28.5 inches of snow and the weather is supposed to remain very cold for the next several days. Walking is going to be a challenge. Howerer, this morning I did about a half hour of saucer sledding. It was fun and it was a great workout!

I'm In The Slow Lane

Got my latest echo report:

2008 gradients: 22/36 mmhg
2009 gradients: 16/27 mmhg

2008 AVA: 1.3 cm2
2009 AVA: 1.2 cm2

2008 ascending aorta: 4.25 cm
2009 ascending aorta: 4.5 cm

2008 aortic root: (SOV 3.5cm, STJ 2.55 cm)
2009 aortic root: 3.7 cm

2008 EF: 55%
2009 EF: 70%

The echos were done a year apart in November. Soooooo, it looks like I'm in the slow lane...relatively stable...in the waiting room for the time being.

Jim

Cardiologist Appointment

The Hotel Julia in Rome, where Dan and I stayed 25 years ago. At the top of the street is the Barberini Palace and the Spanish Steps are not far away.

I saw my new cardiologist, Dr. Keane, on Friday. Two good pieces of information were the results of the stress test that I did in the Spring were negative for coronary artery disease, and that my aorta is normal from above the dilated area through the arch and the entire descending aorta. That's really good news because some of us with BAV have problems with aneurysms in other locations like the descending aorta. My blood pressure is edging higher, a cause for concern. If I can manage to shed a few pounds that might help. The most important decision that we made at this appointment was to evaluate my next echo scheduled for November before proceeding with another CT scan. I proposed that if the numbers are stable then I'd like to put off the CT scan because of radiation exposure. Dr. Keane agreed. So next month I'll get the yearly echo, compare it with last year's echo, and we'll go from there.