Photo: Winter snow scene in Fairmount Park

Last night we got about 16 or 17 inches here in the city. I cleaned off the front steps and made a path on the walk. Even though I'm 62 I don't fear snow shoveling because the kind of heart issues I have are not the kind that people keel over from while shovelling snow. I have been tested and my coronary arteries are fine. Actually, those with congenital bicuspid aortic valves usually do not get plaque in their arteries for some reason not well understood. Instead we have a connective tissue disorder that leads to aneurysms. That's what I have: a stenotic (calcified and narrowed) aortic valve and an aortic aneurysm. So I can't left heavy objects or do anything that raises my blood pressure quickly or excessively. But things like walking, recreational swimming, light shovelling (I'm careful not to lift too much snow and I take a lot of breaks,) these are OK forms of exercise. Surgery is in my future but I have to be "ripe"...the "numbers" have to indicate that it's time. They balance the risks of surgery against the risks of something happening to me without the surgery. My cardiologists thinks I have a year or more to go yet. I see him again in April and get an echo then.

Actually, I walk four to five miles every day but not now with the snow. So my light shoveling and cleaning off the car are my exercise for today so far. Later we will take a walk over to the grocery store. I cleaned off the car but it will be days before I can get it out of its snowed-in location. And then once I get it out I have to worry about finding a place to re-park it. City Life!

Stable: We'll Take It!

Photo: Loki, our Burmese kitten, at seven months

Everything is pretty stable. I'm still doing my twice a day 1 hour walks. I usually log four to five miles a day, seven days a week, weather permitting. I don't feel as though things are getting any worse. Of course, there is no way to feel any changes in the size of the aorta. That assessment will have to wait until the echo in April. I did have my annual physical last Monday. I need to diet... but other than that I passed it. So what else is new?

Time For An Update

Photo: taken near Taormina, Sicily

Thanks to those who commented on my previous post. I seem to be stable except that I notice an increase in fatigue especially at night. I wake up feeling more tired than I did during the day. The throat tightness that I've had for years I can feel now even while walking. At fdirst I felt it only upon heavier exertion. All of this is no surprise, just to be expected. Nevertheless, we're going forward with our travel plans for next year. I see the cardiologist and get an echo in April.

Good News On Minimally Invasive Surgery!

Photo: I try to eat vegetarian as much as I can. For my little Autumn equiniox celebration I had a veggie burger with An Indian curry, nan bread and yellow squash...yummy!

Thank you BenjaminJC and Mary for your great comments to my last blog entry.

Mary, very best wishes to you for your surgery on October 1. Please let me know how you are doing.

Mary and Benjamin...do you know about valvereplacement.org? It's a wonderful web site for support and discussion. Please have a look at it.

On Adam Pick's web site (he wrote a book on valve replacement surgery,) I was able to ask a question of Dr. Roselli at the Cleveland Clinic that is very important to all of us with BAV and aneurysms:

Jim_K: Is a dilated ascending aorta (4.5 cm) a contraindication for AVR via minimally
invasive techniques?
Dr__Eric_Roselli: No. Not at all. Other surgeons and I who perform a lot of minimally
invasive aortic valve surgery will also perform more complicated operations involving
the aortic root, the ascending aorta, the aortic arch and the mitral or tricuspid valve
procedures all at the same time using minimally invasive techniques.

I didn't know this! It certainly is good news for me because when it's time for surgery I will have to have my ascending aorta addressed as well as the valve replacement.

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.