Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

aortic dissection

aortic dissection

If you are like me, then you have an ascending aortic aneurysm associated with bicuspid aortic valve and are potentially at risk for aortic dissection. This may sound fun and interesting, but it’s actually a health risk. Turns out you need to get the darn thing replaced. The tricky thing for cardiologists has been determining what size aneurysm should be an indicator for elective surgery. Apparently, based on this study (from Circulation), there is a neat little calculation that can be used to make that determination. What you do is compare your aneurysm size relative to body size, with the value of 10cm/m^2 being the indicator. But don’t take my word for it:

…adults with small body size should undergo earlier intervention because a higher ratio of aortic size to body size is a predictor of increased risk.85,118,119Calculating the ratio of aortic area in square centimeters to body height in meters, using a ratio of 10 as an indicator of increased risk, has been proposed.85,119 The value of 10 was derived from the mean ratio minus 1 SD at time of dissection in BAV patients; it is a conservative threshold that would theoretically precede 95% of dissections. Increasing “aortic size index,” a ratio of aortic diameter in centimeters to body surface area in square meters, was correlated with dissection, rupture, and death in 1 study; an index ≥4.25 cm/m2 indicated high risk (20% per year).118 The aortic size ratios and indexes should be used as rough guidelines until validated by further studies. Measurement of aortic elasticity by echocardiography may aid with risk stratification in the future; prospective studies are needed.66Genomewide association studies may identify high-risk genotypes that will aid with risk stratification as well.

Source: http://circ.ahajournals.org/content/119/6/880.full

I found this calculator on the Valley Health System’s website so that the layperson can simply enter their aneurysm size, height, and weight to obtain their suggestive results. Turns out I am still just under the recommended elective surgery point, which is great news because the point itself is already conservative. To see my results, just type in my data: height: 5’9″     weight: 158lb     aneurysm: 4.6cm

Calculate Your Relative Aortic Size Link: http://valleyheartandvascular.com/Thoracic-Aneurysm-Program/Calculate-Your-Relative-Aortic-Size.aspx

13 thoughts on “Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

  1. Jim Kelly-Evans

    Enjoyed your site, Anthony. Saw your post on VR.com. GL with your upcoming surgery. At 30 with an ON-X and tubing you should be fine for the rest of your life. I’m 64…diagnosed BAV/aortic dilation nine years ago at age 55. My last echo was 18 months ago and I was stable. My next echo is in October so we’ll see. For exercise I walk 365 days a year 4-6 miles a day. I can’t do anything too strenuous because I get winded, but I still scuba dive conservatively. Best wishes from New York state. Jim Kelly-Evans (my bav blog http://jimshd.blogspot.com/)

    Reply
    1. Anthony DiLemme Post author

      Thanks Jim! I’d love to give scuba a shot someday soon. I see that you found that aorta calculator a year ago and posted it on your own site. I can’t believe it took me that long to find it. Good luck on your next echo? Have you ever received a CT scan? What is the size of your aortic dilation?

      Reply
      1. Jim Kelly-Evans

        Yes, definitely try scuba…it’s great. I just did some diving during a Med cruise in Croatia. But usually I dive in the Caribbean. We go to St. Barths for Spring break. I did have one CT scan. I met with a surgeon and he wanted me to get them regularly, but I balked because of the radiation. My cardiologist agreed with me that for now echos will do. My ascending aorta was 4.3 cm …pretty far from the trip point according to the calculator …for me 5.0. But things can change rapidly with BAV so I plan to keep monitoring things every 12 to 18 months. Where are you going for your surgery?

      2. Anthony DiLemme Post author

        Oh i see, so you must be of fairly large stature! I’m juuuuuuust under the trip point, so it is good that my surgery is scheduled. My surgery will be at Kaiser Permanente in Los Angeles on Sunset Blvd.

      3. Jim Kelly-Evans

        Yes, I’m 6″5″ so my aorta has some growing to do according to the formula. But that is of little comfort when you read statistics about dissections in the 4 to 5 cm range, especially when combined with BAV disease. Are you symptomatic? What precipitated your decision to have surgery?

      4. Anthony DiLemme Post author

        The surgeon thought that I should get it soon. He didn’t discuss the formula though. He felt that if I was leaning towards mechanical over tissue, then it wouldn’t hurt to get it sooner rather than later. Generally I am not symptomatic. I occasionally feel slight shortness of breath, but nothing significant or consistent.

      5. Jim Kelly-Evans

        Surgeons, according to what I have read on VR.com, are more inclined to intervene earlier rather than later. On the other hand, the AHA/ACC guidelines say that surgery for aortic valve replacement is indicated at the onset of the classic symptoms, not before, I believe. The timing for surgical intervention is probably the most controversial and difficult problem faced by cardiologists and surgeons, and us poor patients. I wonder what your valve area is? I assume that your aneurysm qualifies you for surgery under the guidelines…4.5cm or greater with BAV?

  2. Leigh

    Oh my word I have just been diagnosed with a ascending aorta of 4.7 with BAV. I’m 51, and have been told I must have surgery in a few months. Absolutely terrified and so many questions. For those that have had it done whats the post-operative recovery entail also pain wise?????
    Regards Leigh Cape Town South Africa.

    Reply
  3. Anthony DiLemme Post author

    Leigh,
    Everything will be fine, though there are challenges and and choices ahead. I hope that some info on my blog can help. Check out my USEFUL LINKS tab at the top of the page. I HIGHLY recommend going to http://www.valvereplacement.org/
    Create an account, ask questions, and learn from those who are going through this and who have already gone through it. That site has been the most useful for me. Be assured that life on the other side of surgery will be the same, if not better than before. email me if you have any questions: anthonydilemme@gmail.com

    Reply
  4. Abby

    Hello Anthony, my name is Abby. I have known about my BAV since I was 11. I recently found out that mine has dilated to 4.3 cm. I’ve done lots of reading on it, and it seems that people with BAV have a higher risk of dissection or rupture than people who have tricuspid aortic valve with anuerysms. Because we have a BAV, we also congenitally have abnormal valvular tissue that is not as strong. I find your blog to be very comforting, because I am very fearful of a sudden rupture or dissection, which could be lethal. Thank you for your positivity and insightful information!

    Reply
  5. Pingback: The Story of My Heart | Anthony's Heart Valve Replacement Saga

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