Diagnosed with an ascending aortic aneurysm and a mild leaky aortic valve. Is this the cause of concern?
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I am 60 years old and have been diagnosed with an acending aortic aneurism(4.4)I also have a mild leaky aortic valve.My doctor thinks that it have grown very little in the last few years.What are the odds that if I live a healthy lifestyle,my condition will never change and I will never need surgery and live a normal lifespan? Thank you
Posted Fri, 22 Nov 2013 in General Health
Answered by Dr. Shafi Ullah Khan 1 hour later
Brief Answer: Yes Yes & yes Detailed Answer: Hello there! Aortic aneurysm is by definition beyond 4.5cm. between it and 3.5 is is simple aortic dilation a condition less severe than aneurysm. Aneurysms are fatal if they rupture, And there are the odds for it. If the diameter is under 4cm, the odds of rupturing in 5 years are zero percent. If it is between 4 and 5.9 cm. then the odds increase to 16 % ( that is every 16 people out of 100 will be at risk to rupture in next 5 years). before talknig about odds of survival, ANswer my few questions. -Do you have any chest back or abdominal pains. -Do you have shortness of breath?Any blood in sputum or vomitus or stools? Any hoarseness in voice? -Do you smoke? -Are you hypertensive? -Any connective tissue disease like MArfan syndrome, Ehler Danlos syndrome etc. -Any rheumatologic disorders, such as giant cell arteritis, Takayasu arteritis, and psoriatic arthritis.? -Any Syphilis history? -Are ther any bleeding tendencies? deranged clotting profiles? -Is your cardiac status Ok? MI history etc -Are your kidneys fine? -How is your lipid profile? is it atherosclerotic or deranged? if the answers to these question are affirmative and good then less are the chances of trouble. The goal of medical therapy is to reduce the pulse pressure (dP/dt) within the aorta. Reducing the heart rate, the blood pressure (BP), pain, and anxiety are the mainstays of therapy. And as you mentioned your status is well controlled from last few years with no progression so i will say yes you wont be in those 16 out of 100 people for the next 5 years I.A.plus surgery has its risk. At the age of 60 anesthesia is very complicated and post surgical complications all overwhelms the cons over pros. So yes. Yes Yes . you wont need a surgery and you will live a normal life span considering the limitations of your age 60 years. The odds of yoyr aortic rupture or dissection are good enough to Make you go for conservative treatment and management, Just dont forget the goals of Management we talked about and you will stay out of the woods i promise. If you need any more question feel free to ask. I will be Happy to help.Other wise kindly close the discussion and rate the answer as per your experience. I wish you very good health and take some special care of your self. Regards Dr Khan
Follow-up: Diagnosed with an ascending aortic aneurysm and a mild leaky aortic valve. Is this the cause of concern? 44 hours later
Could you please tell me exactly where in the chest and back a pain would be from an acending aortic aneurism.Thank you
Answered by Dr. Shafi Ullah Khan 3 hours later
Brief Answer: Books follow patients.Location may vary Detailed Answer: 1)Ascending aortic aneurysms tend to cause anterior chest pain,Mid sternal chest pain like a sharp knife stab. 2) arch aneurysms more likely cause pain radiating to the neck. 3)Descending thoracic aneurysms more likely cause back pain localized between the scapulae(shoulder girdle wing bone at the back) 4) When located at the level of the diaphragmatic hiatus, the pain occurs in the mid back and epigastric region(soft spot between the two rib cages) But you should remember Books follow patients.Patients dont follow books. The above mentioned locations might be abit different in individual cases.these statistics are for dominant percentage of the cases presented with aneurysmal complaints. Hope i was clear enough and elaborative. Kindly close the discussion if you have no further queries for which i would be more than happy to reply. Regards Khan
Follow-up: Diagnosed with an ascending aortic aneurysm and a mild leaky aortic valve. Is this the cause of concern? 6 hours later
Answered by Dr. Shafi Ullah Khan 4 hours later
Brief Answer: Procedure depends on situation.Medical enough Detailed Answer: Hello there! I think you should continue on medications. Keep a regular check on your hypertenion. Avoid tobacco in any form.Add some beta blockers and vasodilators for medications and you will be out of woods. As we discussed at your level odds are just 16 % of rupture. we recommend surgery when the aneurysm pasts beyond 5.5 cm. But you are 4.4 from long time.It wont come to that trust me, Just follow the precautions i mentioned and you will stay out of the woods. Now in your case as you are 4.4 cm dilated for years and you can control it medically i dont think you should undrgo through surgery at all. As at the age of 60 years surgery will complicate the issues and then comes the warfarins and maintenance,But if you want surgery there are 8 options to do that. Discuss them with your surgeon and see which comes out best for you. Surgical treatment of ascending aortic aneurysms depends on the extent of the aneurysm both proximally (eg, involvement of the aortic valve, annulus, sinuses of Valsalva, sinotubular junction, coronary orifices) and distally (eg, involvement to the level of the innominate artery). The choice of operation also depends on the underlying pathology of the disease, the patient's life expectancy, the desired anticoagulation status, and the surgeon's experience and preference. 1)Ascending aortic aneurysms with normal aortic valve leaflets, annulus, and sinuses of Valsalva are typically replaced with a simple supracoronary Dacron tube graft from the sinotubular junction to the origin of the innominate artery, with the patient under cardiopulmonary bypass.( the one which you mentioned as open heart surgery) 2)If the aortic valve is diseased but the aortic sinuses and annulus are normal, the aortic valve is replaced separately and the ascending aortic aneurysm is replaced with a supracoronary synthetic graft, leaving the coronary arteries intact (ie, Wheat procedure). Sinus of Valsalva aneurysms with normal aortic valve leaflets and aortic insufficiency due to dilated sinuses may be repaired with a valve-sparing aortic root replacement. Two valve-sparing procedures have been developed: a)the remodeling method and b)the reimplantation method. a)The remodeling method involves resecting the aneurysmal sinus tissue while maintaining the tissue along the valve leaflets and scalloping the Dacron graft to form new sinuses to remodel the root. b)The reimplantation method involves reimplanting the scalloped native valve into the Dacron graft. Both require reimplantation of the coronary ostia into the Dacron graft. 3)Patients with an abnormal aortic valve and aortic root require aortic root replacement (ARR). 4)In nonelderly patients who can undergo anticoagulation with reasonable safety, the aortic root may be replaced with a composite valve-graft consisting of a mechanical valve inserted into a Dacron graft coronary artery reimplantation (eg, classic or modified Bentall procedure, Cabrol procedure). 5)For elderly patients, young active patients who do not desire anticoagulation, women of childbearing age, and patients with contraindications to warfarin, the options include stentless porcine roots, aortic homografts, and pulmonary autografts (ie, XXXXXXX procedure). 6) For elderly patients who cannot undergo a complex operation, another option is reduction aortoplasty (ie, wrapping of the ascending aorta with a prosthetic graft). 7)Patients with Marfan syndrome have abnormal aortas and cannot undergo tube graft replacement alone. They must have either a valve-sparing aortic root replacement or a complete aortic root replacement. 8)Aortic root replacement with a homograft is ideal in the setting of aortic root abscess from endocarditis. Now out of these 8 ways in different circumstances Procedures like open heart surgery and stenting. I believe to choose minimal invsive procedures so i will say stenting but it has been shown that open heart procedures last abit longer but with their own pros and conses. I hope you know what to do. Keep Asking if you need any thing further from me. I would be glad to help. Otherwise kindly close the discussion and rate the answer as per your experience Cheers Khan
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