Tuesday, July 19, 2011 - Noon
Eric Roselli, MD
Staff Surgeon, Department of Thoracic and Cardiovascular Surgery
Maran Thamilarasan, MD
Staff Cardiologist, Department of Cardiovascular Medicine, Section of Cardiovascular Imaging
It has been reported by the Centers for Disease Control and Prevention that more patients die annually from aortic disease than breast cancer. It is crucial to know and understand the latest treatment options available if you have been diagnosed with a condition related to the aortic valve or aorta. Take advantage of this rare opportunity to chat live about aorta disease with a cardiologist and cardiac surgeon in a secure online setting.
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Cleveland_Clinic_Host: Welcome to our "Aorta Disease" online health chat with Maran Thamilarasan, MD, and Eric Roselli, MD. They will be answering a variety of questions on the topic. Dr. Roselli is running late from surgery, so we will address the surgical questions once he arrives. Thank you for joining us, let's begin with the questions.
Dr__Maran_Thamilarasan: Thank you for having me today.
Diagnostic Testing for Aorta Disease
Linda: My husband will be having an abdominal aortic ultrasound on July 18, 2011 to rule out an abdominal aortic aneurysm. He is in stage four kidney failure and is an insulin dependent diabetic who has had heart bypass surgery in 2006. His cardiologist and his kidney specialist both have determined that the unrelenting pain that he has recently been experiencing in his back could be a symptom of abdominal aortic aneurysm. Is the abdominal ultrasound the only test that he should be having or is this just the first test which should be done?
Dr__Maran_Thamilarasan: The ultrasound is a good starting test but if that is negative you may need a CT or MRI to look at the descending thoracic aorta.
lmgaiso: Do are hospitals do a 3-D? Is there much more value than a 2-D?
Dr__Maran_Thamilarasan: Not all hospitals do a 3 D echo. In some selected cases it does provide more information, but in most cases, 2 D echo is enough.
SALIOU: Which measurement method is more accurate in measuring the dimension of the aortic root? Echocardiogram? CT? or MRI? Below are my measurements of the aortic root and comments: 2004 Echocardiogram: 5.1 cm (dilated aortic root) 2007 Echocardiogram: 4.4 cm (dilated aortic root) 2007 CT with Contrast: AP 3.5 cm, transverse 3.7 cm (no evidence of aortic aneurysm) 2011 Echocardiogram: 4.9 cm (dilated aortic root) 2011 MRI with Contrast: Comment says "Slight prominence at the aortic root; however, no evidence of aneurysm or dissection". I do not have the actual numbers. The recommendation is to do an echo in October. Is this the right thing to do? How can I get an accurate diagnosis? I should mention that I am 6'9", 220lbs, and a former college athlete. No other morphan feature. I have had a couple episode of atrial fibrillation (2007 after giving a lot of blood during a physical, and 2011 after witnessing a terrible motorcycle accident). Have had occasional murmur and skipped beat in between those years. I apologize for the long message. Thanks
Dr__Maran_Thamilarasan: A gated CT scan with emphasis on looking at the sinus is the best test to evaluate you.
LARRYB: Good day. I have had three *ECHOS* that suggest dilated aortic root with disparities (2004: 5.1 cm; 2007: 4.4 cm; and 2011: 4.9 cm). A *CT* was done in 2007 but says no evidence of aneurysm (2007: 3.5 cm (AP) and 3.7 cm (transverse)). An *MRI* was done in 2011. I do not have measurements yet, but report says "slight prominence at the aortic root with no evidence of aneurysm or dissection.” QUESTION: Which test is more accurate (Echo, CT, or MRI)? How do I interpret these mixed results? What should my next steps be? BACKGROUND: 6'9", 220lbs, and former college athlete. No family history of morphan although height is in the family.
Dr__Maran_Thamilarasan: The best test is the gated CT or MRI done with an aortic protocol. A specialized center in aortic diseases would have the most accurate protocols to assess you.
KareninB: My aneurysm on my ascending aorta was found during a routine chest x-ray. The CT scan said it was 4.4 cm. An echo measured it at 4.9 cm one month later. Why the difference?
Dr__Maran_Thamilarasan: It really depends on what protocol was used for the CT scan. Was it specifically designed to look at the aorta? The possibility could also be that the echo did not completely visualize the aorta well or over estimated it. At this point I would suggest a dedicated aorta CT scan to evaluate.
katherine: can you talk more about the gated CT scan - what is that and how is it different than other CT scans?
Dr__Maran_Thamilarasan: It is gated to the cardiac cycle to make sure it is in the appropriate phase of the cardiac cycle. 3D processing of the images is important to get an accurate measurement. We often see patients that have CT scans that are not gated or tailored to look at the aorta which then over - or under - estimate the size of the aorta when we look at them here.
Aorta Aneurysm, Dissection and General Questions
roserm: What kind of Aortic Disease could cause a build-up of calcium in the aorta but would not spread to adjoining vessels?
Dr__Maran_Thamilarasan: It could be atherosclerotic disease. Prior inflammatory diseases could cause this as well.
pjsherry: what exercises are bad for the aorta, and which are good?
Dr__Maran_Thamilarasan: Generally any type of heavy weight lifting, straining, or twisting motions of the upper extremities are bad. Nothing is particularly good for the aorta, but bicycling for leisure or walking are good things for heart care in general.
Cleveland_Clinic_Host: Dr. Thamilarasan, can you please talk more about the type of patients you see for aorta disease?
Dr__Maran_Thamilarasan: We see patients for multiple types of aorta disease. We have a multi-disciplinary approach with cardiologists, medical genetics, cardiac surgeons and if needed, rheumatology to work up the various types of patients.
Cleveland_Clinic_Host: Is there any new research or innovations that you can discuss as it relates to aorta disease?
Dr__Maran_Thamilarasan: We are currently doing more genetic testing in patients with aorta disease - especially young patients who come to see us with a family history of the same type of condition.
HLW: Is aortal aneurysm repair best done by a vascular or a cardio-thoracic surgeon?
Dr__Maran_Thamilarasan: It depends on the location of the aneurysm and general experience of the surgeon. At the Cleveland Clinic, we have a team approach. The thoracic surgeons treat ascending and descending aortic aneurysms and the vascular surgeons treat more abdominal aneurysms. But we also have complicated cases which involve the entire aorta and this is addressed as a team approach.
msmelinda: You mentioned rheumatology. Why would rheumatology be involved in aortic disease?
Dr__Maran_Thamilarasan: There can be inflammatory conditions such as giant cell arteritis; takayasu's that can result in aortic enlargement. These patients do require medical treatment to quite the condition before we can intervene on the aorta.
meliz04: I have Marfan syndrome, aortic root approx. 4.5, prosthetic MR, had 3 cardiac ablations for A-fib and A-flutter with rapid ventricular response. I have left ventricular hypertrophy and recently had defibrillator placed for svt and V-tach. I am unable to walk as briskly or as far as I was, I use to walk 3 plus miles very briskly, now only walk 15 to 20 minutes much more slowly. I am exhausted if I do too much too fast. Could these symptoms be related to my overall heart condition and how much is related to aorta? Thanks M'eliz
Dr__Maran_Thamilarasan: I would be most concerned about the function of your valves as well as your overall heart function (ejection fraction) given your symptoms.
sally411: when having valve replacement surgery - how is the aorta repaired/fixed - or does it depend on the condition of the aorta?
Dr__Maran_Thamilarasan: If it is dilated, it is generally replaced at the time of surgery with an artificial conduit.
spinja187: Greetings! I have had my aortic valve and ascending aorta replaced, and thankfully, all is well! I an interested in how the tensile strength of the graft and the joints compares to that of healthy tissue, whether the strength increases or decreases over time due to tissue infiltration or deterioration, and whether there is any evidence of increased vulnerability to a blunt trauma to the chest, such as a hard fall or a car accident. Thanks!
Dr._Eric_Roselli: Congratulations on having undergone a successful cardiac and thoracic aortic surgery and recovering well. The tensile strength of the Dacron prostheses is excellent and higher than that of the aorta, especially atherosclerotic or otherwise disease aorta. Another advantage of this material is that it is biologically inert, flexible, relatively elastic and easy to handle in the operating room. The late risk of degeneration is higher for you native aorta (which has already proven to be prone to aneurysm formation) than your new vascular prosthesis. Degeneration of these graft is not unheard, however. They all expand between 10and 20% early after implantation. Occasionally they have been known to become aneurysmal but this occurs in less than 0.5% of implants over their lifetime and seems to be less of an issue with newer configurations of the material. You probably received a woven (not knitted) graft and which has a velour micro surface which stimulates the ingrowth of a fibrotic biologic coating which may add some strength to the prosthesis. Breakdown at the suture lines or a defect in the graft can cause a pseudoaneurysm but these events are very rare unless the device is infected. I would recommend that you are always diligent about taking antibiotics prophylactically with dental procedures to avoid late infection of your new aortic valve and graft.
If you sustain a serious blunt chest trauma or fall you probably have more to worry about than your graft. These are strong, but please don’t have any serious trauma!
jbshocks: My wife is 41 and has a full length type b dissection Is the typical approach still just medical management until an aneurysm develops Are there any proactive repair approaches
Dr._Eric_Roselli: 41 is very young and predictive of the eventual need or aortic repair. For every patient the risk of intervention has to be weighed against the risk of late complications related to the aortic dissection. Currently the standard of care is optimal medical management with good blood pressure control (goal systolic <130, diastolic <90) and limitation of strenuous lifting (usually less than ~40lbs). As long as the blood flow is getting to all of the organs downstream and the aorta is not enlarged enough to be at risk of rupture then that regimen is continued along with close surveillance with serial cross-sectional imaging (i.e. CT or MRI). In the chronic phase of a type B aortic dissection the ability to get the aorta to heal with less invasive therapies like stentgrafting is less predictable because the flap within the aorta and the communications between the two lumens have matured. In addition to young age, some specific characteristics of the aortic dissection may be predictive of late risk for operation such as the overall diameter of the aorta, the relative size of the false lumen, the location of the entry tears, etc., but we are learning more about this disease process every day.
Descending and Abdominal Aorta Aneurysm
HLW: Could you explain the difference between descending and ascending aortic disease?
Dr__Maran_Thamilarasan: Ascending aortic disease involves the aorta from the aortic valve to where the great vessels come off, which is the aortic arch area. Beyond that is the descending aorta. They can have different causes and they can have different thresholds as to complication rates and indication for intervention.
Vicki: Can you have an abdominal stent placed if you had a prior coronary stent procedure - 3 stents placed - and on plavix?
Dr__Maran_Thamilarasan: Yes - you should be able to as long as you have an appropriate cardiac workup to make sure the stents are open.
edgewood: my husband had a dissected aorta in December of 2010, The only thing that has been do e is lower his blood pressure and keep it low. He didn't have high blood pressure before this. My question is, is there any other treatments available for this other than blood pressure control. Of course we are very scared and would appreciate your in put
Dr__Maran_Thamilarasan: I am assuming you are talking about a descending dissection and not an ascending dissection. The main thing we look at is follow up scans to look at end organ compromise or increase in size of the aorta. If this is the case, then stenting or surgery may be performed. Continue to control your blood pressure, if it becomes difficult to control, that may be another indication for surgery. Avoid heavy straining or weight lifting.
Grumpybear: I have a 3cm abdominal aorta aneurysm. I am 71. Do I have any restriction regarding lifting or carrying weights?
Dr__Maran_Thamilarasan: You should avoid really heavy weights or straining but regular activities should be ok.
Harley: I am 75 years old with an AAA at 5.2cm, and stage 3 kidney disease. Have been told that with open surgery, or stent, that I will be on dialysis afterwards. Dialysis is not acceptable. Could I qualify for the stent trials you are doing (does it require dye), or can you offer any other procedure that would not leave me on dialysis? Harlo
Dr_Eric_Roselli: Unfortunately with stage 3 kidney disease your risk of requiring dialysis is high whether you have open aortic repair, endovascular aortic repair, or no repair at all. The endovascular repair procedures can be done with minimal amounts of contrast or with carbon dioxide as the contrast medium or intravascular ultrasound to limit the toxicity to your kidneys. The down side is that the imaging may be more difficult to interpret. To definitively determine whether you are a candidate for such an approach requires a more detailed assessment of the specific morphology (i.e. detailed anatomy) of you aorta and aneurysm.
Having said all that, at 5.2cm the risk of rupture or dissection of your aortic aneurysm is still quite low especially if it has been followed for a while and is stable in size. You and your surgeon have to weigh the risks of complications from your aneurysm against the risk of repairing it and there are many factors which play into this equation in addition to your risk of requiring dialysis. The most important thing you can do at this point is make sure that your blood pressure is well-controlled and you monitor your aneurysm closely with a surgeon you trust.
HLW: I have an aortal aneurysm that was repaired in 2008. A leak was repaired in 2010. It is now leaking again, but my surgeon is afraid that a repair will put me into kidney failure, since I have stage 3 chronic kidney disease and my creatin is currently 1.8. Is the risk of rupture increased by the leak? Is there any procedure for repair that does not require the dye?
Dr._Eric_Roselli: See response to Harley above regarding risks of renal failure. Not all endoleaks put you at increased risk for rupture but if the endoleak was significant enough to treat last year, it may very well be. I would need to review your CT scans to answer that question more specifically. Depending on where the leak is and how it is feeding the aneurysm, it may be possible to repair with little to no dye. If your aneurysm is growing then the risk of rupture may outweigh the risk for requiring dialysis. One thing is for sure, if an emergency procedure is required then the risk of renal failure is much higher than if it is treated electively.
I don’t think there is any activity that puts you at increased risk for the leak. It is a mechanical / anatomic issue that needs a mechanical / surgical / interventional fix.
If what you are describing in your last question is a type 2 endoleak without growth of the aneurysm then yes it is less severe than the other categories of endoleak.
omahatony: How successful are you in stinting an aneurysm in the descending aorta
Dr._Eric_Roselli: In 2010 we have experienced 100% technical success with thoracic aortic stentgrafting. For elective cases the mortality was 0 and for urgent or emergency cases it was 4%. With newer and investigational devices we are now treating most patients with descending disease using endovascular approaches at our institution. These numbers are very low and fairly consistent over the last several years, but the determinants of success are not only based on the technical experience of the surgeons performing the procedures, but the teams ability to select the correct treatment approach for each individual patient. Some patients are best treated with stentgrafts, others are best treated with open repairs, and still others require a combination of both – the so-called hybrid repair option. Our team has vast experience with all of these approaches and it is important that you find a team that can offer you an unbiased opinion about how best to treat your aorta so that you not only have a good short term outcome, but a durable one as well.
Ascending Aorta Disease
betowmiller: A few months ago my blood pressure shot up to 190+, and it was brought down to an average of 125 by medication. When I tried going off the meds, the BP again shot up. I have an ascending aortic aneurysm of about 4.8. Returning to the meds brought it down again. The last test showed the aneurysm to have decreased slightly. There seems to be no other reason for the increase in BP other than that I have spinal pain due to a couple of herniated discs (from an auto accident) for which I use a narcotic to modulate the pain level. Can I expect the aneurysm to further decrease with the lowered BP? Is there a more reasonable explanation for the elevated BP? I really don't want to be on medications on a long-term basis.
Dr__Maran_Thamilarasan: Generally we do not see significant decreases once the aorta has enlarged. Pain can cause high blood pressure, there are many causes for it including essential hypertension, which is no known cause. Workup for secondary causes may be reasonable depending on your age. Given your aneurysm, blood pressure control is very important.
adlertoma: I have an aneurysm of the ascending aorta that measures 5.7 centimeters at the root. It measures over 5 as it ascends. The aortic valve works well but is regurgitating. The heart itself is healthy. Can I fly from Arizona to Cleveland? I am 55 years old, with no other health conditions.
Dr__Maran_Thamilarasan: We generally do have patients who travel from all over to Cleveland. As long as it has been stable as of late, it probably would be safe to travel - but you should probably have an expedited work up. You should proceed quickly with your evaluation.
Chezski: My ascending aorta has a measurement of 4.1. A year and a half ago it was 3.8. Is there a good chance that it can stabilize and not grow further? And if in the future I do need aortic repair, can it be done with the minimally invasive method?
Dr__Maran_Thamilarasan: Every patient varies in their rate of progression. Continued monitoring is important. Medications such as ARBs and beta blockers to control blood pressure and heart rate are good medications to be on. If you have no coronary disease or valve disease, you could probably get a small incision as far as the surgery.
Melinda: My 17 yr old daughter was born with a BAV and developed an ascending aortic aneurysm 4 years ago, which currently measures 4.09 cm. She was put on Losartan 25 mg in January. In late March she began having symptoms which have progressively gotten worse: fatigue, dry cough (especially at night or when she has severe palpitations), intermittent chest pain, palpitations, and shortness of breath with exertion, numbness and tingling in arms and legs, and reflux symptoms. She has also gained weight, but we thought that was due to her lack of activity. She was previously very active with volleyball, show choir and musical theater. Now, she can’t even walk up the flight of stairs in our home without having shortness of breath. My question is this: how can we know for certain that her symptoms are or are not related to her BAV and/or AA? Her cardiologist is not convinced that her symptoms are cardiac related. Her aneurysm has shown no significant growth in the 4 years; she has minimal stenosis, minimal regurgitation, 4.09 cm ascending aorta, and mildly dilated root according to a recent cardiac MRI.
Dr__Maran_Thamilarasan: The MRI does not sound like valve or aneurysm is significant enough to cause those symptoms, but clearly something is causing your daughter's symptoms. I would suggest a second opinion and evaluation. We would be happy to see her.
thomas: I have an ascending aortic aneurysm measuring 5.5 and involves the aortic valve leak and enlarged root. I am 55 years old and have no other health issues. My question is would it be advisable to fly across country to the Cleveland clinic from Arizona it’s a 4 hour flight. or would it be better to drive three or four days to get there?
Dr__Maran_Thamilarasan: I usually tell my patients if it is a stable aneurysm that air travel would be ok. If it is a rapidly enlarging aorta, then probably not a good idea to travel.
kp0558: I am 53 year old female with bicuspid aortic disease. ascending thoracic aortic aneurysm measuring 43 by 40 MM. I am scheduled for a MRA November 21st. He suggests surgery at 45 millimeters. I am interested in having this done in Cleveland. I am a CRNA and am aware of complications that can occur. Do you have any suggestions
Dr__Maran_Thamilarasan: It depends on your height as far as when to have to surgery. Our general recommendation is when the cross section area of the greatest aorta dimension divided by the height in meters exceeds 10. We would be happy to evaluate you to determine need for surgery.
dukefan55: I am a 56 yo female with an Ascending Aortic aneurysm of 4.5 cm. What is my risk of dissection and what activities should I avoid? Thanks for taking my question.
Dr__Maran_Thamilarasan: It depends on why you have an aneurysm. You should first have a work up for bicuspid aortic valve or connective tissue disorder. If that is absent then your risk of dissection is probably about 1 - 2% per year or less. Avoid heavy weight lifting or straining - walking bicycling and those types of aerobic activities are fine.
waleslar1: My aorta is 4.8 - 4.9 ascending upwards from root, and I'm bicuspid. I just found out recently, after a TEE and MrI with contrast. They are going to look at it every 6 months, and see if it remains "stable". Is this what is typically done? I'm 57 years old, with high blood pressure. My BP is good as of late, because of medication. Larry
Dr__Maran_Thamilarasan: At our institution we index that according to your height. So if you are less than 6 feet, we may actually consider surgery at this point depending on the appearance of the aorta.
Aortic Valve Disease
lmgaiso: I have mild AR for 10 years and mild MR for 6 months. Do you think that the MR could have been caused by the AR? Should there be a change in my monitoring?
Dr__Maran_Thamilarasan: If it is only mild AR, then unlikely. Probably should get a follow up echo within 6 months.
lmgaiso: I have mild AR and mild MR. I do aerobics. Is it bad if my heart goes over 85% of max predicted HR?
Dr__Maran_Thamilarasan: In general - we recommend 70 - 80% max heart rate for sustained exercise.
lmgaiso: I have mild AR and mild MR. I lift weights. I do 2 sets of 15 repetitions for each body part. The 15th repetition is the last that I can perform in good form (i.e., momentary muscular failure). Is this OK?
Dr__Maran_Thamilarasan: You do not mention the amount of weight you are lifting.
lmgaiso: I have mild AR and mild MR and normal blood pressure. How do you feel about ACE inhibitors for someone like me?
Dr__Maran_Thamilarasan: We do not recommend use of medications for mild MR and mild AR in the setting of normal blood pressure.
lmgaiso: I have mild AR. My pulse pressure is widen, i.e., about 55-60. Is there a direct correlation between the degree of the pulse pressure and the degree of the AR?
Dr__Maran_Thamilarasan: The worse the AR, the greater the pulse pressure.
lmgaiso: I have mild AR and mild MR. Will a transesophageal echo provide better information?
Dr__Maran_Thamilarasan: TEE would give you better pictures of the valves, but if clinical evaluation is consistent with mild valve disease it may not be necessary to have a TEE at this point.
kdonnelly: Should my mother that is 81 with severe aortic stenosis stay off of Mobic for pain. She was on it and went to the hospital with fluid overload.
Dr__Maran_Thamilarasan: If she developed heart failure while on this medication, she should avoid it. If she developed fluid overload in the setting of severe AS she should be evaluated for potential surgery.
KareninB: What is AR? What is MR?
Dr__Maran_Thamilarasan: AR is aortic regurgitation. MR is mitral regurgitation. Regurgitation is a leaky valve. Mild leaks are well tolerated. Severe leaks may require surgery to fix.
PistolPete: I had a bicuspid valve and apparently this is a hereditary thing as my son had one and it was replaced via a mechanical valve. Will my son's children need to be checked for this condition?
Dr__Maran_Thamilarasan: Yes - and for aortic enlargement. The latter can be seen even in family members who have tri-leaflet aortic valves so it is important for screening. The doctor can look for bicuspid valve with echo right away but the aorta dilation may or may not be seen for some time, so will need ongoing surveillance.
msmelinda: My 17 yr old daughter has BAV and ascending aortic aneurysm. Do bicuspid aortic valve (BAV)s coincide with other inflammatory conditions?
Dr__Maran_Thamilarasan: As far as we know there is no increased incidence in inflammatory conditions such as arthritis in patients with bicuspid aortic valves.
lmgaiso: Are there rheumatic diseases that can cause aortic regurgitation (AR)? If so, which ones? If rheumatic disease can cause AR, can knowing affect the longevity of one's native valve?
Dr__Maran_Thamilarasan: Yes. lupus is one and some cases of rheumatoid arthritis and ankylosing spondylitis are a few conditions that can cause AR. If there is active inflammation and valve involvement then treatment of the condition can slow the progression of the valve disease.
kent1954: I have aortic valve regurgitation and have developed all over body swelling and joint stiffness could my condition be related to my aorta?
Dr__Maran_Thamilarasan: it is possible you may have some rheumatologic condition and should be evaluated as such.
kymaverick: In a patient with an ascending aortic aneurysm involving the root, how does having a normal functioning mechanical St. Jude valve going to complicate the procedure? Will the valve likely need to be replace or not?
Dr._Eric_Roselli: If you need a redo operation for a root aneurysm and already have a mechanical aortic valve in place, you don’t necessarily need the valve replaced but chances are the surgeon will because it may be technically easier to do so. That decision is typically made in the operating room based on technical details unless you wish to have the valve exchanged for a biologic valve (i.e. pig or cow valve). Redo aortic surgery can be complicated so it is important to find a surgical team who has experience doing these operations, but if you are otherwise healthy the risk may be only marginally higher than that of the first operation.
roserm: After an aortic valve and partial aorta replacement surgery (have been told the surgery will take about 8-12 hours, open chest), about how long on average does it take someone to wake up? I realize it will depend on the patient, but generally what could one expect?
Dr._Eric_Roselli: 8-12 hours sounds like a long operation so I suspect your operation may be particularly complicated. If all goes well and brain protection is optimized, then I would expect you to wake up within the first couple of hours after returning to the intensive care unit the night of surgery when the anesthesia wear off. However, there may be many confounding factors that may delay your emergence from anesthesia but even in those instances most patients are awake by the next morning. That does not necessarily mean that you will be extubated (i.e. off the ventilator) when you wake up because your lungs may require more time until you are ready to breathe on your own
Aortic Valve Surgery
kdonnelly: My mother is 81 with severe aortic stenosis. She has been told that she is too high risk for surgery. She is also in pain with spinal stenosis and is also being told she cannot have surgery because of her heart. Should I bring her here from Florida for a second opinion?
Dr__Maran_Thamilarasan: At least have all her records sent here for evaluation because we do have the options of percutaneous valve procedures which she may or may not be a candidate for - and we also have high risk surgery, which may be an option. You can contact us through our website contact us form for more information on this process.
PistolPete: Son 38 has a mechanical aortic valve, can this be replace with a tissue valve later on when valve replacement is necessary?
Dr__Maran_Thamilarasan: Yes. It can be.
PistolPete: My son age 38 just had a mechanical Aortic valve put in, how long will this valve last?
Dr__Maran_Thamilarasan: It is quite variable but we have patients who have had better than 30 years with a mechanical valve. It requires regular follow up to assess.
Percutaneous Aortic Valve
PistolPete: 70 yrs old. Just had aortic valve and descending aorta replaced. Will the percutaneous intervention work on a Bovine valve that I have?
Dr__Maran_Thamilarasan: We are hoping it will in the future. There has been cases in Europe but it has not been approved in the US for that indication. It depends on the size of your current valve prosthesis as well.
lmgaiso: How many years until we can say whether percutaneous aortic valve replacement is better or worse than operation?
Dr__Maran_Thamilarasan: We only have a few year follow up on percutaneous valves and decades of research on traditional valves. It may be a while before we can say they are comparable.
PistolPete: Could you talk a little about the Percutaneous Intervention
Dr__Maran_Thamilarasan: You are referring to aortic valve or descending aortic disease? We were one of the initial centers for the percutaneous aortic valves. We have had good results in patients who are at too high risk for surgery or high risk surgical candidates. We will be involved in further trials in lower risk patients. The FDA hearings are tomorrow to look at the results of the current studies to determine if the valve should be approved and in what settings.
PistolPete: The valve replacement via groin does not remove the current valve but in place over the existing valve is this true?
Dr__Maran_Thamilarasan: That is true.
PistolPete: I have an artificial conduit with a bovine valve, will the artificial conduit interfere with a valve replacement via the groin down the road further
Dr__Maran_Thamilarasan: Normal size conduit should likely accommodate the delivery system. These are all potential applications down the road but we are not certain what the indications will be at this time.
Atrial Fibrillation (Afib)
PistolPete: Got afib as result of aortic valve replacement surgery. Used amiodarone for 10 weeks and stopped. When checking for Afib it is hit and miss when getting EKG or echo. What happens if I am still in Afib because I can not feel it?
Dr__Maran_Thamilarasan: IF your heart rate is controlled, your heart can likely tolerate the afib but you may need to be on a blood thinner to prevent the risk of clot formation. A 24 hour monitor may be a worthwhile way to check to see if you are in atrial fibrillation or having silent episodes of afib.
PistolPete: I did the 24 hour monitor and no afib indicated but will remain on coumadin for a while. Is the 24 hour monitor good enough test to determine afib?
Dr__Maran_Thamilarasan: It is a good start. Unless you are monitored continuously there is no way to know if you have any silent episodes of afib. Generally postoperative afib is only short lived.
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