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Aorta Disease - Including Marfan & Connective Tissue Disorders (Drs. Eagleton, Roselli and Moran 3/18/13)

Monday, March 18, 2013 - Noon

With: Matthew Eagleton, MD, Eric Roselli, MD and Rocio Moran, MD


The Centers for Disease Control and Prevention estimates there are more than 43,000 patients that die each year from aortic diseases. Those who have aortic disease should be treated by an experienced team of cardiovascular surgeons and specialists. Take this opportunity to learn more about aortic disease, including genetic conditions and connective tissue disorders, and ask your questions from a team of specialists from Cleveland Clinic.

More Information

Moderator: Welcome to our Online Health Chat "Aorta Disease: Including Marfan and Connective Tissue Disorders" with Dr. Matthew Eagleton, Dr. Eric Roselli and Dr. Rocio Moran. We are thrilled to have them here today. Let’s begin with your questions.

Marfan Syndrome

rubyred: My son has not been diagnosed with Marfans Syndrome, although he does have various of the symptoms and characteristics. I have an appointment with a cardiologist and geneticist tomorrow for diagnosis. Some of his symptoms are pinching on the hands, numbness of his palms, cold feet and hands and pinching or blood pumping on his feet and legs, also he feels hard fast heart beats and feels like his blood is pumping on his left side back shoulder, would all this be caused by his enlarged aorta? Are there any treatments to relieve these symptoms or will he just have to deal with them, he is pretty frustrated since he started getting these symptoms, and his cardiologist does not seem to be too concerned?

Dr. Rocio Moran: The first step is to make sure that you are dealing with Marfans and not another vascular disorder that can have overlapping features with Marfan Syndrome. Your geneticist will be speaking with you tomorrow about these disorders.

Matthew_Eagleton,_MD: In addition there are a variety of noninvasive methods in which his blood vessels can be assessed to try to determine the cause for his current symptoms.

Shelly: My daughter is 16 years old. I have Marfan Syndrome and she was also born with this. She has an aortic root dilatation of 4.5. Can she have an aortic root replacement surgery if her valve is still good. Is that what you would do to prevent further dilatation of the aorta?

Dr. Moran: There are many factors that are involved in considering elective surgery for Marfan Syndrome - one is family history; whether or not a complication occurred in the aorta at a smaller diameter.

Eric_Roselli,_MD: Without a family history of rupture or dissection, we would typically recommend elective repair of a Marfan patient at 5 cm or an aortic valve area to ht ratio of greater than 10.

aliconadawn: My brother was diagnosed with marfans in 2000 myself in 2007 and then my 2 younger brothers shortly after me. I have had aortic root repair and valve sparing surgery in 2007. After my last pregnancy my aortic valve is leaking, it only has a backflow of 30%. But the last 6 months I have developed sob often, I used to be quite active, exercise an hour a day. But now I can hardly do yoga. Could the leak in the valve cause those symptoms even if the leak isn’t that bad?

Eric_Roselli,_MD: Backflow of 30% is not a typical way of describing aortic insufficiency so it is hard for me to quantify but patients with normal ventricular function will usually not have symptoms unless their valve is leaking more severely and for quite some time. Have you had a transesophageal echo to evaluate your valve more closely? That may be something to consider or get a second opinion.

Hope4Hearts: If a patient has Marfan syndrome and has grafting surgery to repair the aortic root aneurysm, I have read that it is extremely difficult to stitch the tissue and it is like stitching tissue paper. What percentage of Marfan patients have complications because of this and what percentage do not survive the surgery? Thank you for taking this question~

Eric_Roselli,_MD: It is not true. Marfan’s patients' tissues actually hold suture well as long as you get to healthy tissue. The risk of aortic surgery in Marfan’s patients is dependent upon other associated medical problems and the experience of the surgical team. Usually a patient’s risk of survival from surgery is greater than 98 percent.

Hope4Hearts: Hello, My son is 14 years old & was diagnosed with Marfan syndrome when almost 12 years old. At the time of his initial diagnoses his aortic root was measuring top normal. He presents with a 'text-book' case of Marfan syndrome ( Spontaneous Mutation) per genetics physician that is extremely knowledgeable about Marfan. (He has NOT had dislocated eye lenses, thankfully)This past November, 2.5 years since diagnosis, his aortic root is measuring 3.7 cm. Per cardiologist it should be measuring a max of 3 cm. His Z score is currently 2.7 He began taking Losartan 25 mg this past December. My son has played basketball for 8 years and is being told that this is contraindicated for several reasons; risk of joint injury and eye injury, that the elevated HR and BP during activity are thought to increase the aortic root dilation. I have researched via the web and we obtained a second opinion which was in agreement with other doctor. My question is this-is there proof to support the recommendations or is this what is believed to happen based on the nature of the connective tissue. I am concerned that we are denying an opportunity for my son to play the game he loves and maybe we are wrong? Is there documented proof to back-up the recommendations? My husband and I want to do the best thing to help our son live a longer and healthier life, any advice and or direction would be sincerely appreciated. Thank you~Hope4Hearts

Eric_Roselli,_MD: Currently we don't have hard evidence to support any specific recommendations about how much activity is too much. The most important thing is that you understand the theoretic risks and are diligent about strict blood pressure control and regularly scheduled imaging to monitor changes in the aorta. As a parent I understand your wishes for your son to live as normal a life as possible and I am confident that with modern medical care, he can do so.

Aortic Valve

NJDave: I am a 51 year old male. As I child I had no health conditions, other than a heart murmur that was tracked until I was about age ten I think. I am in general good health, with no prior surgeries. I did have prior hospitalizations for: pancreatitis due to salmonella in 2007 (eliminated by 30 days of CIPRO); and kidney stones in 2005. I have a sedentary and stressful office job, and a history of failing to exercise regularly although I do eat fairly healthy. I am considered obese at 215 pounds with a height of five feet nine inches. I have somewhat high cholesterol, but never high enough to be on any drugs for it.

In January of 2011 I thought I was having a heart attack so I drove myself from my office to the local emergency room. I was kept overnight so they could take blood every few hours. They also did a stress echo. The next morning they told me I definitely did not have a heart attack. They felt the chest pain I felt was from gerd and prescribed prilosec daily (to this day it is the only prescription drug I take). They also told me I had a bicuspid aortic valve (BAV) and that since I was never aware of this previously I should immediately establish a relationship with a cardiologist. I followed up with a well regarded cardiologist and in March of 2011 they gave me a thorough echo. The outcome was that my BAV did exhibit a mild degree of stenosis, so they would do an annual follow up but I was told to advise if I began to exhibit symptoms or felt any significant change.

January of 2013 I went to my cardiologist for a follow up and complained of chest tightness at night which caused me to have to get up, drink water and eat Tums ( despite the daily priolsec). As a result he sent me for an echo in early February that revealed the stenosis of my BAV had progressed to severe. There was also mild regurgitation of the BAV. I then had a catheterization at the end of February that confirmed the result of the echo and also revealed that I had an aneurysm on my ascending aorta (not on the root, but the segment just above that). A CT (without contrast) was then done which estimated the aneurysm to be approximately 4.1cm. I then met with a very well regarded aortic surgeon who recommended that: (a) I replace the BAV with a mechanical valve as it lasts almost indefinitely whereas the tissue valves only last 10 to 15 years and therefore a mechanical valve would negate the probable need for a second valve replacement surgery in my 60s or 70s and thus the risk of daily Coumadin was the lesser risk; and (b) not operate on the aneurysm as it was below 4.5cm but monitor it carefully henceforth.

I went for a second opinion with an unrelated, but also very well regarded aortic surgeon who recommended that: (a) I replace the BAV with a tissue valve (from a cow) as they last 15 to 20 years and by then, if it went, a replacement could be inserted through the groin and therefore at my age he would avoid the Coumadin risk associated with a mechanical valve; and (b) I simultaneously allow him to remove the aneurysm and replace it with a tube graph. He based this recommendation in part on the article entitled Ascending Aortic Dilation Associated with Bicuspid Aortic Valve, which recommends surgery on an aneurysm in excess of 4cm in connection with surgery to replace a malfunctioning BAV. He also stated that he was dissatisfied with the non-contrast CT and wanted a CT Angio Chest with IV Contrast done before finalizing his recommendation regarding the aneurysm. Needless to say I am concerned about the conflicting recommendations. I know the type of valve used to replace my BAV is in part based on my personal preference (I favor tissue as the Coumadin concerns me a bit); but the real question is why would one hospital say tissue valves last 10 to 15 and another say 15 to 20 years? Is there really a difference among the tissue valves used by one hospital versus another? Keep in mind these are both large university hospitals in major metropolitan cities.

The more important question I have is what is the correct view of the aneurysm? Certainly I have a dysfunctional BAV that must be replace, should the decision to include the aneurysm as part of the surgery be based on a 4.5cm of 4cm measurement? Regards, NJDave.

Eric_Roselli,_MD: Neither one of the treatment approaches is wrong. Unfortunately we don't have an ideal valve replacement option. The decision about valve choice really is the patient's choice. Our ability to predict how long a biologic valve will last in an individual is quite limited. I actually will tell patients they will last between 10 and 20 years - one predictor of durability for biologic valves is the patient's age and it is an inverse relationship so the younger you are the faster the valve wears out. So - it is more likely that your valve will last 10 - 15 years than 15 - 20 years. But no one can say that with certainly. The standard recommendations is to replace the ascending aorta when it is 4.5 cm or above when there is already an indication for valve replacement. But we have shown that it is safe to extend the indications for aortic surgery to as low as 4 cm in patients with no increase in operative risk. So - I will often replace a 4 cm aorta if it looks diseased in a Bicuspid Aortic Valve (BAV) patient. We are happy to see you in Cleveland for another opinion.

Biagini: My father was just evaluated for the Partners TAVR, but it was not recommended because the aortic annular size appears quite large, at least 27 mm. He was told that there is no suitable transcather valve available for him at this point. He shows preserved left ventricular ejection fraction (60%) and severe aortic stenosis with a mean gradient of 56mmHg and a peak gradient of 92mmHg. The calculated aortic valve area is 0.8cm2. Although he is dizzy with most motion, and with exertion, this is not primarily attributed to the aortic stenosis, rather sequelae to a hx of a cerebral hemorrhagic stroke and vestibular issues arising from brain trauma. He is not a candidate for traditional valve replacement due to other comorbid conditions. He is an otherwise well appearing 94 year old. Are there any options? His AVA has been stable since 2010.

Eric_Roselli,_MD: Yes. Although the 29 mm prosthetic device is not commercially available yet, it is as part of a clinical trial at certain centers; Cleveland Clinic included.

Somerset: I had aortic valve replacement at CCF April 2012. I am experiencing afib about once a week lasting 10-12 hrs before it converts. We are trying meds to get it under control. Will the valve surgery make it less successful to try the ablation procedure?

Eric_Roselli,_MD: No. Ablation procedure will not be affected by previous valve surgery.

Aortic Root

RandallW: I am a 66 yr male who was diagnosed w dilated aortic root (4 cm) w slight valve regurgitation a few months ago. The most troubling aspect of diagnosis is that I have compulsively controlled blood pressure (labile w "white coat syndrome") & diet, w no grossly abnormal issues. There are no known aneurism issues in my family. My nuclear stress test came back OK. Two questions: 1)is there anything that was in my blind spot to cause this? 2)if I am already doing all I can regarding risk areas, how can I minimize growth of dilation? Thank you.

Eric_Roselli,_MD: Given your age and lack of family history it is hard to say what the cause of your dilated aortic root may be. I would recommend that you continue to be diligent about your blood pressure control and you should have a thorough imaging study of your thoracic aorta (CT scan or MRI).

Matthew_Eagleton,_MD: In some people in spite of good control of risk factors, they still have aneurysms and we do not completely understand why.

cg13: My daughter had a pre-op echo at age 3 which showed an aortic root in the upper normal range of 2cm (max 2.1,z of 1.4), all other areas of echo were close to 0 or negative z-scores. She had a repeat echo at age 6 which stated her aortic arch and ascending aorta appear upper normal size, with her root stable at 2.2cm(z of 1.1) and her ascending going from 15mm(z of -.06) to 19mm (max 21, z of 1). I realize there is a margin of error with echo measurements, my question is would this be considered stable, or is it reasonable to ask for a follow up echo in 3-5 years? Thank you so much.

Dr. Moran: we would like to know if there is a family history of aortic disease or why the imaging was done.

NG: Hi Drs. I'm a 61 man, have a bicuspid aortic valve with moderate aortic regurgitation and stenosis, last Echo 1 month ago, aortic valve gradient about 70, EF 65%. I have an aortic root aneurysm now measuring 5.3 with Echo and 5.5 cm by last CTA also done last month with a rate of growth of about 1 mm\/year. Aortic size index 2.8--2.9. I'm completely asymptomatic, I avoid using the elevator, do 3 flights of stairs at least 4 times\/ day with no symptoms what so ever .I was advised to have surgery about 2 years ago, however, I'm very scared. I know there is inherent difficulty in measuring the aortic aneurysm. I know the recommendations have changed to having surgery for an aneurysm size of 5 cm. However I have seen in search ascending aortic aneurysms can grow large some ones can grow up to 8 cm or larger. How reliable is the aortic size index in predicting dissection or rupture. What is the incidence of stroke with the combined replacement of the aortic valve and the repair of the aneurysm. Thank you for your time and advice. N. G.

Matthew_Eagleton,_MD: You are unlikely to achieve an aortic diameter greater than 6 cm without complications. The risk of death or stroke for elective ascending aortic surgery at Cleveland Clinic is less than 1 percent.

KareninB: My physician found an aneurysm on my ascending aorta during a routine chest x-ray in Feb. 2011. I am now 67, female and healthy. In March, 2011 I had a CT scan and the aneurysm measured 4.4 cm. In April of 2011 I had an echo and it measured 4.9 cm. In Nov.2011 it measured 4.0 cm on an echo. I thought these aneurysms were not supposed to shrink. I have changed to a whole food plant based diet 10 weeks ago and feel great! No more cholesterol meds and my BP meds have been reduced. Do these aneurysms really shrink and will a vegan diet help?

Eric_Roselli,_MD: Aneurysms do not shrink without mechanical intervention. It is more likely that the aorta was mis-measured previously. Echocardiography is not the best modality for imaging aortic disease. You should have a CT scan or MRI for more accurate assessment.

Aorta Disease

Samadi: As a 57 y/o female weighing 120 lbs and 5'3" I have a fusiform TAA of 4.4 cm when should I consider sx intervention? Also I had my first CT scan Nov 2011, then the next one May of 2012. I was told I would not need another one for 2 years is that safe?

Eric_Roselli,_MD: 4.4 cm is a small fusiform aneurysm by any criteria. The decision to operate depends on other confounding factors like exactly where the aneurysm is in the aorta. I wouldn't wait more than 2 years to have another imaging study.

asgalian: My family has a genetic condition of aortic dilatation with high blood pressure. Pressure appears not to even need to be too high (140\/90) causes dilatation. Four of my mom's six siblings were affected with aortic dissections. Can keeping blood pressure low (metoprolol and losartan) actually stop the further growth of aneurysms over a lifetime of 30 years for someone in their early 50s (when my parents generation were first affected\/died as a result of the condition - even with awareness and being on high bp meds 25-30 years ago).

Eric_Roselli,_MD: Blood pressure control is important but it is not everything. It is important because we can control it. Your genetics you cannot change (yet). The better your blood pressure is controlled the more likely you are to slow progression of growth.

chambiges: Thank you for conducting this very informative chat! I was found to have a 4.2 cm enlargement of my ascending Aorta in 2008 at Mayo Clinic during a Chest CT. I also have a Grade 2 systolic ejection murmur. I also have a history of Prizmetal's Variant Angina diagnosed at Mayo with a provoked coronary artery spasm to confirm this diagnosis via cardiac catheterization. The doctor preformed my catheterization and after confirming my Prinzmetal's Angina Endothelial Dysfunction diagnosis he very successfully treated me by having me take L-Argenine. I went from having 10 to 12 episodes per month of Angina with nausea to only have had 1episode in the last few years. My question for you is related to my enlarged Aorta. I get yearly 2-D Extensive Color Flow Doppler echos at Mayo Clinic to measure my Aorta. For the last three years is showed Mild Ascending Aortic dilation, diameter 44mm at mid-level. The root 2D sinus of valsalva 33mm, the ascending proximal 42mm and the arch 32mm. How often should I have my Aorta measured since it seems to have stopped enlarging? Also, what tests do you think I should continue having if any to measure my Aorta in the future? Once the Aorta has enlarged will it always continue to enlarge or could it remain stable like mine for the rest of my life? Because my aorta has not enlarged in the years that it has been measured, would it be reasonable to only measure it using echos (adult TTE), and to wait for 2 to 3 years before the next echo is done? Also, Is it possible that my Aorta will not continue to enlarge, or it is always inevitable that once the Aorta has enlarged that it will continue to do so and eventually merit the need for surgical treatment. P.S. My height is 167cm, my weight is 83kg, my BSA 1.92m2, my BMI 29.76, and my Blood pressure is 130/88. I take 10mg of Lisinopril daily. Thank you for taking my questions.

Eric_Roselli,_MD: Everyone's aorta enlarges with age. We cannot predict what rate it will enlarge and if it will continue to degenerate. We routinely follow our patients annually with MRI or CT scan for at lease several years before extending it out to every other year. We don't have really great data that supports the details of our follow up regimen - the important thing is that you follow with your doctor on a regular basis and keep your blood pressure under good control.

FRANM: I have been diagnosed with an Ascending Aorta Aneurysm. In April, 2012 it was discovered during a CT Scan of my lungs to examine a Cavitary Lesion in the upper lobe of my Right Lung. The Aneurysm measured 3.7cm. at that time. In a follow up scan in July, 2012 it measured 4.1. Based on this increase in that time line, am I at risk for a tear or rupture? At what point is treatment required and what treatment is available for this particular Aneurysm? Thank you very much. Fran M.

Eric_Roselli,_MD: Hard to say for certain without seeing the images but I suspect the difference in size is due to different techniques of image acquisition. In other words a CT of the lungs will not be as accurate as a CT scan performed to evaluate your aorta. So, it probably has not grown very much. At 4.1 cm, we would not recommend an operation but would recommend that you have scheduled follow up with imaging.

Samadi: When performing surgery on an ascending thoracic aortic aneurysm, is the entryway through the sternum, same as in a bypass, and what size is the incision length for the average female? Does the Cleveland Clinic accept recent CT scans from other hospitals if a patient needs to be seen for consultation for a TAA by an Aortic Specialist MD.

Eric_Roselli,_MD: If the surgery only requires ascending aortic repair, then it can be performed through a minimally invasive incision, approx 3 inches. I will accept outside CT scans if the quality is adequate.

spirit7759: Thank you for doing these chats. I learn a little more each time I participate. I have an ascending aortic aneurysm (4.47) and also a venous lake on my bottom lip. Could the two be related? (PS: I was tested for Marfans and the other genetic disorders related to aneurysms and they were negative.)

Dr. Moran: The genetics of disorders related to vascular disease is rapidly evolving. There are new genes being discovered at a rapid pace. Depending when your testing took place, you may want to follow up with additional testing.

chuckarc: My mom has a 5.1 cm ascending aortic aneurysm. What is the % of rupture at 5.1? Also, she is on atenolol (100mg per day) for mitral valve prolapse. She suffers from tachycardia. On atenolol her systolic drops to 90 or 80. How low can her systolic pressure safely go?

Eric Roselli MD: At 5.1 cm the rate of rupture is less than 5 percent per year unless the patient has other risk factors such as a family history of rupture or dissection.

dukefan55: I am a 58yo female 5ft 3, 170 lbs. I have a BAV with moderate stenosis and an ascending aortic aneurysm of 4.4 cm. I also have mixed connective tissue disease (MCTD). Am I at a greater risk of dissection because of the MCTD and when would you say I need my aorta repaired? Thanks!

Eric_Roselli,_MD: Yes we think that you are at a greater risk given your BAV and aortopathy associated with that. We would recommend aortic repair when the aorta reaches a size of 5 cm or a Max area to ht ratio greater than 10. Or, we would recommend surgery when your valve becomes severely stenotic and symptomatic. Whichever comes first would be the indication to operate. Both problems can be taken care of at the same time safely.

eDavid: I had an enhanced CT angiogram prior to my ablation procedure for proximal atrial fibrillation which was done in January of this year, it was discovered that I had an ascending aortic aneurysm of 4.3 cm. The recommendation was to check this again in about a year. I'm 68, appropriate weight for my height, have no other health conditions that require medication or treatment other than for the proximal afib, which has now been treated. I am on Pradaxa 150 and Sotalol 40, both twice a day. Questions: 1) Should I expect to get off the Pradaxa? It's planned to take me off the Sotalol in about a month. 2) I exercise, for my age I would say vigorously, Should I back off it some considering the aortic aneurysm? Any other recommendation? 3)What measurement of the aneurysm condition is considered to be a point when I would need to worry'?

Eric_Roselli,_MD: Pradaxa and Sotolol recommendations are up to your cardiologist and have no bearing on your aorta. Please continue to exercise but avoid heavy lifting greater than half your body weight. I wouldn't worry too much about your aorta unless you see growth of greater than 5 mm in one year’s time, or reach a diameter much greater than 5 cm.

Margaret.C: I am a 67 year old professional woman, who was diagnosed with a 4.2cc aortic aneurysm in October 2012, based on both an echocardiogram and a CTA. Because of increased symptoms since January, including fairly chronic, but mild, pinching\/gripping and pain over my heart and under my right ribcage, labile BP, and periodic flushing and tingling or burning in my left arm, hands and ankles, all of which varies from day to day and frequently disrupts sleep, I am scheduled to have an MRA on March 25. In the meantime, I am wondering if it is okay to continue doing level one yoga and aerobic exercise on the treadmill. Typically, this type of exercise lowers my BP for several hours. Please advise.

Eric_Roselli,_MD: You need to discuss this with your primary physician who knows you best. �I do not have enough details.

gm3: I have AAA that has in five years has grown from AP 6.0cm to 6.1cm after Excluder Stent Placement . Transerve measure went from 4.1cm to 5.5cm and sac volume went from 170mL to 236.mL. Have slight Endoleak II that Drs have tried three times to repair with no success. What is your opinion on the AAA growth rate and should I be considering Open Surgery Type Repair.

Matthew_Eagleton,_MD: It would be concerning to me that the aortic diameter and volume have increased despite endovascular repair of the aneurysm. Most type II endoleaks are benign, but we have seen a small subset of patients in whom they tend to persist despite what appear to be adequate attempts at embolization. This subset of patients, like yourself, are often the ones that we have offered explantation to with open conventional repair.

Diffuse Disease (Multiple locations)

VickiA: I have widening of my abdominal aorta and ascending aorta. I have had an infarct on my right kidney also. Are these all related - could they be a tissue disorder?

Matthew_Eagleton,_MD: Certainly having aneurysmal degeneration at multiple places in your aorta may indicate that you have a connective tissue disorder. There are many other factors that go into determining this. We would recommend that you be evaluated by a physician with knowledge of aortic disease to make this determination and recommend any further testing if necessary.

CharlesLW: I am 65 years old. I have had carotid artery surgery on both arteries and had an abdominal aortal\ femoral bypass done last May. I had a checkup and found that I have renal artery blockage near my aorta and my bypass is almost closed. Not sure what to do - Will this keep continuing? How many surgeries are still safe? Do I have something wrong with my arteries?

Matthew_Eagleton,_MD: It is very difficult to answer this question without more information and imaging of your arteries. There is certainly something wrong with your arteries. We would be happy to evaluate you here for all of your problems but I am not sure we can provide you with an answer in this venue. Please contact us for further evaluation.

Aorta Surgery

Billb3000: Please explain the process by which a graft to the ascending aorta is assimilated into the remaining aorta. Also please comment on the strength of the grafted vessel relative to the strength of the original.

Eric_Roselli,_MD: The graft is never completely assimilated to the aorta - it is held in place with suture material that is placed at the time of the operation.(the sutures are permanent).

Matthew_Eagleton,_MD: The long term durability depends on the integrity of the aorta that is not replaced.

coljake1: I have a thoracic aortic aneurysm at the left renal artery suprarenal 3.8cm. I have an aortic aneurysm in the aorta pelvic area 3.0cm. I have an existing AAA stent graft installed in November 2000, open surgery, 5.5cm.--have never had a problem. DOB June 1, 1929. Active life. Open surgery is not an option for me. My purpose is to verify that physicians with Cleveland Clinic can perform the minimal invasive\/endoscopy Thoracic and AAA vascular stent graft procedure on me and save my kidneys, i.e. if the aneurysm\/s grows to a size large enough that the procedure is necessary. What are the sizes of my aneurysms when surgery is normally recommended? If Cleveland Clinic does perform this procedure, questions as follows:1. Success rate? 2. Procedures completed annually approximate? 3. First year the procedure was perform approximate? Thank you. Bob.

Matthew_Eagleton,_MD: As part of a clinical trial, the Cleveland Clinic does have available endovascular devices to treat complex aortic aneurysms similar to the one you described. We frequently can do this safely with minimal risk to renal function but at no point can anyone offer you aortic surgery that is completely free of any renal failure risk. The specific size criteria we use to determine when this type of surgery is necessary depends upon a number of factors including the size of the aneurysm, the location of the aneurysm and your other medical problems. We would be happy to evaluate you here to see if you meet enrollment criteria for this trial. It is not currently commercially available in the US.

Eric_Roselli,_MD: We agree with the recommendation for her to have prophylactic surgery for her aortic root aneurysm. We would perform a valve sparing root replacement (David's procedure). We can get you in touch with our International Center who would provide you with financial details. Global Patient Services website:

WashDCNT: I have Marfan Syndrome. I am 58 years old. Had Type B aorta dissection 7 years ago in my descending aortic aneurysm down to the abdominal aorta. It is now 5.5 cm. in the descending aortic aneurysm after the arch. Is surgery required? What would that involve?

Eric_Roselli,_MD: Yes. Given your history of Marfans, the presence of a chronic dissection and your young age, we would most likely recommend repair of your aneurysmal aorta. Usually for patients like you, that involves open surgical approach but may also include a hybrid approach where we combine open surgery with endovascular surgery. It would be unlikely that we would recommend a purely endovascular approach in a patient with your profile.

chuckarc: Could my mom be a candidate for endovascular repair of her 5.1cm ascending aortic aneurysm? She will be 81 in July and has 1 kidney. She has mild to moderate regurgitation of the mitral valve. Would she be a candidate for the endovascular repair at Cleveland Clinic?

Eric_Roselli,_MD: Most ascending aortic aneurysms are not amenable to endovascular repair. Unless this is a focal sacular aneurysm or pseudo aneurysm we probably would not recommend repair at 5.1 cm. But those focal aneurysms are the kind we would consider for endovascular repair.

Mitral Valve Disease

leto352: for mitral valve prolapse with mitral valve regurgitation do you have minimally invasive surgery techniques to repair the chordae tendinae?

Eric_Roselli,_MD: Yes.

Complications After Surgery

fowens: Is there an increased risk of getting a blood clot in a leg if you had major surgery such as an aortic valve replacement and you are over 60? I ask this because I got a leg clot some months after such surgery. Thank you.

Eric_Roselli,_MD: Yes.

Judy: Do aneurysms form during surgery. A friend recently died after rotator cuff surgery ..resulting from an aneurysm...sounds really scary to me. Is this common??

Matthew_Eagleton,_MD: If he died from an aneurysm, it was likely not a cause from the rotator cuff surgery but an undiagnosed problem. One of the difficulties in identifying patients with aneurysms is that they do not cause any symptoms and they are frequently only realized as an incidental finding on other studies.

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of Cleveland Clinic institution or other Cleveland Clinic physicians.

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