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Aortic dissection, aortic aneurysm - The aorta - Life after an aortic dissection

Numerous and divergent opinions regarding my aortic root size and its implication.

As an update to my previous post, in total I had thirteen Cardiothoracic Surgeons', Cardiovascular Radiologists' and Geneticist's opinions regarding my thoracic aortic root and received disparate opinions as to its size and prognosis. So far, the aortic root (based on three contiguous years of MRAs) has been measured anywhere from 3.65-4.5cm, which is a major discrepancy, and have been told by at least six of these specialists that I will probably not need a surgical repair in the future while three others indicated that I will require a surgical intervention sometime in the unforseeable future.

These dichotomous opinions emanated from some of the most respected Cardiothoracic Surgeons and researchers in the US (and probably in the world) which is scary! In short, there is no consensus regarding the size of my aortic root and significant disagreement as to its future implications. In fact, although my most recent MRA (3/12) revealed a growth of the aortic root from 4.17 (rounded off to 4.2) to 4.35 (rounded off to 4.4) in thirteen months, subsequent reviews of these same MRAs by the surgeons and radiologists noted above, resulted in a difference of interpretation ranging up to approximately 8.5mm! Some perceived it at 3.65, 3.9, 4.1, 4.3 4.4 and 4.5, all based on their review of the same MRAs I provided them. In fact, three of these highly reputable surgeons noted that in spite of the initial radiologist's report of an almost 2.0mm growth of the aortic root during the past year, their review, as well as a review of these same MRA images by their respective radiologists, did not find ANY growth whatsoever of the aortic root during the past three years! They held that it remained unchanged in size.

Interestingly, one of these surgeons, who is one of the worlds most prolific researchers on aortic disease and dissection, indicated that if I wished he would replace my aorta now, while his colleague, and an equally renowned researcher from another facility, related that by no means should I seek a surgical repair and warned me of the adverse outcomes if I did so. In  addition, there was a 5mm difference in their measurement of the diameter of the aortic root based on a review of the same MRA CDs! In fact, although the Geneticist I consulted did not believe I required any genetic testing after a thorough physical examination and review of my records, she initially held that I would require surgical intervention sometime in the future BUT immediately balked and backed off from this assessment after I apprised her of the opposing opinions of several other surgeons, including one who was her mentor!

Regardless of the differences in opinions, including those who believe that I will not require a surgical intervention, I am gearing up psychologically for the possibility that I will require a surgical repair.

Any thoughts regarding this very disconcerting experience would be appreciated. Thanks, Vinny 

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Hi Vinny,

 

It must be very frustrating getting so many opinions & even more confusing.

I can only give an overview of what happened to me & would generally concur that at some stage further surgery will be impending.

I had my first emergency procedure in 2006 to repair my aortic valve after a rupture had occurred. I was informed that they would manage the tear through BP control & hence began a long regime of medication. I had my annual checks, like everyone else, & there were no signs of any growth.

In late 2010 I was called in to see my surgeon after the annual check up leading to a bought of tests & scans. The inevitable conclusion was that my tear had grown from 44mm to nearer 55mm + & growing. There was no reason, no change to life style, blood pressure or stress levels. The only conclusion I can reach is that I tried to live a normal life & pushing myself to do the things that came naturally had their toll – But what is natural now?

Anyway, had the second Opp with a Dacron Implant & had the all clear in February. I am still making slow progress to a full recovery, but it’s in sight.

I hope this helps & can only suggest you get checked regularly & will keep my fingers crossed you will be fine for many years to come.

 

Rgds

Harry

Hi Harry,


It definitely appears that you have been through a difficult  experience. I look forward to hearing good news regarding your rehab progress.

So far, I have not experienced a dissection although the risk, no matter how small at this time, is always present. That is the reason I am making such efforts to determine, as close as possible, the measurement of the aortic root. Regards, Vinny

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