aortic root

[pearse713]

I had my aortic valve replaced in Oct 07. I had an echo done and then a CT scan a few weeks ago. I was told that my aortic root was dilated. My Doctor said in was 4.3 cm. Not to worry about it and that he would do another echo in 6 months. Is this normal? Why would it be dilated? I was told it was 3.5 cm before my operation. I have to admit, it's always on my mind. Should I be worried?

[Cleveland Clinic]

The difference in aortic root sizes is probably related to the different measuring tools used, echo versus CT. When there is a difference between the two, CT is often preferred as its measurements are orthogonal to axis of the vessel being measured. There likely was some distortion of the aortic sinuses with surgery, and this may the cause of the remainder of the difference.
More importantly is do you have Marfan's syndrome? Has anyone checked for the presence of the phenotype? How old are you and what was the cause of the aortic valve failure requiring the replacement? If you do that this is a systemic process that affects most of the aorta and you need to make sure follow up is continued and that medical management is appropriate and maximal as mentioned in the post above.

[nickppatel]

Guess it would've been easier if I'd posted all this in a single post instead of 3.  :-)

Here's the link (I put spaces in there so it would show up; remove the spaces when you type it into your URL address bar):

http://www. marfanlife. net/bb3/ viewtopic. php?f=40&t=529&start=15

[nickppatel]

PS, if you have questions, send me a private message.  I don't check these forums often enough and I'll probably miss your reply.

[nickppatel]

No, it's not normal.  Specifically, that rate of growth is abnormal and that size in general (4.3) is abnormal.  

No way to tell for sure why it's dilated.  I believe most people's aortic roots dilate because of some sort of connective tissue problem.

Your 3.5 measurement is suspicious.  It sounds small for someone who had aortic valve surgery (I'm assuming you had it because of aortic insufficiency/regurg).  I think your root might have been bigger than that, but no way for me to tell.

I would not worry.  What I WOULD do is spend the next 6 months doing my homework before the next doctor's appt.  What homework?  You need to learn about ARBs (angiotensin receptor blockers) and ACE inhibitors.  These drugs have recently been shown to halt and even reverse aortic root dilatation.  

I could talk for an hour about these drugs, but here are the key facts:  the best ARB to take is probably telmisartan because of its high tissue penetration.  The best ACE inhibitor to take is perindopril.  Some other ARBs and ACE inhibitors may work less effectively or not at all (some ARBs I know to be good - besides telmisartan - are valsartan, irbesartan, candesartan.  Most of them are good EXCEPT for losartan, which is a surmountable antagonist and, theoretically, would lose its effect over time).  

Next fact:  you need to take a high dose.  The average sized person, to see any effect, would need to take a maximum FDA-approved dose (for telmisartan I believe this is 80mg/day or, if you take perindopril, I think it's 8mg/day).  If you are significantly bigger than the average sized person (body surface area = 2.1+), you need to consider taking higher-than-max doses.

I won't get into the biochemistry, primarily because it's not understood PRECISELY how these drugs work on aneurysms - we understand it only at a general level.

If you want more information, click on my screenname and read my old posts and/or visit www. m a r f a n l i f e .net/bb3 and peruse the forums there to learn about these drugs.

Above all, make sure you have a cardiologist who keeps up with the research.  If your cardiologist casually dismisses these drugs in favor of beta blockers because they're the "gold standard," you need to fire him/her and find a cardiologist (preferably at a large university/teaching hospital) who knows the latest research.

Better to try an FDA-approved drug on a new use than to be dead.

In Christ's service,
NP