Category: Aortic Valve

My Aortic Valve is in need of replacement as well as my Aortic Root

I just found out this week that my aortic valve(bicuspid valve) is now leaking at the moderate/severe level and that my left ventricle is enlarged due to the overloading. Also, I was informed that my aortic root was at 5cm and my cardiologist, Dr. Otto at the University of Washington said it was time to start looking.

What was interesting is that they scheduled me to get another echo in 6 months, but said they would schedule me with the surgeon Dr. Ed Verrier.
So, I am waiting to see what that appointment will be. I also have another surgeon there Dr.Gabriel Aldea, that I want to see. As well as I have appointments with Dr. Paul Ryan at Swedish and also with my original surgeon Dr. James Brevig at Providence.

My decision to where to have my surgery is going to be based on who is the most qualified and which surgery institution has the best success rate. I am a bit leary of going to a teaching hospital such as the U of W, but my logic is simply I don’t want students assisting my surgery. I want the well run team that works well together. I am holding a bias only because I personally don’t know if my statement is actually true. My research has led me to wanting to do it at Swedish with Dr. Paul Ryan whom actually assisted Dr. James Brevig 15 years ago in Everett.

My existing Dacron tube will be removed and from what I gather, a longer piece will be required to cover the aortic root and in harmony, my leaking aortic valve replaced at the same time. Dr. Otto seems to think Ed Verrier is the most qualified. But, she’s biased for wanting her institution to do it. I am sure it would be a great learning experience as I doubt they have this many of my type of surgery requirements. I actually emailed Gabe at the U of W last night about my situation and will be interested to get his response. Gabe got back to me and he said both him and Ed could do the surgery.

I also reached out to Mr. Starnes at USC who is considered on of the top surgeons in the world regarding heart stuff. I hope to hear from him too.

God Bless, Jesus is coming soon!
Brian 🙂

Brian’s update

Well, I am coming up on 15 years 8/23/2018. My Latest CT/Angio says everything is still stable verified by the U of W team and my buddy at Stanford. But… my valve is still leaking moderately, but…..My left ventricle is getting enlarged somewhat. I am now going to get a second opinion at Swedish Hospital. I am thinking that the suctureless value with the minimally invasive technique where they don’t have to cut your entire sternum would be great. Also, less time on the Heart Lung Machine too and quicker recovery.

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Regards,
Enrique Zolezzi, MD
Cardiology Fellow

Transthoracic Echocardiogram 3/15/2018:
CONCLUSIONS:
Bicuspid aortic valve (fusion of right and left coronary cusps) with moderate regurgitation and an antegrade velocity of 1.9 m/s.
Severe left ventricular dilation (EDVI 110 ml/m2, ESVI 40 ml/m2) with normal systolic function, EF 64%.
Dilated aortic sinuses, 4.3 cm diameter. Ascending aortic graft not well seen. Diastolic flow reversal seen in the descending thoracic aorta. The aorta would be better imaged by CT or MRI.
Normal estimated pulmonary systolic pressure, 28 mm Hg.
Normal right ventricular size and systolic function.
Compared to 12/10.2015, aortic regurgitant severity is similar with an increase in LV EDVI from 89 to 110 and ESVI from 34 to 40 ml/m2.
ice of Catherine M Otto, MD
04/05/2018 10:00 AM
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RE: Latest Echo
Dear Mr. Tinsley,

The echocardiogram shows the degree of aortic valve regurgitation remains the same and is moderate. The size of the aorta is also unchanged. These results are reassuring. We look forward to seeing you in clinic next month.

Enrique Zolezzi, MD
Cardiology Fellow

Valve-sparing David I procedure in acute aortic type A dissection: a 20-year experience with more than 100 patients†

article source

Abstract
OBJECTIVES: The aortic valve-sparing David procedure has been applied to the elective treatment of patients with aortic aneurysms with excellent results. The use of this technique in patients with acute aortic dissection type A (AADA) is still a matter of debate. We present our long-term experience with 109 patients with AADA who had the valve-sparing David I procedure.
METHODS: Between July 1993 and October 2015, 109 patients with AADA had the valve-sparing David I procedure at our centre. We conducted a retrospective review with follow-up.

RESULTS: The mean age was 54 ± 12 years; 78 (72%) patients were men. Marfan syndrome was present in 6 (5%) patients and bicuspid aortic valve in 3 (3%). Only 4 (4%) patients received the isolated David procedure; 50 (46%) underwent additional proximal, 13 (12%) subtotal and 42 (39%) total aortic arch replacement. The in-hospital mortality rate was 11% (n = 12). Intraoperative/discharge echocardiography showed aortic insufficiency ≤ I° in 93 of 97 patients (96%). Mean follow-up time was 8.3 ± 5.7 years.

The survival rate after discharge at 1, 5 and 10 years was 94%, 90% and 78%, respectively. Thirteen percent (n = 13) of patients underwent valve-related reoperation. Freedom from valve-related reoperation at 1, 5 and 10 years was 96%, 88% and 85%, respectively. Compared to patients who underwent the David I procedure for any reason other than AADA, there were no significant differences in long-term survival rates (P = 0.29) and freedom from a valve-related reoperation (P = 0.39).

CONCLUSIONS:
The valve-sparing David I procedure has acceptable long-term results even in emergent operations for AADA and is not inferior when performed in elective settings.
Aortic valve-sparing root replacement , David procedure , Acute aortic dissection type Stanford A
Subject Great vessels Valve disease
Issue Section: Original Article

One-year TAVR outcomes superior in women vs. men

Compared with men, women undergoing transcatheter aortic valve replacement for significant aortic valve disease have superior 1-year survival, although they have a greater adjusted risk for in-hospital vascular complications, according to recent findings. Read more……

“What Are The Key Indicators For Aortic Valve Repair Vs. Aortic Valve Replacement?” By Dr. Lars Svensson

I just happened to be checking some links on my site and for some reason, clicked my Blog Roll Link for Adam Pick.  He’s the guy behind the website “Patients Guide to Heart Valve Surgery” and this is of interest to me.  I have a small leak in my bicuspid aortic valve and need to keep an eye on it.

I just noticed a great video he published by Dr. Lars Svenson, “What Are The Key Indicators For Aortic Valve Repair Vs. Aortic Valve Replacement?”  I think this is not only a great website, but this article will most likely help many people. Can you get your aortic valve repaired or do you have to get an entirely new mechanical or pigs valve?

Have a great day…

Brian

Losing a loved one to an aorticdissection-perhaps could have been prevented?

This is a very sad email from one of my members. I am terribly sorry for his loss of a son. If you have a family history of aortic dissections, PLEASE get tested! Thanks Steve Atkatz for sharing.

I, a survivor of an aortic dissection and major surgery, Bovine aortic valve and dacron grafts replacing the ascending, arch and a good part of the descending aorta, have just suffered the terrible experience of losing a son to an aortic dissection.

Joel was 50 years old but of extremely low risk. He was a Kung Fu Master and ran a school in Atlanta. He never drank or smoked, was very careful about his diet, kept his body fat to 8% and was in wonderful physical condition.

I followed up with geneticists both at Columbia Presbyterian in NYC and the University of Texas Medical School [Memorial Herman Hospital] in Houston. In both cases I was advised that they are starting to identify genes and chromosomes that lead to a thinning of the aortic walls and eventually aneurysms. All of the mutations being identified are dominant, meaning if only one parent is carrying it he/she will pass it on to all offspring. They have not reached the point where they have enough evidence to publish their findings but are getting closer.

Their advice is if you, or someone in your family, are an AD survivor. Or if their have been multiple unexplained sudden deaths in you immediate family, to have all direct descendants get a CT scan with particular attention for aortic abnormalities, and to repeat them at least every five years.

I have been told that a normal thoracic aorta is 3cm in diameter. At 4cm it can generally be controlled and managed medically with drugs. At 5cm surgery is called for whether it has dissected or not. Surgery before dissection has a mortality rate of 1-2%, after dissection >50%. Nuff said.

Thanks,
Brian Tinsley

David’s Reimplantation Video-Lars Svensson, M.D., Ph.D.

I was surfing around the web tonight and actually had this video already on my site. However, I really never paid attention to what this procedure actually is. It appears that this is something that I might end up having to get? I presently do have a leaky/bicuspid valve and after watching this, it looks like the folks the the Cleveland Clinic have got this down to a science.

You can watch this procedure here and see what I am talking about. It’s apparently the way to go if your valve can be spared and get around the mechanical one and having to be on cumedin for the rest of your life.

Here’s a link to their Aorta Center, these guys are voted Number one in heart care the last 15 years.

Thanks,
Brian Tinsley

Aortic Valve Inofrmation

Here’s some good information:
      Aortic Valve Replacement
            Minimally Invasive Aortic Valve Surgery
      Aortic Valve Root Repair
      Quadricuspid Aortic Valve
      Congenital Valve Defects in Adults
      Mitral valve prolapse
      Tricuspid regurgitation
      Bicuspid Aortic Disease
      Congenital Valve Defects in Adults
            Repairing Aorta
            Congenital Heart Lesions
            Coarctation of the Aorta-Diagram

Thanks,

Brian

Chip Hurdle-52

Personal Stories: Chip Hurdle

November 24, 2003 was a day I will remember forever. I was on my way to work and had a terrible stomach ache. My back was also hurting. I stayed at work for 3 hours suffering cold sweats, stomach ache and back ache. I finally went home and saw my family doctor. He could not find anything wrong, but scheduled a CAT SCAN later that week. After two days of waiting for the CAT SCAN, I drove myself to the emergency room where they performed a CAT SCAN and immediately rushed me to Baptist East Hospital in Memphis. I was diagnosed as having an Aortic Dissection on the descending side. I was put on meds to control my blood pressure. I stayed on meds until I developed 5 aneurysms on my descending aorta and had an enlarged aortic root.

The aneurysms grew in size until July 26, 2005. At that time it was decided to operate on the aneurysms behind my heart. My surgeon, Dr. Russ Carter, God Bless his soul, performed a miracle of a surgery.


He went in through my rib cage and inserted 15 inches of dacron tubing inside my descenting aorta. I faced being paralyzed from the waist down if the blood to my spine was severed. Everything went fine and I recovered completely.

In January 2006 I had my second surgery in my stomach area and down both legs. Again, a dacron tube was inserted into my aorta and down into both legs. The second surgery turned out to be the worst one. I had complications with my intestines. Anyway, after a couple of weeks in the hospital, I went home to recover. My enlarged aortic root grew in size and on August 22, 2006 I had my third and hopefully final surgery.

The ascending aorta just below the arch was removed and replaced with yet some more dacron tubing. Dr. Carter was just before closing up my chest when my ascending aorta sprung a leak. He had to replace my aortic valve with a mechanical valve. I still have not gotten used to hearing my heart make so much noise! I am hear today as a survivor and wish to tell every other survivor to be patient and thank GOD for providing us with competent doctors and nurses. Without the concern they provide and this internet site, it would be a much longer road to cover for us survivors

Thanks Brian! Chip Hurdle – Collierville, TN

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