Surgeon Q&A: Understanding Aortic Aneurysms & Valve Disease (including Bicuspid Aortic Valves) with Dr. Eric Roselli
As we learned in the recent video about atrial fibrillation, other cardiac disorders can accompany a heart valve disease diagnosis. For example, many patients in our community were also diagnosed with an aortic aneurysm.
To help you learn more about aortic aneurysms, I recently met with Dr. Eric Roselli, a heart surgeon at the Cleveland Clinic. So you know, Dr. Roselli has performed successful surgery on many members of our community including Denise Kirchner, Matt Miller and John Carr. Here are the video highlights from our discussion.
I hope that helped you learn more about aortic aneurysms and heart valve disease. Many thanks to Doctor Roselli for sharing his research and clinical experience with our community.
Keep on tickin!
P.S. A written transcript of Dr. Roselli’s video is provided below:
Dr. Eric Roselli: Hi, I’m a staff cardiac surgeon at the Cleveland Clinic. I have been in practice for 8 years and I have performed 1500 valve surgeries.
Adam Pick: What attracted you to cardiac surgery?
Doctor Eric Roselli: The thing that is, most exciting to me about what I do is that I get to make a difference in people’s lives, immediately, every day. In a very short period of time, when we meet somebody, to be involved with them and their whole family to make one of the most important decisions in their life, and it is a privilege I never under-appreciate. I love it and I am going to do it for a long time.
Adam Pick: A lot of patients in our community have what is known as an aortic aneurysm. Can you explain what that is?
Dr. Roselli: What it means in simplest terms is an enlargement of the aorta. A lot of folks think about the aneurysm like there is as a weak spot that is bulging out of the side of a blood vessel. And there are aneurysms that are like that. But most aortic aneurysms that are relevant to valve disease, are what we call fusiform aneurysms, where the whole aorta is enlarged like a balloon. Because the stress of the wall of that aorta is evenly distributed, we can often predict how dangerous that aneurysm is going to become.
Adam Pick: What causes an aortic aneurysm?
Dr. Eric Roselli: We know that there are some risk factors, the most important of which is family history. The reason that is important is because a lot of aneurysms are caused by genetic causes. Some of which we know of and we can screen for, many of which we are still learning about it yet. Some of the factors that you can control, that have an impact on how fast an aortic aneurysm will grow, is your blood pressure. If a doctor tells you, you have borderline hypertension, do not ignore it. Take care of it, and treat it. And that’s true in fact because hypotension is associated with a lot of cardiovascular diseases.
Adam Pick: Can aortic aneurysms be harmful to the patient?
Eric Roselli, MD: Yes, absolutely. I think one of the biggest problems with aortic aneurysm is the fact that they don’t cause symptoms until they are so dangerous that they are life-threatening. An aortic aneurysm can rupture, and you can bleed out from it. Or, the aorta can tear and start to fall apart. And that will cause serious abrupt onset of symptoms, which at many times weaken, address emergency surgery. The important thing to be specific about is thoracic aneurysms are often associated with aortic valve disease, and most commonly bicuspid aortic valves. We think that at least a third, if not half, of patients that have bicuspid valves also have a propensity to develop an aneurysm of the first portion of their aorta, either the aortic root or the ascending aorta, or the aortic arch or combination of all three. And so it’s important that when someone has the diagnosis of a bicuspid aortic valve, that they have the appropriate screening done to make sure they do not have the aneurysm that is associated with it. You can have the aneurysm even if your bicuspid valve is functioning perfectly well, or if it is stenotic, or if it is regurgitant or combination of all those things.
Adam Pick: So, for the patients who have been diagnosed with a valve disorder and an aortic aneurysm, can these be treated together?
Dr. Eric Roselli: Yes absolutely. So most often we will treat them together. The decision then has to be made by someone with a lot of experience and I believe we can combine the operation for the valve and the aneurysm in one setting, without adding really any significant risk.
Adam Pick: Specific to valve disease, we often hear about valve repair or the replacement. Is it the same thing with aneurysms? Can they be repaired or are there parts that are just replaced?
Dr. Roselli: We generally use those terms interchangeably because those repairs have not been proven to be durable. And so in general, we replace that diseased segment of the aorta. And it makes sense because the tissue itself is not complete and still under pressure. And so by replacing that segment of the aorta, we have taken care of the problem. The nice thing is, unlike valve replacement, the replacement for the aorta is a piece of polyester that will outlast all of us.
Adam Pick: Can you tell us about outcomes for the treatment of aortic aneurysms?
Doctor Eric Roselli: At the Cleveland Clinic last year, nearly 500 elective operations on the ascending aorta, our risk of mortality is 0.4%. That is exceptionally low. And it is important to understand that is the number we balance against the risk of rupture, or dissection, or complications from your aneurysm. Again, I think the key is to go to a place that has a lot of experience where they have the complete team to take care of all the complex portions of the operation, that are important for having those great outcomes.
Adam Pick: What would you suggest is the most important piece of advice for patients?
Dr. Roselli: We cruise along in our everyday lives and when we have a diagnosis — we are stopped in our tracks. And when that diagnosis “aneurysm”, I understand how it can be really scary. But it does not have to be. And so stay calm. Find somebody who understands the disease. Learn about it and develop a plan. We have many people who had the diagnosis of aneurysm who have lived perfectly normal, long healthy lives.
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.