UPDATE: My surgery, March 4, 2020, is distant history. Procedure: Bicuspid (turned out to be unicuspid) aortic valve replacement (bioprosthetic), aortic root (bio-bentall procedure), ascending aorta and a single bypass (obtuse marginal). My recovery has been smooth and fairly quick to the point that it's hard to believe I had such a complex procedure. I'm up to walking 3 miles a day (split between two different walks) with a goal of one long walk next week. My pace is pretty much back to my pre-surgery pace. Beyond the immediate surgical back pain, I haven't had much pain since leaving the hospital – even with a full sternotomy. I consider myself very fortunate.
UPDATE: Flew to CC to meet with Drs. Griffin (the cardiologist) and Svensson (the surgeon.) Had a battery of tests: Echo, Stress Echo, Echocardiogram, Chest Xray and CT w/contrast. Showed a radical change in my valve, of all things - went from mildly to severe stenotic; and regurgitation to severe from moderate-severe. Plus, my mitral valve is now leaking. Dr. Svensson suggested we get this done "soon," largely to avoid any damage to my left ventricle, which is slightly dilated, and any further issues with my mitral valve. If done soon, he believes the ventricle and mitral valve will repair myself. The good news is that my heart muscle is considered in very good shape, which barring complications should result in a good outcome. The bad news: Because of the root, which will be a Bentall procedure/composite root, I will have a full sternotomy. He said it can be done with a more minimal incision, but that the results tend to be better for this type of procedure with a full viewing area. As a bonus, it helps make sure the calcium from my valve doesn't go where it isn't supposed to be. He looked at me in the eyes and said, "I'm meticulous." I thought, "Where do I sign up?" Ready to get this show on the road.
UPDATE: Latest MRA showed he aortic root had grown from by 0.4 cm in 6 months to 4.9. Reason to get more serious. Ascending aorta i at 4.9. My cardiologist thinks at the time of surgery they should also do the arch, which is something I had not been counting on. A surgeon, of course, could have a different opinion. I plan on sending the latest films to Cleveland, and possibly set up an appointment with Dr. Svensson. I also may consider a visit with Dr. Castro in the Bay Area, who was kind enough to hop on call with me.
UPDATE: My how time flies. I'm now 67. By the echo my AA has expanded to 4.9cm; by MRA, it's around 4.7. Aortic sinus and left ventricle now starting to show signs of slightly enlarging. I'm now n the 3-months scan plan, and watching it like a hawk.
My stats: I'm 64. In good shape. Exercise regularly. Controlled high blood pressure.
My story, bear with me: I was first diagnosed with a "murmur" in the late 1970s. Since then, I've monitored it closely over the years, with an echo (often a stress echo) annually for more than 20 years.
In most of those scans, because of my body structure, the techs had a hard time getting a clear view of my valve but I was often told I have a "probable" bicuspid valve. That was confirmed with an MRA in 2005 that was conducted for something totally unrelated to my valve.
Here's the interesting part: it wasn't until a few years ago, when we moved back to San Diego - after having been gone for three years - that I learned I had an aneurism of my ascending aorta.
In the short span of time we were gone my cardiologist had retired, so I went to UCSD and saw the head of cardiology. He suggested I get a baseline reading of my aorta. I had a CT scan (without contrast, at my request) and the results came that I was the lucky holder of a 4.6cm ascending aorta.
I find it pretty remarkable that over the years nobody suggested getting a better picture of my aorta, especially given my bicuspid valve. Glad I did! And I'm grateful to the UCSD doc for suggesting it. BUT... I subsequently switched doctors because the UCSD cardiologist left it to a fellow to break the news to me, with no follow-up by the cardiologist - even after I had ticked off a list of obvious questions the fellow couldn't answer. (Told me all I needed to know about that cardiologist!)
I then switched to cardiologist Chris Suhar, who runs the Center for Integrative Medicine at Scripps. He's terrific. (My consulting cardiologist is Eric Topol, ex-Cleveland Clinic, who is also at Scripps.)
Given the size of my aneurism, Dr. Suhar suggested a six-month rotation for an echo and then an MRA. I had my most recent MRA a few weeks ago.
Therein lies the story, and why I'm now posting here: It showed 4.7/4.8cm. Dr. Suhar, who is not an alarmist, said it was time to see a surgeon.
I did. He remeasured and found my aorta at 4.5cm and my root at 4.6cm.
My wife insisted I get a second opinion, so through Dr. Topol got a second opinion from Dr. Lars Svensson at the Cleveland Clinic.
He confirmed the 4.5 aorta/4.6cm root.
So, here I am in the waiting room, where I hope I am for a very long time as long as it's not so long that my health isn't as good as it is now when the day of reckoning comes.
More Info About Me & My Heart
More About Me
I am from:
San Diego, CA
My surgery date is:
March 4, 2020
I was diagnosed with:
Bicuspid Aortic Valve
Coronary Artery Disease