[HSF] Bicuspid aortic valve and dilated ascending aorta

[Mitch Lirtzman]

I hope the group doesn't mind a slight curveball...
We may have covered this briefly, but when to recommend root replacement 
for a mid-60-ish healthy male. Root 4.1cm with a tricuspid valve, no AI, no 
MR, normal LV, normal distal asc ao. Last visit, I scheduled a repeat 
surface echo in 6 months.
Thanks in advance.
Mitch LirtzmanAt 08:45 AM 4/27/2007, you wrote:
>Dr. Borger's article say 4.5cm instead of 4cm
>
> > Tom Martin is 300% right!
> >
> > Dilated ascending aortas and/or aortic roots should be replaced in BAV
> > patients whenever their diameter reaches 40 to 45 mm. If some one needs
> > more scientific information here are two good papers, dealing with this
> > topic:
> >
> >
> > Borger et Al. Should the ascending aorta be replaced more frequently in
> > patients with bicuspid aortic valve disease?
> > J Thorac Cardiovasc Surg 2004; 128: 677-83
> >
> > Von Kodolitsh Y et al. Predictors of proximal aortic dissection at the
> > time of aortic valve replacement  Circulation 1999; 100 (supp II) II:
> > 287-94
> >
> > Jean BACHET,
> > Institut Mutualiste Montsouris
> > Paris France
> > ----- Original Message -----
> > From: <tdmartin2000 at aol.com>
> > To: <OpenHeart-L at lists.hsforum.com>
> > Sent: Friday, April 27, 2007 6:15 AM
> > Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
> >
> >
> >> Sorry I have not responded to this earlier but I have been too busy
> >> doing redo complete sternotomies for patients that had previous
> >> bicuspid aortic valves replaced with "dilated" (4 cm) aortas.  That is
> >> supposed to be funny but in reality I just did a redo in a patient
> >> that had a bicuspid AVR several yrs ago and was refered to me with a 7
> >> cm ascending. I actually see quite a few pts also that have had
> >> previous bicspid AVR's that come to us with acute dissections.
> >> Patients with bicuspid aortic valves and dilated ascendings have
> >> abnormal collagen and WILL have a problem in the future. My advice in
> >> this area is- at the minimum AVR plus ascending if the aorta is 4cm or
> >> greater and if the sinuses are significantly enlarged, do a root. As
> >> for the "mini" sternotomy or minimally invasive approach to the aortic
> >> valve my question is WHY!? There is no real benefit to the patient in
> >> any fashion and it is harder to do.
> >>
> >> Tom Martin
> >> U of Florida
> >> Gainesville
> >>
> >>
> >> -----Original Message-----
> >> From: prasannasimha at gmail.com
> >> To: OpenHeart-L at lists.hsforum.com
> >> Sent: Mon, 23 Apr 2007 10:27 PM
> >> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
> >>
> >>
> >> 5.0 cm does not merit "prophylactic " replacement of the ascending
> >> aorta.  Prasanna
> >>
> >> Zhandong Zhou wrote:
> >> > To Forum,
> >> >
> >> > I have a 51 year old patient with bicuspid aortic valve, severe AR >
> >> with 4.0 cm root. choices between mini-invasive AVR (through 2nd >
> >> intercostal space, 2.5 inch incision) vs full sternotomy with
> >> Bentall. > I personally prefer mini AVR then see what happens in the
> >> future.
> >> >
> >> > Any suggestions?
> >> >
> >> > Z Zhou
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