[HSF] Aortic Aneurysms and Bicuspid Valves

[Edward Bender]

Hal,
I just went thru this with a 47 year old with a ruptures ascending  
aorta.  Most are recommending 4.5 cm as an indication for aortic  
replacement.  That doesn't necessarily mean Bentall procedure,  
though. If the coronary sinuses are normal, I have been reading about  
and performing ascending aortic replacement instead of entire root.   
I would also not blow off the genetics.  Stanford and Hopkins groups  
are suggesting echos for all first degree relatives (children and  
parents).  Hal Dietz at Hopkins (of Lowes-Dietz syndrome) and his  
clinic is a great resource on the east coast.

Ed Bender, MD


On Jan 13, 2007, at 9:23 AM, Hgrmd at aol.com wrote:

> Dear Members,
>   I did an interesting case 3 days ago in which a 50 yo man had   
> atypical
> chest pain.  A CT revealed a 10 cm aortic root!  That's the   
> biggest root I can
> recall seeing. There was a well-functioning Starr-Edwards  aortic  
> valve that
> had been implanted in '87 for bicuspid stenosis.  Even 20  years  
> ago, I thought
> no one was using the Starr-Edwards in the aortic  position.   
> Anyway, I did an
> uneventful Bentall, and the patient is  currently doing well.
>   My question for the aortic experts of HSF (I certainly don't   
> consider
> myself one) is what minimum aortic diameter would you now  
> recommend  Bentall
> instead of simple AVR for symptomatic bicuspid stenosis?  I've   
> heard and read that
> the bicuspid aorta has the same biology as Marfan's.   Comments?
> Hal
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