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[Ninjacat]

Hi, I’ve got an ascending aortic dilatation/moderate regurgitation and ectopic with bouts of svt. I just wondered what you guys thought should be my treatment. I seem to be on a routine follow up, with daily bisoprolol.

[MichaelJH Heart Star]

Hello and welcome to the forum! Bisoprolol seems an appropriate treatment for the ectopics and SVT. A friend has virtually eliminated his ectopics by eliminating caffeine, alcohol, chocolate and spicy food from his diet. It does though require strict adherence!

As regards the aortic valve issues I would expect this to be monitored yearly (probably with an echocardiogram) and six monthly if it deteriorates. If there ever comes a day when surgical intervention is needed you could be a candidate for a minimally invasive TAVI (transcatheter aortic valve insertion). This carries the proviso that no coronary arteries need bypassing. Keep us updated.

[Ninjacat in reply to MichaelJH]

Thank you for you positive reply I feel less anxious now 😁 .. I’ve been so anxious and unable to sleep for ages now I’ve found this site yay!

[RoyM]

Hi Ninjacat. Reading your post I understand you also have an ascending aortic aneurysm plus an Aortic valve moderate regurgitation. In relation to the AAA it's important that blood pressure is controlled ideally 120/70 and the Bisoporol is just one tool in the dr's toolbox for blood pressure control. Personally, because of a ascending aortic aneurysm I am monitored 6 monthly should the aneurysm increase to over 5cm then elective surgery may be offered. The valve may be dealt with at the same time.

[Ninjacat in reply to RoyM]

Hi thank you for your positive reply as well - feel great now 😁

[Cliff_G]

Hi Ninjacat, I echo the advice given by MichaelJH and RoyM, with some extras.

Firstly, AAA is the accepted acronym for Abdominal Aortic Aneurysm. The acronym for aneurysm in the non-abdominal aorta is usually TAA meaning Thoracic Aortic Aneurysm, but that term can also apply after the arch, to the descending, there's no particularly accepted acronym for the ascending though I have occasionally seen TAAA. But if you are searching for information, searching AAA will give you the wrong information. The thoracic and abdominal parts of the aorta are different in embryonic origin and the nature of their underlying pathologies.

As Roy says, once the aorta is above a certain diameter they will seek to operate. Whoever told Roy 5 cm is more enlightened, as some still use the original 5.5 cm. Make sure you know your diameter, once it gets above about 4 cm you need more frequent scans. Echos are ok for the valve and ascending aorta but if the diameter is on the large size they should also do CT or MRI scans, which image it better ans are more accurate. A series of scans should always be by the same person/hospital by the same method.

You don't give your age, but if you are younger than say 50-55 they should particularly be looking for *why* you have a dilated aorta. The younger you are, and particularly if anyone else in your family also have aortic problems, the more likely it is that there is a genetic cause. Currently 37 genes are flagged up in connection with aortic problems, these are things like Marfan syndrome but also quite a few others. The importance is that if you have one of these genes, the intervention diameter is reduced to 4.5 or even 4 cm. Worth asking about genetic tests. If they say "it's not necessary" ask them how do they know what diameter to screen against? I can give you the reference to this information.

As I understand it, TAVI is not generally used for enlarged aortic valves. The regurgitation may be due to either an expanding aortic root or stiff/sclerotic leaflets. Make sure again that your doctors tell you which it is and what the likely options are.

Bisoprolol or ARBs are options for not just BP control but also protection of the aortic tissue. This is proven in aortopathy associated with Marfans but it is thought non-Marfans will also receive some protection too.

You are right to be happier you have found this site and others to talk to about this. The main thing now is to ensure find out as much as you can and that you get proper monitoring.

[Ninjacat in reply to Cliff_G]

Hi Cliff. My goodness how informative you are, thank you so much. I am 56 and the aortic regurgitation/dilated root was picked up on a scan with a possible bicuspid when I was 51. I was never given any advice on diet or exercise. My ectopics seem to have got worse and it was only last Saturday that I was tidying up and I can across the original result/report. Of course it sent me into a panic! The original finding was 3.5 and I had a second opinion at st Thomas and they said I didn’t need any further follow up or review. It is now 3.7. I worry as I have a young son. I do have Lupus as well (hence the review at st Thomas). I read an American paper and it seemed to advocate an earlier op as the prospects were better. Thanks for looking .

[Ninjacat in reply to Cliff_G]

Hi again - can I just ask, in your opinion, what sort of exercise can I do? For all this time I’ve been running and cross trainer and weights - I am not sure whether this is appropriate?

Every time I have had an appointment (think I’ve had 2) no mention of the TAA is mentioned. Only the ectopics.

[Cliff_G]

Ninjacat , I would say that the ectopics and the aortic issues are probably separate problems; both can have inflammation as a root cause which could of course connect with the lupus, but you or your doctor would probably be unlikely to pin this down. The problem with ectopics is they are most often benign, but are bothersome (mine drive me crackers and prevent me sleeping) whereas aortic dilation is usually entirely asymptomatic (apart from an aortic valve issue) but when it gets to a large size, definitely the most dangerous. A cardiologist will tend to focus on the ectopics and the AV; how much they know of the details of aortic pathology depends entirely on the particular cardiologist.

Your findings of 3.5 and 3.7 cm are not terribly high, statistically speaking (normal is around 3 cm but there's a range either side) unless you were Marfans or particularly Loeys Dietz when they would start regular monitoring. This is probably why your doctors are unconcerned. Apart from absolute diameter, the normal rate of growth throughout adult life of an aorta is 0.1 cm per 10 years, so your 0.2 *might* be an indicator of faster growth, but you didn't state the interval between these readings. *However*, measuring an aorta is not an exact process and depends on what method, who did it, who reviewed it etc. Always best to have the same place and method and 0.2 cm is well within the margin of error. So 0.2 cm might mean no growth at all, just that they were different methods.

Yes, to operate before a dissection is definitely better, but an operation is itself a risk so the decision is made on a balance of risks - when the risk of dissection (at large diameter) is greater than the risk of the operation. This is often quoted at around a 5.0 or 5.5 cm figure, but often 5.0 for a woman. Diameter is not everything and the full picture needs to be assessed.

Bicuspid AV is a known risk factor for aortic dissection. If proven (they will be able to tell using an echo, I think) then it's worth asking what to do. But with this history and a possible bicuspid, I would personally (and I'm not a doctor) be more comfortable with echo scan of the valve and ascending aorta every 2, maybe 3, years, reducing in interval if enlargement continues.

Concerning exercise, cardiovascular exercise is good, provided it's not excessive. Light weights and lots of reps are probably ok, but heavy weights, or pushing/straining are not. Anything that puts your blood pressure up isn't so good either (such as competitive sports).

Re the ectopics, have a look at Dr Sanjay Gupta's youtube videos (York Cardiology).