Bicuspid Aortic Foundation View From Here June 2007

Making Decisions About Both the Valve and Aorta

A strong active man should never have had the crushing chest pain that sent him to the ER. But he did. He should have had an opportunity to have surgery on his ascending aorta. But he didn't. As I listened to his wife describe his heart murmur, the sound of a leaking aortic valve, a picture emerged of focus on his heart valve alone, with no attention paid to his aorta. During routine checkups on his valve, the aorta was not included. Even in the midst of the crisis, no one thought about his aorta.

The aorta must be included in the picture.

Those with BAVD or other forms of connective tissue disorders affecting heart valves and blood vessels require comprehensive evaluation that includes both the heart valves and the aorta. Then, they must make some very important decisions. Typically those choices include the aortic valve and the aorta, although the mitral valve may also be involved.

There are choices regarding the valve.

When a diseased valve is found, choices are discussed. They are important. Is the valve ready for surgery? Repair or replace? Replace with tissue or mechanical? Which is better for an individual? There are no perfect answers, but there are lifesaving options that should be carefully reviewed.

But it doesn't stop there.

There are choices for the aorta. Is it enlarged? Does it need surgery? Remodel the root or totally replace it? Does the aorta's condition change the choices for the valve? Will the ascending aorta be completely replaced using total circulatory arrest?

Ultimately, the aortic valve and the aorta come together in one plan that includes what is best for both of them. That plan is made in partnership with an aortic surgeon, someone who can handle the complexities of fragile aortic tissue as well as the valve.

These are decisions for life.

These decisions are challenging and complex, but they are decisions for life. They are decisions that we can welcome, understanding that surgical solutions and well-planned choices may prevent an emergency and save our lives. Timing is important. Unlike the typical failing heart valve, the aorta may give little warning. Even the most perfect solution for the valve alone will not matter, if the aorta tears or ruptures.

The man who went to the ER that day never returned home. His life was lost there, in the emergency room. It was left to the autopsy to find the torn ascending aorta. Perhaps someone had plans for replacing his aortic valve some day. Some day, when the valve was ready. Those plans were incomplete then and useless later, because his aorta was not included.

The Bicuspid Aortic Foundation's mission includes providing information to individuals and families about the need for a comprehensive approach to aortic disease in the chest. Several important topics will be covered during the second annual "Our Families, Our Friends" Conference. Sessions being planned will touch on several aspects of thoracic aortic disease, centered on the welfare of those who have it.

I hope you will join us in September,
as together we create a climate of hope.

Sincerely,
Arlys Velebir
Chair, Board of Directors
Bicuspid Aortic Foundation

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