Bicuspid aortic valve and aortic aneurysms

  I am a very small (4"10", 90lb.) 54-year old female born with a bicuspid aortic valve.  I've had two heart surgeries - one was a commissurotomy when I was 19 and the last was a aortic valve replacement and aneurysm repair back in 1999. (I chose a mechanical). Four years ago a CT scan showed an aneurysm of the ascending aorta (4.4 cm) plus aneurysms in the origins of the brachiocephalic and left common carotid arteries. This year the left subclavian artery joined the club as aneurysmal. Also new this year (at least to me) was a note that there is "high-grade stenosis of the left vertbral artery without change." I know that stenosis is narrowing, so how important is the vertbral artery and is this something to be concerned about? My cardio's nurse didn't mention it at all when she called and said everything is fine.  I don't see my cardio until July so I'm just curious.  Is this something that may need to be addressed with surgery? Thanks in advance for any information.  

Your brain gets its blood via 4 arteries, the L+R carotid and vertebral arteries. They connect with each other at the base of the brain. The vertebral arteries supply the blood to the back of your brain. Most of the time there is plenty of collateral circulation, so that one blockage has no clinical significance, thus you should not worry about this at this point. I am more concerned about your aneurysms, even though they are not big enough yet to require repair, depending on whether there is evidence of rapid expansion from previous studies. Some people with this type of disease may have a condition called cystic medial necrosis of the aorta, a condition found in patients with Marfan syndrome, even though your small size argues against this.

Medications that reduce stress on the aorta, such as beta blockers, are recommended. Appropriate imaging studies (ECHO, CT, or MRI) should be performed at frequent intervals to monitor the status of the affected segment of the aorta. Genetic testing may be necessary for some patients.

When the rate of dilation of the ascending aorta becomes a concern, repair is recommended to prevent a life-threatening aortic dissection or rupture.

You can read more here:

I suggest you ask for a consultation with a service that has a lot of experience with this disease, usually major medical institutions.
Hope this helps,
Dr T


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